INFANTICIDE

DR. RAKIBUL HASAN KHAN

ASSISTANT PROFESSOR & HEAD,
FORENSIC MEDICINE
SHEIKH HASINA MEDICAL COLLEGE, TANGAIL
BASIC

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 Pre-embryo: Fertilized ovum up to 14 days after conception, until the
implantation occurs.

 Embryo: Pre-fetal product of conception from implantation to the end

of 8th week (2nd month or 56 days).

 Fetus: Unborn young from the end of 8th week after conception till
delivery.

 Neonate: Infant in the first 28 days of extra-uterine life.

 Infant: Child from the time of birth to 1 year of age.

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INFANTICIDE

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 INFANTICIDE
Infanticide means the unlawful killing of a child under the age of one
year.
Neonaticide is the deliberate killing of a child within 4 weeks of its
birth.
Foeticide is the killing of the foetus at any time prior to birth.
Filicide is the killing of a child by its parents.
Medicolegal Importance of Infanticide:
Infanticide is homicide which is amount to murder if the child born
alive after age of viability.
Only the mother can be charged with the offence when the
circumstances justify it. 5
Investigations or ML questions to be answered in case of death of a
newborn and infant

(1) Whether the child was stillborn or dead born?

(2) Whether the infant has attained viability or not?
(3) Whether the child was born alive?
(4) If born alive, how long did the child live?
(5) What was the cause of death?

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 CAUSES OR MOTIVES OF INFANTICIDE

1. Illegitimacy.
2. Poverty.
3. Social taboo.
4. Children born in brothel home.
5. Unwilling to accept of a female child due to scare (fear) of dowry.

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 MODES OR METHODS OF INFANTICIDE
1. Acts of commission:
Suffocation
Smothering
Strangulation
Drowning
Burn
Cut throat injury
Blunt head injury
Stab wound
Fracture and dislocation of cervical vertebra.
Concealed puncture wound
Poisoning
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2. Acts of omission:
Does not take ordinary precautions to save her child after birth.
Failure to provide proper assistance during labour may cause
death by suffocation or head injury.
Failure to tie the cord after it is cut may cause death by
hemorrhage.
Failure to clean the air passages which may be obstructed by
amniotic fluid or mucus.
Failure to protect the child from heat or cold.
Failure to supply the child with proper food.
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STILLBORN

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 STILLBIRTH / STILLBORN
A stillborn child is one, which is born after 28 week 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.
• Stillbirth occurs more frequently among illegitimate and immature
male child in primipara.
• To be declared as a stillborn fetus, the birth of the fetus should occur
after 28 weeks of pregnancy which includes fetuses of viable age
who are born dead, as legally accepted age of viability of fetus is 210
days or 30 weeks.
• The frequency of still birth rate is calculated as 1 in 18 births. The
incident is about 5%.
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 CAUSES OF STILLBIRTH
Prematurity,
Anoxia of various type,
Birth trauma especially intracranial haemorrhage,
Placental abnormalities,
Toxaemias of pregnancy,
Erythroblastosis foetalis,
Many types of congenital defects.

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DEADBORN

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 DEAD BIRTH OR DEADBORN
A dead-born child is one which has died in utero, and shows one
of the following signs after it is completely born.

1. Rigor mortis at delivery.

2. Intrauterine maceration
3. Spalding’s sign
4. Intrauterine mummification.

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Spalding’s sign: Loss of alignment and
over riding of the bones of the cranial
vault occurs due to shrinkage of the
cerebrum after death of the foetus.

Mummification: Mummification occurs

when the foetus dies from deficient
supply of blood, when liquor amnii is
scanty, and when no air enters uterus.
Fetus is dried up and shriveled in > 2
weeks. 15
 MACERATION

It is a process of aseptic autolysis, and is

the usual change. This occurs when the
dead child remains in the uterus for about
3 or 4 days surrounded by liquor amnii
but the exclusion of air.
If air enters the liquor amnii after death of
the foetus, putrefaction occurs instead of
maceration.

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 FEATURES OF MACERATION
• The earliest sign of maceration is reddening of skin with peeling and
slippage.
• Gas in great vessels of fetus indicates fetal death (Robert's sign).
• The body is soft, flaccid and flattens when placed on a level surface.
• It has a sweetish, disagreeable odor.
• The tissues are reddish due to hemolysis and edematous.
• The abdomen is distended.
• The bones are flexible and readily detached from the soft parts.
• Internal organs show autolytic decomposition, but the lungs and
uterus remain unchanged for a long time.
• The skull vault bones may partly overlap each other, a condition
known as "Spalding sign“. 17
 DIFFERENCE BETWEEN DEAD BORN & STILL BORN

Dead Born Still Born

Site of Death In utero Course of delivery
Time of death Before delivery process During delivery process
Rigor mortis at delivery Present Absent
Maceration Present Absent
Spalding’s sign Present Absent
Mummification Present Absent

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LIVE BIRTH

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 LIVE BIRTH
It means that the child showed signs of life when only part of the child
was out of mother, though the child may not have breath or
completely born.

Medicolegal Importance:
• Death of such child is regarded as homicide.

