జర్నల్ ఆఫ్ ఫోరెన్సిక్ రీసెర్చ్

An Autopsy and Medicolegal Evaluation in a Case of Sudden Maternal Death from Pulmonary Embolism

Abstract

Pawan Mittal, Prateek Karagwal, Balraj Sharma, Meenu Gilotra, Amrita Kulhria, and Abhishek Saini, Saurabh Juneja

Pregnancy and the postpartum period carry high risk of thromboembolic phenomenon which increases manifold postpartaly. Multiple predisposing risk factors, usually acting in combination, add up to this risk. All three of the Virchow’s triad conditions predisposing to vascular thrombosis, i.e, endothelial injury, venous stasis and hypercoagulability, are present in pregnancy. The deaths caused by pulmonary embolism may become the subject of medicolegal investigation due a sudden and unexpected fatal outcome. A thorough dissection, documentation and ancillary investigations pertaining to pulmonary emboli are important components of evaluating such fatalities. The investigation requires a dependable protocol that should include a proper evaluation of the timing of the embolus along with the residual and other thrombi, whenever discovered. Because of the pathophysiology and propagation of thrombus over a range of time period, one may see a broad histological range of thrombosis and organization. The present case pertains to the sudden death of a young female in the postpartum period who suffered a massive pulmonary embolism about 6 weeks after delivery. An extensive dissection of the lower limbs showed multiple deep venous thrombi in the calf and femoral regions while moderate to large coiled emboli were found in the pulmonary arterial vasculature. An additional histological dating of the thrombi as well as pulmonary embolus was performed that helped in elucidating the time range of their development.