Foeticide is the killing of the fetus at any time prior to birth.

Filicide is the killing of a child by its parents.

Neonaticide is the deliberate killing of a child within 4 weeks of its birth.

Infanticide means the unlawful destruction of a child under the age of one year.

 

Stillbirth

A stillborn child is one, which is born after 28 weeks of pregnancy and which did not breathe or show any other signs of life at any time after being completely born.

The child was alive in utero, but dies during the process of birth.

Meconium staining of the body merely indicates that fetal distress has occurred before or during delivery. Lungs are dark-red.

 

Common causes of Still Born:

1. Prematurity

2. Anoxia of various types

3. Birth trauma especially intracranial hemorrhage due to excessive moulding

4. Placental abnormality

5. Toxemia of pregnancy

6. Erythroblastosis foetalis

7. Many other types of congenital defects

 

Dead born /Dead birth

A dead born child is one, which has died in utero and shows one of the following signs of life after its completely born:

1. Rigor mortis at delivery

2. Maceration

3. Mummification 

Maceration is a process of aseptic autolysis. This occurs when the dead child remains in the uterus for about three or four days surrounded with liquor amnii but the exclusion of air.

If air enters the liquor amnii after the death of the fetus, putrefaction occurs instead of maceration.

Mummification

It is a late post-mortem change in which there is rapid drying of the dead body due to some environmental factors, when the soft tissues become dark, hard and stay preserved. The dry, hard skin gets almost adheres with the underlying bones is known as mummification.

Putrefaction

It is a process of liquefaction of elements or compounds due to the action of the fermentation process or due to autolysis.

 

Signs of dead born child:

Sign of maceration a. Odor: Sweetish disagreeable odor b. Skin: Reddening of the skin with peeling (epidermis detaches easily) & Large blebs (small bister) appears containing a red serous or serosanguineous(mix of blood & serum) fluid c. Abdomen: Distended d. Serous cavity: may contain a turbid reddish fluid e. Bone: flexible f. Joint: abnormally mobile g. Skullbone: separated h. Brain: grayish-red-purple appearance i. Viscera: soft, edematous & lose their morphology but lungs & uterus remain unchanged for long time.

Sign of mummification Fetus is dried up and shriveled. Mummification occurs when the fetus dies from the deficient supply of blood when liquor amnii is scanty, and when no air enters the uterus.

Spalding's sign  Loss of alignment and overriding of bones of cranial vault occur due to shrinkage of the cerebrum after the death of the fetus.

Rigor mortis: Presence in the muscle of fetus

 

Viable age

It is the earliest intra-uterine age at which if the child is born alive, is physically capable to lead a separate life outside the body of the mother, depends on many biological and physiological factors as also on the extrinsic factor.

Average: 210 days or 7 months (After 28th week of intrauterine life)

Earliest: 180 days or 6 months

 

Viability of infant:

It means the physical ability of a fetus to lead a separate existence after birth apart from its mother by a virtue of a certain degree of development.

 

Live birth

According to the law of Bangladesh, live birth means the child shows signs of life when only part of the child was out of the mother, through the child may not have breathed on completely born.

The causing of death of such a child is regarded as a homicide.

 

Signs of live birth:

In civil cases, any sign of life after the complete birth of the child is accepted as proof of live birth.

In criminal cases, signs of livebirth have to be demonstrated by postmortem examination of the child.

In civil cases: 1. Hearing of cry 2. Seeing of movement of the body or limbs 3. Muscle contraction/muscle tone 4. Heart sound

In criminal cases: 1. Shape of chest: Before respiration, the chest is flat. After respiration, the chest expands and becomes arched or drum-shaped. 2. Position of diaphragm: Diaphragm lies at the level of the fourth or fifth rib if respiration has not taken place, and at the level of the 6th or 7th rib after breathing. 3. Change in the lung: inflated, soft, spongy, elastic 4. Change in stomach: Presence of milk, it shows mucous, saliva, air bubble 5. Air in GIT Changes in the Middle Ear: (Wredin's Test): Before birth, the middle ear contains gelatinous embryonic connective tissue but no air. 6. Skin: bright-red, which becomes darker on the second or third day, then brick-red, yellow, and normal in about a week.