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 Establishing whether live born?
In civil cases:
Following are considered signs of live birth:
• Baby's cry
• Muscle twitching/movements of limbs, etc.

In criminal cases:
Signs of live birth have to be demonstrated by autopsy examination of
the newborn.

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 SIGNS OF LIVE BIRTH
A) Sign during lifetime:
• Crying of Baby
• Feeling and hearing of Heartbeat
• Slight muscular movement.

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 SIGNS OF LIVE BIRTH
A) Sign during lifetime:
• Crying of Baby
• Feeling and hearing of Heartbeat
• Slight muscular movement.

Vagitus vaginalis: A foetus may inhale air and cry, when the head is
inside the vagina, a condition termed as vagitus vaginalis.
Vagitus Uterinus: A foetus may inhale air and cry, when the head is
inside the uterus. (After the rupture of the membrane, air enters the
uterine cavity. So, the foetus may inhale and cry)
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 SIGNS OF LIVE BIRTH
B) Postmortem findings of life birth:
• Shape of chest: Arched or drum shaped.
• Diaphragm: At the level of 6th or 7th rib.
• Changes of Lungs:
Volume- Enormous increase in volume.
Margin- Large and round margin.
Consistency- Crepitant and spongy.
Colour- Rosy red colour.
Pleura: Thin, tense.
Weight- The lungs become double.
Hydrostatic test- Expand or whole lung float in water. 24
 SIGNS OF LIVE BIRTH
• Changes in stomach & intestine
Presence of air
Presence of milk
• Changes in middle ear
Presence of air

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 Difference between Unrespired and Respired Lung
Features Unrespired lung Respired lung
1. Color Bluish red Mottled
2. Volume Small Large, cover heart
3. Margins Sharp Rounded
4. Surface Smooth Uneven
5. Consistency Dense, firm, noncrepitant (liver-like) Soft, spongy, elastic, crepitant
6. Weight 1/70 of body weight 1/35 of body weight
7. Diaphragm 4th-5th rib level 6th-7th rib level
8. Blood oozing (Cut Little frothless blood Abundant frothy blood
section)
9. Hydrostatic test Whole and parts sink in water Floats in water
10. Alveoli Not expanded Expanded, rise above surface
11. ML importance Indicates still/dead born infant Indicates live birth 26
 HYDROSTATIC TEST

This is a old time important test for respiration of lungs. Un-respired

lung being solid has a more specific gravity from 1040 to 1050 then
water. Hence, sinks in water. On the other hand, respired lung has less
specific gravity 940 then water. Hence, float in water.

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 PROCEDURE OF HYDROSTATIC TEST
• A ligature is tied on the bronchi, and lungs separated.
• Each lung individually is placed in water.
• If they float, each lung is cut into 12 to 20 pieces and placed in water.
• A small piece of liver may serve as control. If the liver floats, the test
is of no value.
• If these pieces float, they are each squeezed in between thumb and
index finger under the surface of water, to see if any bubbles of air
escape.
• The pieces are again placed in water, and if they continue to float, it
indicates that respiration has taken place.
• If the pieces sink after pressure, respiration has not taken place.
• If some pieces float while others sink, it shows feeble respiration. 28
 Hydrostatic test is not reliable because it sometimes shows false
positive and negative results
False negative cases
• Diseases like bronchopneumonia where air in the lungs may be
replaced by acute edema or pus.
• Diseases like atelectasis may cause non-entry of air into alveoli.
• Due to feeble respiration, sometimes air may not be able to reach
the alveoli.
False positive
 Putrefaction-Putrefative gases may cause floatation of lungs.
 Artificial respiration- Due to artificial respiration air forcefully enter
the lungs. 29
 BRESLAU’S SECOND LIFE TEST OR STOMACH-BOWEL TEST

It is a test done to determine whether the child was born alive or not.
When respiration is established and child begins to cry,
 A small amount of air enters into stomach within 5-15 minutes of birth,
 in the small intestine after 1-2 hours &
 a portion of air also passes into the large intestine after 5-6 hours.
If the stomach and intestines are removed after tying double
ligatures at each end they float on water.
This is known as Breslau’s second life test or stomach-bowel test.

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INFANT DEATH

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 CAUSES OF INFANT DEATH
A) Natural causes
B) Unnatural causes
a) Accidental
i. During Birth
ii. After birth
b) Criminal
i. Acts of commission
ii. Acts of omission

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A) Natural causes
• Prematurity
• Post maturity.
• Congenital malformation.
• Cerebral birth trauma.
• Rh incompatibility or Erythroblastosis foetalis.
• Neonatal infection.
• Haemorrhoges from umbilical cord, genital organ, stomach and
rectum.
• Pre-eclamtic toximia
• Disease of placenta and its accidental separation from uterine
wall.
• Crib or cot death. 33
B) Unnatural causes
Accidental
a) During birth
1. Injury to the mother’s abdomen.
2. Prolapse cord.
3. Prolonged labour
4. Twisting of the cord around the neck.
5. Death of the mother.
b) After birth
1. Suffocation.
2. Precipitated labour.
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B) Unnatural causes
Criminal

}
a) Acts of commission
Discussed Earlier
b) Acts of omission

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VIABILITY

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 VIABILITY & VIABLE AGE
Viability means physical ability of a fetus to lead a separate existence
after birth apart from its mother by virtue of certain degree of
development.

