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Infant Deaths
1. INFANT DEATHS
Dr Arun Pinchu Xavier
Assistant Professor
Dept: of Forensic Medicine
Sree Mookambika Institute of Medical Sciences
2. •Infanticide refers to the deliberate killing of a child within
one year after its live birth...
• In England ,Germany and in UK, there is a clear-cut
distinction between Homicide and infanticide
But in India ,No such distinction exists ,.Mother is
punished under S 302 IPC - MURDER
•Neonaticide is intentional killing of a
new-born within
24 hours of
its birth.
3. Motives for infanticide..?
•Commonly committed by unmarried woman, widows and
married woman living apart from husband (illegitimacy)
•Certain communities ,where dowry is prevalent leading to
female infanticide (poverty) and problem related to
prostitution leading to male infanticide (unwanted sex)
MLI of Infanticide / objectives of Fetal autopsy..?
•Child attained viability or not at birth
•Still born / dead born / live born..?
•If live born..duration..?
•Cause of death. Was death due to deliberate act of
commission or omission..?
5. INTRUTRINE :
•Fertilized Ovum - 7 to 10 days (Fertilization - implantation)
•Embryo - until the end of 2 months of gestation
•Foetus – beyond 2 months until birth
EXTRA-UTRINE :
•Neonate - first 28 days of extra-uterine life
•Infant -28 days – 12 months
6. MONTHS
Completed
LENGTH
Cms
WEIGHT
Gms
OTHER FEATURES
End of 1 1 1 Eyes seen as dark spots
End of 2 4 10
First ossification centre OS,
4-5 weeks -Clavicle
6 weeks - Maxilla
End of 3 9 30 Nails appears ,neck is formed
End of 4 16 120
Sex can be determined,
Convolutions begin in brain
Meconium found in duodenum
End of 5 25 400
Nails distinct, light hair on head
Vernix caseosa
Meconium seen at large intestine
OS seen at Manubrium ,1st piece of
Sternum and Calcaneum
7. MONTHS
Completed
LENGTH
Cms
WEIGHT
Gms
OTHER FEATURES
End of 7 35 900-1.2
Eyes open
Testes found at external inguinal ring
Gall bladder contains bile
Caecum in RIF
OC -in Talus , 2&3rd piece of Sternum
End of 9 45 2.2-3
Scrotum wrinkled
OC- 4 piece of Sternum
OC -Lower end of femur
End of 10
-
Full Term
48-52 2.5 &
more
6 fontanels present
Cartilage of nose & ear present
Testes present in scrotum
OC- upper end of Tibia
9. STILL BIRTH
•A stillborn child is one which is born after 28 weeks of
pregnancy, and which do not breathe or show any signs of
life, after being completely expelled.
•The child was alive in uterus, but dies during the process of
birth.
•Illegitimate , Immature Male child , Primipara
Causes of Still Birth are:
•Chronic disease in mother - TB ,DM Syphilis
•Difficulty in labor -
Malposition of foetus,
Abnormality of bones of pelvis
11. DEADBIRTH
A dead born child is one which had died in utero before birth
process began ,period of gestation is immaterial and shows
one of the following signs after it is completely born…
• RIGOR MORTIS AT DELIVERY
• MACERATION
• MUMMIFICATION
12. Maceration- aseptic autolysis
•If child remains in uterus for 3- 4 days after death surrounded
by liquor amnii but with exclusion of air & intact membranes
•Earliest sign is skin slippage – 12 hours after its death
•Gas in great vessels –Robert sign
•Large blebs with red serous or serosanguinous fluid-24 hours
•loss of alignment and overriding of the cranial vault due to
shrinkage of brain –SPALDING SIGN- 5-7days
13. Maceration…
•If the dead born is retained in utero for more than a week
,there is fading of skin color from red to yellow
•Body soft flaccid and flattens out when placed on surface
•It has a sweetish, disagreeable odor.
•Bones are flexible and detached from soft tissues.
•All viscera soft and edematous.
14. Mummification
When fetus dries up from the deficient supply of blood
• Scanty amniotic fluid but with exclusion of air.
