Infanticide

•Infanticide is killing of an infant at any time from

birth upto the age of 12 months.
• Feticide is the killing of fetus at any time prior to
birth.
• Filicide (Latin filius: son) is deliberate act of killing
of a child by the parents.
Infanticide does not include the death of fetus during
labor, when it is destroyed by craniotomy or
decapitation.
• In India, infanticide is homicide, with punishment of
murder.
• In Canada, Italy, UK and Australia murder of a child
< 1 year of age by his own mother is not considered
homicide. Instead, the mother is charged with a lesser
offence of infanticide, for which the punishment is lesser.
This is because such murders could be due to 'post-partum
depression' or 'baby-blues'.
• it is difficult to prove that it was a case of live birth, that
born foetus was viable, that the death was not due to any
natural or accidental cause and that death was due to
deliberate act of commission by mother or somebody else.
• Hence in India the punishment for infanticide is not an
easy outcome.
• Hence in case of infanticide the matter to be proved
are:
1. Whether a foetus was viable when born.
2. whether it was born alive.
3. Whether it had separate existence for sometime.
4. The cause of death is neither natural nor
accidental.
5. Death was due to some deliberate act of
commission.
6. The dead infant examined belonged to the woman
charged for commission of infanticide.
- Hence after proving the above points it is believed
1. Whether a foetus is born viable:
- It is not easy to decide.
- Viability or capacity to live separate life outside the
womb depends on many biological and physiological
factors and external factors too.
- The age of viability of a foetus is fixed to 28 weeks.
- The features of 28 week baby have body length 35
cm, weight 1 kg, scalp hair > 1cm, nails are thick and
proximal to tip of finger.
- Left testicle at external ring in male. Gall bladder
contains bile. Ossification centre of talus is
appeared. Meconium is present in distal end of large
intestine. Placenta is abt 350gm in wt. Eyelids are
- Further the foetus born much earlier can be made to
survive whereas born after 28 weeks dies after birth.

2. Whether the child was born alive:

- Here two conditions are described when they are not
born alive:
a. Still born foetus
b. Dead born foetus

a. Still born foetus:

- A still born foetus is a foetus which is born after 28
weeks and does not show any signs of life after birth.
- It is the position in which the foetus are live during
birth, with some part of the body being out of
mother’s body and their death occurs before full birth.
- So it becomes confusing for still born and live birth.
- But still birth includes the birth where death occurs
during the passage of foetus from mother’s womb to
outside.
- In some cases still born foetus may have signs of
respiration without any part of body outside the womb
then putrification starts from inside as it has inhaled
contaminated air.
- Generally speaking, in still born foetus putrification
starts from outside as they usually do not breath at all.
• Medicolegal aspect of still born:
- Charges of infanticide will not stand if it is seen that
a foetus is still born.
- But it may be confusive like definition when a foetus
which was alive when head and neck comes out and
then strangles to death before complete birth.

b. Dead birth:
- It means death of a foetus inside the uterus without
specific mention of its intrauterine age.
- This foetus shows any of the signs below as a proof
of death inside the uterus.
• Signs of intrauterine death:
1. Rigor mortis: presence of rigor mortis in muscles of
the foetus indicates that the death of foetus must
have occurred at least 2-3 hrs before birth.
2. Intrauterine maceration: this is the condition of
autolytic decomposition of dead foetus in aseptic
environment.
- When a dead foetus remains inside the uterus for at
least 2-3 days after death.
- Signs of intrauterine maceration: after birth the
dead foetus lie flat and flaccid on tray. There is
emission of sweetish disagreeable smell. Skin color
is reddish or reddish purple.
- PM blisters on skin is found with reddish tinge.
- The cuticle is removed easily. Internal organs shows
autolytic decomposition. Brain is pulpy. Skull vault
bones may be partly overlaping known as “spalding
sign”, which is detectable by X ray before birth.
3. Intra uterine mummification:
- This condition occurs in dead foetus inside the
uterus due to scarcity or absence of amniotic fluid
for a reasonable period.
- Diagnosis is done by x ray and normal delivery is not
possible. So foetus is extracted.
- Intrauterine mummification suggestive of death of
foetus long back inside the uterus.
3. Live birth:
- In India, it means that the foetus is alive after
complete birth or when at least one part of its body
comes out of mother’s body.
- Live birth does not necessarily means separate
existence of foetus as its death may occur during
the course of delivery.
- To prove live birth we have to depend on signs of
separate existence:
• Signs of live birth:
a. Signs during lifetime of new born:
1. layman’s perception of live birth:
i) A baby cries after birth is strong evidence as people
outside the labour room hears the voice. Crying
helps in expansion of lung alveoli.. A foetus may
inhale air and cry when head is inside the vagina
(vagitus vaginalis) or it may even cry inside uterus
(vagitus uterinus) when air enters the uterus after
the rupture of membrane.
ii) Movement of the limbs or any part of body.
iii) Sneezing or yawning by new born.