Viable Age is the age of the fetus, after which it can lead a separate
existence after birth apart from its mother. It is 210 days or 28 weeks.
Medicolegal Importance:
• In case of infanticide, question of viability arises.
• Death of fetus after age of viability is still born.
• A mother with still born may be charged with infanticide.
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 FEATURES OF VIABLE AGE
• Length: About 35 cm.
• Weight: Around 1 kg.
• Scalp hair: More than 1 cm long.
• Gall bladder: Contains bile.
• Left testicle: At external ring.
• Meconium: Present up to distal end of large intestine.
• Placenta: About 350g.

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PRECIPITATED
LABOR

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 PRECIPITATED LABOR
Labor terminating in a very short time than that taken on an average
either by a primipara or multipara.
Features:
• All 3 stages of labor are merged into one.
• Delivery occurs without the knowledge of mother.
• Fetus is normal or premature.
• It usually occurs in multiparous women.
• A woman may be delivered unconsciously during fits or periods of
coma, hysteria.
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The child may die from :
• Suffocation by falling into a lavatory pan,
• Head injury and fracture of the skull by a fall on a hard floor, if the
woman was standing,
• Hemorrhage from the torn end of the cord.
• Drowning, If the birth occurs in the bowl or bucket containing liquid.
Medicolegal Importance:
 Mother or her relatives may accused of infanticide, while the death
may be due to injury, hemorrhage or asphyxia from precipitate labor.
 In a case of murder, death of the child may be attributed to
precipitate labor.
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BATTERED
BABY
SYNDROME

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 BATTERED BABY SYNDROME
Synonym: Caffey’s syndrome, Child abuse syndrome, Nonaccidental injury
of childhood, Maltreatment syndrome in children.
A battered child is one who has received repetitive physical injuries as a
result of non- accidental violence, produced by a parent or guardian.
In addition to physical injury there may be non-accidental deprivation of
nutrition, care and affection.
The constant feature is repetition of injuries at different dates, often
progressing from minor to more severe.
These children usually come from isolated families having multiple
problems like paternal maladjustment, foster parents, alcoholism or
poverty in family, sexual abuse of the child may also seen in such cases.
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 FEATURES OF BATTERED BABY SYNDROME
• Age: Usually less than 3 years old, though it may occur at any age.
• Sex: Slightly more in males (55 to 63%).
• Position in family:
One child of a family, commonly the eldest or the youngest
Often unwanted, such as the result of pregnancy before marriage, failure of
contraception or an illegitimate child.
• Socio-economic factors:
• Lower social class and lower education.
• The family is usually isolated.
• Often a history of family disharmony, long-standing emotional problems
• or financial problems.
• Fathers may have criminal records, or unemployed or socially unstable.
• Mothers may have multiple social and psychiatric problems. 44
• History:
There is obvious difference between the nature of the injuries and the
explanation given by the parents, which may change on several times of
repetition, each time the child is taken to a different doctor.
• Treatment:
There is always delay between the injury and medical attention.
• Precipitating factors:
Violence is precipitated by actions of the child itself, e.g., crying, refusal to
be quiet, persistent soiling of napkins, etc.

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46
Accidental Injury Non Accidental Injury

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 SUDDEN
INFANT DEATH
SYNDROME

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 SUDDEN INFANT DEATH SYNDROME (SIDS)
Synonym: cot or crib death.
It may be defined as the sudden or 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.

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 CAUSES OF SUDDEN INFANT DEATH SYNDROME (SIDS)
There is no single cause of cot death, and death may result from a
number of causes which combine and act via a common pathway of
cardiorespiratory failure.
• Sleep apnoea,
• Respiratory viral infection,
• Auto-immune reaction,
• Myocarditis,
• Mechanical upper airway obstruction due to anatomical abnormalities,
• Prone sleeping position,
• Adrenal insufficiency etc.

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• Incidence: 0.6 per 1000 livebirths.
• Age: 2 weeks to 2 years, but mostly between 1-7 months.
• Sex: There is slight increase in males.
• Twins: There is increased risk (3 fold)
• Geographical distribution: The occurrence is worldwide.
• Time of death: During sleep at night with a moderate increase in the
early morning hours.
• Prematurity has a higher risk.
• Socio-economic standard of the family is usually low.
• Cigarette smoking and drug abuse by pregnant increase the risk.
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CONCEALMENT
OF BIRTH

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 CONCEALMENT OF BIRTH
Whoever, secretly buries or otherwise disposes of the dead body of
child, whether such child dies before or after or during its birth, is
called Concealment of birth.
Medicolegal Importance:
According to Section 318 PC of Bangladesh,
• Intentionally conceals the birth of such child, shall be punished with
imprisonment up to 2 years.
• If the child whose dead body is so disposed off is of a girl child, the
person committing such offence shall be punished with 5 years
rigorous imprisonment with fine.
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