Toxicological analyses of placenta and umbilical cord to document the death of a newborn: a case report

Summary Drug abuse during pregnancy may be associated with serious obstetrical, fetal and neonatal complications, including the death of the newborn. Detection of in utero drug exposure can be performed through different biological matrices alternative to urine and plasma, such as hair or meconium. When meconium is not available, and to document more recent exposures, umbilical cord and placenta matrices have proven their usefulness. In this case report, we describe a forensic case concerning the death of a newborn. First comprehensive screening showed the presence of tramadol and its main metabolites (O-desmethyltramadol and N-desmethyltramadol) in newborn's gastric content. These results led us to develop a liquid chromatography tandem mass spectrometry (LC-MS/MS) method to confirm the presence of opioids compounds in the different available matrices. The analyses allowed to show the presence of tramadol, O-desmethyltramadol and N-desmethyltramadol in all samples from the newborn (blood, bile, gastric content, umbilical cord) and his mother (blood, placenta). Alfentanil was revealed only in mother's samples (13.6 ng/g in placenta and trace levels in blood ( in utero exposure and allowed to document the origin of tramadol even if an in vivo exposure could not be totally excluded.