2. Physical examination of the newborn by doctor:

- This includes:
1. Inspection, palpation and auscultation of
respiratory movements and heart beats.
2. Pain sensation test by pinching the skin of any
body part.
3. Muscular tone and activity by trying to move a
limb or finger.

b. Signs of live birth and separate existence in dead

infants:
- Many tests are performed during PM examination
to decide whether the child was born alive or not.
• External signs:
1. Shape of the chest and its measurement:
- Chest is more flat anteroposteriorly in foetus born
dead.
- In foetus born dead, the circumference of the chest
is about 2-3 cm less than that of abdomen at the
level of umbilicus. But in live birth circumference is
2-3 cm more than the abdomen.
2. Changes on body surface:
a) Vernix caseosa: it is present on body surface of a
new born. It is either cleaned or removed by itself
within 1-2 days in live birth.
b) Immediately after birth, the color of the skin is
bright red and darkens after 2-3 days. Permanent
VERNIX CASEOSA
[Link] succedaneum:
It is compression around the presenting part during
delivery causes some extravasation and diffusion of
blood and accumulation of fluid in subcutaneous
tissue of the presenting part with swelling. It
resolves within few days after birth. Hence it is
definite sign of live birth.
4. cephalhaematoma:
There is gross extravasation and collection of blood in
head which occurs usually due to use of instrument.
It takes longer time to resolve. Its presence is
suggestive of live birth and its regression suggests
separate existence of child after birth.
Caput succedaneum
Cephalhaematoma
5. Changes in umbilical cord:
- In case of live birth the free end of umbilical cord
attached with the child shows clean cut margins
with ligature. The cut margins dries up by 2 hrs. The
cord dried up in 24 hrs. A red ring appears around
the umbilicus on 2nd day. The shrivelled, dried cord
falls off by 4th-5th day and complete healing occur by
7th day.
CHANGES IN UMBILICAL CORD
• Internal examination:
1. Position of diaphragm: it goes down from 3rd-4th rib
to 6th-7th ribs after birth due to respiration and
expansion of lung.
2. Examination of lung:
a. Naked eye:
i) General appearance: unrespired lungs are small in
size, located in upper part of thorax, dark red or
brown in colour, tough in consistency, on dissection
shows frank bleeding. Margins are sharp. The lungs
are non crepitant on pressure.
but respired lung are large in size, bright red in colour,
soft, spongy in consistency. Frothy blood comes out
ii) Weight of lungs:
weight of lungs become almost double after
respiration of what was there before respiration. It
is 30-40gm before respiration and becomes 60-
70gm after respiration due to blood and air
circulation.
the weight if lungs may increase in still born foetus is
due to: inhalation of amniotic fluid, oedema of
lungs & congenital pneumonitis.
iii) Contusion over the surface of lungs:
due to vigorous attempt of artificial respiration, there
may be contusion of surface of lungs suggestive of
efforts on living newborn.
b. Hydrostatic test: this is a time old test for
respiration of lungs.
- The unrespired lungs being solid has high specific
gravity than water hence sinks in water. A respired
lung being inflated with air has low specific gravity,
aquires buoyancy and floats on water.
- 1st stage test:
- The vessels and bronchus are tied at hilar region
and two lungs are placed in water separately.
- In case of complete expansion of both the lungs due
to respiration, they will float on water.
- In case of partial expansion due to any reason any
of them or may not float.
- 2nd stage test:
- Irrespective of lungs floate or sink, the next phase
of test must be done.
- The lungs are cut in small pieces & then squeezed.
- In case of inflation of any part of lung due to
artificial respiration or decomposition gas,
squeezing will expel the air or gas completely & the
lung which floats earlier will sink now.
- In case of inflation of some pieces of lung due to