 

Difference between dead born and stillborn: (Ref. Review Book)

Feature	Stillborn fetus	Dead-born fetus
Definition	Fetus which is born after 28 weeks of pregnancy, and which did not breath or show any other signs of life at any time after being completely born	Fetus which has died in utero
Condition in utero	Fetus was alive in utero but dies during the process of delivery	Dead in utero
Predominance	Seen mostly among illegitimate and immature male children in primiparae	No such predominance
Findings	Signs of prolonged labor, like edema, bleeding into the scalp, caput succedaneum, and severe moulding of the head may be seen	Maceration Spalding’s sign Robert’s sign Rigor mortis at delivery Mummification
Cause	Anoxia, prematurity, birth trauma or toxemia	Congenital anomaly, ABO and Rh incompatibility

 

Difference between live birth and stillbirth

 

 

Difference between putrefaction and maceration:

Putrefaction	Maceration
Sign of death	Dead birth
Outside of uterus	Inside of uterus
Air enhances it	Air inhibits it
Offensive foul smell	Sweetish disagreeable smell
Skin green in color	Red/purple

 

Battered baby (Caffey's syndrome/child abuse syndrome/non-accidental injury of a child)

A battered baby is one who has received repetitive physical injuries as a result of non-accidental violence, produced by a parent/guardian.

 

Precipitate Labour

Labour terminating in a very short time than that taken on an average pregnant woman either in a primipara or multipara is called precipitate Labour.

The child may die from

1. Suffocation by falling into a lavatory pan,
2. Head injury and fracture of the skull with subdural hemorrhage often bilateral, by a fall on a hard floor, if the woman was standing, and
3. Hemorrhage from the torn end of the cord.

 

Medicolegal Importance of Precipitate Labour:

1) The mother or her relatives may be accused of killing the infant, while the death may be due to injury, hemorrhage or asphyxia from precipitate labour.

2) In a case of murder, the death of the child may be attributed to precipitate labour.

 

Infanticide

Unlawful killing of a newborn baby within 15 days of its birth is called infanticide. (In case of Bangladesh)

Unlawful killing of a child under the age of 1 year.

 

Medico-legal importance:

1. Determination of whether the child has attained viability or not.

2. Determination of whether the child was alive.

3. If born alive, how long the child survived

4. Determination of whether the child was stillborn or dead born

5. Determination of nature of death whether natural, accidental or criminal.

 

Motive of infanticide:

Infanticide is rare and usually committed by a young unmarried woman or widow.

Infanticide irrespective of the child  1. Illegitimate childbirth by Widows Unmarried girl Married women during the prolonged absence of the husband 2. Inheritance 3. Poverty of parents 4. Physical deformity of the child

Infanticide in respective of only the female child Dowry system or unavoidable heavy expenditure at the time of daughter marriage

 

Methods of infanticide:

1. Act of commission (Acts done positively to cause the death of the infant)

2. Act of omission (failure to take proper care of the infant)

Example:

Act of commission 1. Mechanical violence: - Suffocation - Strangulation - Burning - Concealed puncture wound  - Drowning - Throttling - Head injury - Wound - Twisting of neck 2. Poisoning

Act of omission 1. Failure to tie the cord after its cut 2. Failure to provide nutrition to the baby 3. Failure to protect the child from the weather 4. Failure to clear the air passages 5. Failure of proper nursing

 

Causes of infant death:

Natural causes 

1. Immaturity

2. Intrapartum Asphyxia

3. Birth trauma 

4. Congenital Abnormality

5. ABO & Rh- incompatibility

6. Neonatal infection

7. Early separation of the placenta

8. Pre-clamtic toxemia of mother

9. Malformation 

10. Sudden infant death syndrome (SIDS)

 

Un-natural cases 

1. Accidental:

I. Prolonged Labour - causes the death of the fetus due to injury to the brain because of compression of the head or due to asphyxia.

