The cases were detected during routine assessment of referrals to a specialized Mother and Baby Unit for suspected pregnancy-related depressive illness. The assessment included inquiry about thoughts of or actual physical harm to the fetus or the child after birth. The analysis of the causes focused on the identification of possible factors associated with this behavior. The most common type of abuse found involved repeated punching or hitting of the abdomen. In some women this was in response to fetal movements. Although the fetus is cushioned from such abuse by the amniotic fluid, potential danger to the fetus lies in possible placental abruption and fetomaternal hemorrhage, which may result in fetal anemia or possibly fetal death. In all of the cases the pregnant women were suffering from depression and also had comorbid anxiety. They described varying degrees of ambivalence toward their babies. Four of the five pregnancies were known to be unplanned, and these women had considered a termination, with two of them deciding against it just prior to the procedure. Relationship difficulties with their partners prior to and continuing throughout their pregnancies were described by three of the five women. Of these, two eventually separated from their partners. In addition, three women had suffered from previous postpartum depression. None of the women reported a history of alcohol or drug abuse during their pregnancies. Postpartum attachment disorder of varying severity occurred in three cases. There is no knowledge that the children born to the five women have suffered from subsequent child abuse. Still, issues associated with attachment and the subsequent well-being of the child are important. Due to the apparent multifactorial etiology of fetal abuse, it is unlikely that a single treatment approach will benefit all. It is likely that both psychological and social issues must be addressed. Physicians should inquire about possible fetal abuse in any pregnancy. 11 references