respiration, residual air will remain in the alveoli
and that piece will float now also.
• Fallacies of Hydrostatic test:
- If the Hydrostatic test is not performed properly
then it may give wrong information.
- The unrespired lungs may float due to following:
1. Due to accumulation of decomposition gases.
2. Due to inflation of lungs by air due to forceful
mouth to mouth respiration.
- The respired lungs may sink due to following:
1. Very feeble respiration involving small area of lung.
2. Due to atelactasis.
3. Due to oedema of lungs.
4. Due to congenital pneuminotis.
• Contraindications of Hydrostatic test:
1. When foetus has gross congenital anomaly.
2. When foetus is below 28 weeks.
3. When stomach contains food.
4. When foetus shows signs of intra uterine
maceration or mummification.
5. When umbilical cord shows cicatrisation.
6. When there are bruises on lungs suggestive of
efforts to respirate the foetus.
c) Histological examination of lungs:
- Section from different parts of the lungs are
examined.
- The unrespired lung tissue will show less
vascularisation, no air sacs.
- The glandular structures are lined with cuboidal or
columnar epithelium.
- In respired lungs, shows vascularisation, expanded
air sacs, lined with flat squamous epithelium.
- In case the foetus inhaled amniotic fluid in uterus
and didn’t respire, the alvoelar sac are expanded,
hylinised and are not empty as in case of respiration
3. Findings of stomach and intestines:
- Presence of food like milk, saliva or saliva alone or
air in non decomposed new born ( swallows during
inspiration). These substances if present in small
intestine, further confirms live birth and separate
existence.
4. Meconium in the intestine:
- Meconium is made of inspissated bile and mucus
secreted from intestinal wall.
- In case of live birth the large intestine is completely
free from meconium within 24 hrs after birth.
- In still birth it is present in intetsine.
- In case of breech presentation & hypoxia meconium
may be completely expelled out of intestine before
birth thus may be absent in still born too.
5. Changes in blood vessels:
- Vessels of foetal circulation has no role after birth.
- So umbilical arteries are almost obliterated within
12hrs after birth, which is complete in 3 days.
- By that time umbilical vein and ductus venosus has
began obliteration, will complete in next day.
- It will take 10 days for obliteration of ductus
arteriosus.
- Though anatomical obliteration occurs at different
times but their function will stop after birth.
6. Change in heart:
- Closure of foramen ovale occurs within 3 months
after birth.
7. Incremental line in enamel of teeth:
- Neonetal incremental lines are the surest sign of
live birth.
8. Air in middle ear:
- Gelatinous substance present in middle ear during
fetal life id gradually replaced by air in some days.
9. Presence of some ossification centres, lower end of
radius, head of humerus & femur & capitulum of
humerus are signs of separate existance.
10. Changes in blood:
- Nucleated RBS is absent within 24hrs after live
birth. Foetal Hb is present in blood up to 6 months
after birth.
- At birth RBC, WBC, retic count & Hb is high & will
gradually fall down in few days.
11. Closure of frontanelle:
- It occurs at different timings after birth.
- Post frontanelle – up to 1 ½ month.
- Ant frontanelle – 2nd yr.
- 2 post- lat frintanelle – short time after birth.
- Antero lat frontanelle – up to 6th month after birth.
4. Cause of death id neither natural or accidental:
a) Natural cause of death:
- Prematurity
- Asphyxia due to hyaline membrane disease or
atelectesis.
- Birth truama
- Congenital malformation
- Haemolytic disease including Rh incompatibility
- Neonatal infection
- Infective condition or pre eclemptic toxaemia of
pregnancy.
- SIDS
b) Accidental causes:
- Injury to mother on her abdomen
- Prolapse of cord
- Prolonged labour
- Cord around neck
- Non availability of nursing care.
- Non rupture of membrane
- Precipated labour – head injury, suffocation,
bleeding from cord.

