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Seat belt injury in pregnancy resulting in fetal death. A need for education? Case reports

A 30-year-old married woman in her fifth pregnancy was involved-at 36 weeks gestation-in a road traffic accident as a front seat passenger. She had been wearing a conventional threepoint fixing seat-belt. She was admitted to the accident and emergency department, where she was noted to have marked bruising over the anterior chest wall and abdomen. She had multiple rib fractures. A laceration of her leg required suturing. There was evidence of a cervical whiplash injury. She began to bleed vaginally and was transferred immediately to the nearby maternity hospital. On arrival no fetal heart was heard. Fetal death was confirmed by ultrasound scan. Having excluded any coagulation defect labour was accelerated with intravenous oxytwin. Fetal cells were seen on Kleihauer test. Blood loss was corrected by transfusion. After a short labour she had a spontaneous vertex delivery of a fresh stillborn girl (birthweight 2.668 kg), without apparent abnormalities. The placenta was delivered in two halves, bisected, half spontaneously, half by controlled cord traction. Postmortem examination of the stillbirth revealed evidence of acute asphyxia. There was also bruising over the posterior skull. A large