II. Prolapse of cord or pressure on cord: It may cause stoppage of fetal circulation during birth, and death of the newborn may occur during or just after birth.

III. Twisting of cord around the neck - causes asphyxia due to strangulation.

IV. Death of a mother

V. Injury to mother on her abdomen-cause premature separation of the placenta or injury to the fetus

Suffocation: Due to the non-availability of nursing care, the neonate may die due to smothering or choking due to inhalation of amniotic fluid or blood immediately after birth.

 

2. Criminal causes:

a. Act of commission: These acts are done positively to cause the death of infants. i. Strangulation by a ligature material or the umbilical cord (to simulate natural twisting of cord round the neck) or by throttling. ii. Poisoning: Earlier, opium was used for the purpose (ideal infanticidal poison). Nowadays, acids and insecticides are used. iii. Smothering the baby to death with the help of hand or clothes. iv. Head injury: The head of the fetus may be struck against a wall or on the floor by holding its legs, this may leave an impression on the legs also. v. Concealed punctured wound may be caused by a nail or a needle through the fontanelle, nape of the neck, or inner canthus of the eye. vi. Twisting the neck: Death occurs due to fracture, dislocation of the cervical vertebrae, and injury to the medulla. vii. Burning the newborn alive or disposing of the living newborn inside an oven. viii. Drowning which also serves the purpose of disposal of the unwanted child.

b. Act of omission or neglect: A woman is guilty of criminal negligence if she does not take ordinary precautions to save her child after birth. 1) Failure to provide proper assistance during labour may cause death by suffocation or head injury. 2) Failure to tie the cord after it is cut usually does not cause death by hemorrhage. Tearing of the cord within the uterus during delivery may cause massive hemorrhage and fetal death. 3) Failure to clear the air passages which may be obstructed by amniotic fluid or mucus. 4) Failure to protect the child from exposure to heat or cold. 5) Failure to supply the child with proper food.

 

SUDDEN INFANT DEATH SYNDROME (Cot Death/Crib Death)

Sudden infant death syndrome (SIDS), or cot death or crib death is defined as the sudden and unexpected death of seemingly healthy infant, whose death remains unexplained even after thorough case investigation, death scene examination, review of clinical history and complete autopsy.

 

Possible causes of Sudden Infant Death Syndrome (Lecture)

• Prolonged sleep apnoea
• Non-pyrogenic infection of the respiratory tract
• Staphylococcus aureus infection of Upper respiratory tract
• Conduction system anomalies
• Suffocation
• Bacterial infection
• Neurogenic shock

 

Features:

1) Incidence: 0.6 per thousand live births.

2) Age: 2 weeks to 2 years, but most deaths take place between one and 7 months, with a peak at 2 to 4 months.

3) Sex: There is a slight increase in males.

4) Twins: There is an increased risk (threefold) amongst members of a twin pair. Most twins are premature and of low birth weight.

5) Geographical distribution: The occurrence is worldwide.

6) Time of death: Death always occurs during sleep at all times of night with a moderate increase in the early morning hours.

7) Prematurity has a higher risk.

8) Socio-economic standard of the family is usually low.

9) Cigarette smoking and drug abuse by pregnant women increase the risk.

 

Hydrostatic test (Raygat’s Test)

It is based on lowering the specific gravity of the lung due to the expansion of alveoli by inspired air during the fact of breathing.

Principle:

It is based on the fact that the specific gravity of the lung before respiration is 1040–1050 and becomes 940-950 after respiration which is less than that of water. This makes the respired lung to float.

 

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 has fo~med.