6. Death due to act of commission and omission:

a) Acts of omission (deliberate neglect):
After birth the newborn needs care & attention for
survival.
- Failure to tie the cord.
- Failure to protect the child from being suffocated
by linen or in birth fluid.
- Failure to nourish.
- Failure to protect it from exposure to cold and heat

b) Acts of commission:
- Smothering
- stramgulation
- Poisoning: opium was commonly used previously.
Now a days any available poison is used.
- Head inury
- Concealed punctured wound: caused by nail, needle
on nape of neck, inner canthi of eye or frontanelle.
- By cut throat: rare
- By drowning
- By burning
- By twisting neck
6. That the dead infant belongs to mother who is
charged for act of commission:
a. Abandoning the child.
b. Concealment of birth
• Sudden infant death syndrome (SIDS) or cot death/
crib death:
- Def: Sudden and unexpected death of seemingly
healthy infant whose death remains unexplained even
after complete autopsy. It is an autopsy diagnosis, not
a clinical.
- Features
i. Incidence: 0.2-0.4% of all live births.
ii. Geographical distribution: Worldwide.
iii. Age: Between 2 weeks to 2 years. Mid infancy is the
most vulnerable age (peak 2-4 months).
iv. Sex: Male infants have a proportionately higher
v. Socio-economic status: Low and middle class family
with poor housing condition, large family and lack of
health consciousness.
vi. Time of death: In most cases, the infant is discovered
dead, either in the early morning (death
possibly occurring at late night) or sometime after
first feed in the morning.
vii. Season: In most occasions, deaths are seen to occur
commonly in rainy and winter seasons in
temperate zones, but no clear pattern in tropical
zones.
viii. Twinning: More among twins as opposed to single.
Prematurity and low birth weights which are often
ix. Addiction: Smoking (pre- or postnatal) and drug
abuse by pregnant women increases risk.
• Cause: No definite cause is known.
i. Prolonged sleep apnea is presently accepted as
the most acceptable of the suggested causes. A
periodic failure to breath during sleep makes them
susceptible to hypoxia. Hypoxic state may be
promoted by many allied factors, e.g. Some
infective condition of the respiratory tract.
ii. Respiratory infection may cause viremia which
leads to sleep depression of respiratory centre and
death.
iii. Nasal edema and mucus secretion may narrow
upper respiratory passages, a flaccid pharynx and
neck posture may reduce airway.
iv. Local hypersensitivity of the respiratory tract
lumen to cow's milk was thought to cause laryngeal
spasm.
v. Bedclothes and pillow falling accidentally over
the mouth by the movement of the child.
vi. Overlying of the baby by a sleeping or intoxicated
mother. Infants placed to sleep prone or on their
side increases the risk of SIDS.
vii. Other causes: Conduction system anomalies;
hypoparathyroidism; deficiency of selenium,
antibodies, calcium, magnesium and vitamins B,
C, D and E; house-mite allergy; sodium overload
in feeds and hypothermia.
• Postmortem Findings
- Postmortem findings are negative.
- Trachea contains milky vomit, sometimes blood
stained with shed epithelial cells.
- Multiple petechial hemorrhages on heart (posterior
epicardial surface), lungs and thymus—agonal in
nature.
- Pulmonary edema is common.
- Milk or bloodstained froth on child's mouth or
bedding. Hands are often clenched around fibres from
bedclothes.
• Medico-legal Aspects
1. SIDS is a natural death in which the parents may be
wrongfully linked for having criminal involvement mor
negligence.
2. Some infanticide cases may be presented as cot
death cases.