• Longer time in utero
• But if ,air enters, by rupture of membranes ,it causes -
Putrefaction
15. Radiological signs of foetal death in utero
•SPALDING’S SIGN:
After several days there will be shrinkage of the brain and
dura gradually becomes separated from the cranial bones
leading to loss of alignment ,loosening and overriding of the
cranial vault bones
•ANGULATION OF SPINE:
Exaggeration of foetal spine curvature is caused by loss of
tone of para-spinal muscles and ligaments .On radiograph it
appears as crumpled up foetus with spine angulated and ribs
crowded together
•ROBERT SIGN:
Gas in large vessels caused by degradation of blood
18. LIVE BIRTH
•When a child has showed signs of life, even if only a part of
the child was out of the womb, though the child may not
have breathed or been born completely.
•The evidence in respect of live birth can be Circumstantial
and which could be confirmed from - Postmortem
examination
•The law presumes every new born child found dead, was
born dead until the
Contrary is proved..!
• Therefore sings of live birth has
to be demonstrated..!
19. LIVE BIRTH…
Circumstantial
Signs of life such as cry, movement of body are likely to be
accepted as signs of live birth.
A child may utter a cry either in uterus or in the vagina,which
may be heard outside the delivery room.
As Cellular life continues even after
death, causing muscular
twitching
20. SIGNS OF LIVE BIRTH AT - AUTOPSY:
•Skin changes
•Blood
•Changes in circulation
•Cephal-haematoma
•Caput Succedaneum
•Changes in Middle ear
•Signs of respiration
•Extraneous material in lungs
•Changes in Stomach & intestines
•Umbilical cord
•Meconium
21. Signs of respiration - lungs
features Respired Lung Un-Respired lung
Shape of chest Arched drum shaped flat
Diaphragm Level of 6th or 7th rib Level of 4th or 5th rib
LUNGS
Volume Voluminous ,fills the
thoracic cavity
Small ,lying at the back of
thoracic cavity
Edges Round to varying extend Clearly defined and sharp
Color &
appearance
Mottled pink, due to
expanded air vessels and
development of circulation
Reddish brown or bluish red
22. features Respired Lung Un-Respired lung
LUNGS..
Consistency Soft spongy elastic &
crepitant
Dense firm liver like non
crepitant
Alveoli Expanded Not so
Cut section Exude frothy blood Exude blood but no froth
Weight of lungs
Ploucquet’s test
Weight of lungs is
1/35th of body weight
Weight is 1/70th of body
weight
Amount of blood
in lungs
Doubles after
respiration
less
Weight of both
lungs
Fodere’s Test
60-70 grams 30-40 grams
24. HYDROSTATIC TEST / RAYGER’S TEST
•Here lungs of new-born are cut and placed in water in order
to judge from their specific gravity whether or not a child has
breathed
•Specific gravity of non respired lung is 1050,heavier than
water and that of respired lung is about 950 ,lighter than
water. Fetal lungs therefore sink in water and respired lung
float
•A ligature is tied on bronchil and lungs separated .Each lung
individually is placed in water.if they float,each lung is then
cut into 12-20pieces and placed in water.A small piece of
liver acts as control.
•If the liver floats- no value !
25. HYDROSTATIC TEST…
•The piece are then squeezed in between thumb and index
finger under water surface, to see if any bubbles escapes and
if they persist to float ,its wrapped in a piece of cloth and
squeezed by putting weight to remove tidal air.
•Pieces are placed in water ,if they continue to float ,due to
presence of residual air – active respiration ..!
•If pieces sink after pressure – No respiration ..!
•Some pieces sink while others float – feeble respiration
26. FALLACIES OF HYDROSTATIC TEST :
Expanded lungs may sink: Atelectasis ,bronchopneumonia
Unexpanded lungs may float : Putrefactive gases,
Artificial respiration
27. Hydrostatic test is not necessary when..?
•The fetus is a monster.
•The fetus is macerated or mummified.
•The fetus is born before 180 days of gestation.
•The stomach contains milk.
•The umbilical cord has separated and a scar is formed.
