Motor vehicle accident associated with minimal maternal trauma but subsequent fetal demise

Traumatic fetal injury in the absence of significant maternal injury is rare. A 21-year-old woman at 27 weeks estimated gestational age sustained a front-end motor vehicle collision at 35 mph while wearing a seat-belt and shoulder harness with minimal maternal injury. Marked variable fetal heart rate decelerations were noted on the patient's presentation. Although the initial ultrasound examination was normal, sequential examinations showed an enlarging fetal intracranial mass. Fetal demise occurred five days after the accident with necropsy confirming cerebral hemorrhage, hepatic hemorrhage, and hemoperitoneum. In this case, an abnormality of fetal heart rate first suggested a severe fetal injury, with ultrasonography confirming the injury four days later.