28. CHANGES IN STOMACH AND INTESTINES :
•Presence of milk in stomach – positive proof
•Stomach Bowel Test / BRESLOW’S SECOND LIFE TEST
Here stomach and intestine are removed after applying double
ligature at each end. They float in water if respiration has
taken place ,otherwise they sink..!
If stomach along with duodenum floats when placed in water
it is a reliable evidence child being born alive..!
CHANGES IN MIDDLE EAR :
•Gelatinous tissue in the middle ear is replaced by air after
respiration- WREDIN’S TEST
29. PRESENCE OF EXTRANEOUS MATERIAL IN LUNGS:
•Presence of extraneous material in secondary bronchi or
beyond is strongly indicative - Born alive ..!
SKIN CHANGES:
•Bright red on first day-darker on second third day- yellow
and normal on third day
•Physiological jaundice seen
on third day
•Vernix Caseosa- white fatty cheesy material comprising of
sebaceous secretions seen on flexures of joints and neck folds
Protects fetal skin against maceration, persists for 1-2 days
30. UMBLICAL CORD:
BLOOD:
•Initially foetal haemoglobin is seen which is completely
replaced by adult haemoglobin at 6 -12 months
•Nucleated RBC usually disappear from the circulation with
24 hours
UMBLICAL CORD CHANGES TIME SINCE BIRTH
Clots of blood seen 2 hours
Dries up 1 day
Inflammatory ring 36-48 hours
Cord mummifies 2-3 days
Detaches itself 5-6 days
Complete healing is seen with residual scar 10-12 days
31. CEPHALHEMATOMA
•Localized collection of blood between pericranium and flat
bone of the skull mostly parietial bone and it never crosses
the sutures
•Its due to rupture of small emissary veins and mostly
associated with fracture of skull bone
•Not present at birth but develops after 12-24 hours.
•May be caused by forceps delivery and also in a normal
Delivery
•Resolves with 10-14 days like a bruise
32. CAPUT SUCCEDANEUM
•Edematous swelling over the presenting part (of head)
seen at fronto-parietal region
•Its not limited by stutres
•The swelling is due to stagnation of fluid in layers of scalp
•The swelling is composed of blood or serum, or both
•Disappears within 2-5 days after birth
MECONIUM:
•Expelled 1-2 days after birth
39. Precipitate labour
•Labor terminating in a very short time, without the usual
labor pains and suddenly ,without the mothers knowledge
Usually occurs while attending natures call ..!
•Possible in multipara with large roomy pelvis.
•Occurs when mother is in upright position, and by falling to
ground - sustain injuries to head – leading to death
•No evidence of moulding of head,umblical cord torn at fetal
end,mud ,gravel found struck in scalp hair
•Fissured fracture ,limited to parital bones
MLI:
•Mother and relatives can be accused of infanticide
•Plea of precipitate labour is put as a defence
40. CRIMINAL CAUSES
Acts of commission :
Acts done positively to cause death of the infant.
•Suffocation
•Strangulation
•Drowning
•Burning
•Blunt force impact to head
•Administration of poison in milk
•Inflicting concealed injuries
41. CRIMINAL CAUSES…
Acts of omission:
Ordinary precautions to save the life of the child after birth
are not taken.
Failure to..!
•Protect the child from heat or cold.
•Provide assistance during labour.
•Clear the air passages of mucus.
•Cut the umbilical cord.
•Feed the child.
43. BATTERED BABY SYNDROME
•A child who suffers repetitive physical injuries inflicted by a
parent or guardian, which are non accidental in nature.
•In addition there may be deprivation of nutrition, care and
affection
Classical features / Diagnosis:
•Disparity between clinical findings and parental
explanation
•Injuries are of different duration
•Inexplicable delay between serious
injury and seeking help
44. •Eldest / Youngest, Mostly male,usually less than 3 years
•Unwanted child-pregnancy before marriage/ failure of
contraception / illegitimate.
•Low socio economic status.
Injuries :
•Bruises ,fracture of bones and damage to abdominal organs
•Bruises around mouth eyes, face, arms ,leg abdomen
•Laceration of the mucosa of upper lip, often tear of frenulum
• Black eye, Multiple fractures
•Circular six penny bruise – from adult finger pad
•Bruise may be of different colours – intermittent abuse ..!
45. BATTERED BABY SYNDROME…
Radiological is necessary to detect multiple fractures and
fractures of different ages
•Large periosteal haematomas
•Multiple rib fractures are seen on the posterior angle
,after 1-2 weeks - Callous formation which can be seen
on X- ray seen as - “String Of Bead” appearance –
Nobbing fractures
•To detect old fractures ,to detect metaphyseal and
epiphyseal injuries
48. •S 315 - IPC
Act done with intent to prevent child from being born alive or
cause it to die after birth
•S 316 - IPC
Causing death of a quick unborn child by act amounting to
culpable homicide
•S 317 - IPC
Abandonment of child under 12 years ,
by parent or person having care of it
49. S 318 IPC – CONCEALMENT OF BIRTH
•Whoever secretly buries or otherwise disposes dead body of
a child ,whether such child dies before or after or during its
birth, intentionally conceals or even endeavours to conceal
birth of such child.
Punished with imprisonment up to 2 years +/- fine
•If the child so disposed is a Girl,
Punished with imprisonment up to 5 years +/- fine which may
extend to 50,000/- Rs
52. MUNCHAUSEN SYNDROME BY PROXY
•Type of factitious disorder, mental illness
•Parents, fabricate symptoms in children, thus subjecting to
unnecessary medical test / surgical procedures so as to attract
attention, sympathy & for emotional needs
•Parents itself can inflict injuries and can even kill the child
Examples:
•Mother pricks her finger and adds blood to the urine of the
child and take the sample to the RMP
•Mother gives insulin to child & takes the child to hospital
with hypoglycaemia
53. MUNCHAUSEN SYNDROME BY PROXY…
•Child has a history of frequent hospitalizations, with
nonspecific symptoms but no firm diagnosis..!
•Simulated symptoms in the child
•Requests for repeated medical attention ,resulting in multiple
medical procedures
•Guardian's denial of knowing the cause of symptoms
•Regression of symptoms when the
child is separated
from the
guardian
55. SUDDEN INFANT DEATH SYNDROME
COT / CRIB / Sudden unexplained infant death syndrome
Sudden and unexpected death of a seemingly healthy infant
whose death remains unexplained even after:
•Complete and thorough examination,
•Proper clinical history
•Investigation of scene and circumstances of the death
•Complete autopsy
Features:
•Low socioeconomic status
•2 weeks – 2 years age group,
• Male preponderance ,3 fold risk amongst premature twins
•Occurs mostly in rainy & winter season
56. SUDDEN INFANT DEATH SYNDROME …
Causes of SIDS:
•Prolonged sleep apnea,failure to breathe during sleep
•Accidental prone position of child favouring smothering
•Respiratory infections
•Overlaying of body of an sleepy / intoxicated mother
•Respiratory tract hyperactivity & mucus secretion
•Pillow and bed clothing may accidently cover baby's face,
obstructing respiratory passage
•Criminal involvement of either or both parents
58. SHAKEN BABY SYNDROME
•Form of Child abuse
•Abusive head trauma can be caused by direct blows to the
head, dropping ,throwing or shaking a child
•Shaking a infant may cause damage to neck spine & eyes …
Clinical features:
•Mostly occurs in ages less than 2 years, but seen up to age 5
•H/o poor feeds, lethargy ,irritability
•Childs brain are softer, their neck muscles and ligaments are
weak ,not fully developed and has got a larger and heavy
head in proportion to their body
59. Injuries :..
•Injuries causes by both acceleration (shaking)and
deceleration forces (hitting an object)– Whiplash Injuries
•When a toddler is shaken, the brain bounces back and forth
against the skull,casuing:
•Cerebral contusion
•Oedema
•Intracerebral haemorrhage - permanent brain damage ..!
•Damage to neck, spine and eyes - loss of vision- Retinal
haemorrhage
•Subdural haemorrhage –Veins may tear, leading to further –
bleeding, swelling & raised intracranial pressure
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