INFANTICIDE -I
Dr. Sono Mal Ratnani
Associate Professor
Department of Forensic Medicine & Toxicology
Jinnah Sindh Medical University,
INFANTICIDE
It means unlawful destruction of a newly born full term
viable infant up to one year of age after birth.
It is punishable under SEC 302 PPC. Although most of the
new born babies are destroyed with in hours after birth
but for Legal purposes newly born infant under this Act is
defined as one who is in the first year of its life.
• FOETICIDE:
Is the destruction of the fetus at any time prior to
birth.
• NEONATICIDE:
Is the destruction of the child in the first month.
• Punishment for infanticide is death, imprisonment for
life and also fine.
•Infanticide differs from ordinary murder.
•It is necessary for prosecution to prove
that child was alive and viable at the time
of birth and criminal violence was applied
to fetus after birth.
• According to English Infanticide Act of 1938 the
mother may not be held responsible for killing her
child when her mental balance is disturbed by
experience of labor, tension and strain of child birth
and its after effects. She is not charged and
punishment is two years imprisonment.
MOTIVE FOR INFANTICIDE
• To get rid of an illegitimate child of a widow or
unmarried girl.
• Married girls killing female child to escape
defame of not having a son (as Rajputs in India).
• Extreme poverty of parents.
• Killing of male child by prostitutes
MEDICOLEGAL ASPECTS
• WAS THE CHILD BORN DEAD, IF SO WAS
STILLBORN OR DEAD BORN
• STILL BORN OR SILENT CHILD
• Child, who has issued from its mother after 28th
week or after viability and it did not at any time
after being expelled, breathed or showed any
other signs of life.
Maceration
• When fetus dies in uterus aseptic autolysis of fetus
commences.
• If dead fetus in uterus is surrounded by liquor amni
and remains there for at least 24 hours, then signs of
maceration appear.
• Process is aseptic because the child enclosed in
membranes in aseptic sterile conditions.
• In case membranes rupture, air enters in and signs of
putrefaction appear.
• DEAD BORN CHILD.
• Child who died within the uterus. Age should be above
28th weeks according to some but some say that age
does not count. Dead born child shows signs of.
• Rigor mortis before birth making labor and delivery
difficult.
• Maceration.
• Adipocerous formation.
• Mummification.
• Putrefaction.
• FINDINGS OF MACERATION.
• Body is softened, flaccid.
• Emits out unpleasant, sweetish odor.
• Skin is brown or black, not greenish as in putrefaction.
• Epidermis peels easily leaving moist and greasy
patches.
• Bony junctions in the skull and joints are abnormally
mobile.
• Important radiological signs known as Spaulding’s sign
which confirms over riding.
• Umbilical cord is soft, smooth, thickened and is easily
lacerated.
• On histological examination. Degeneration of nuclear
structure.
• FINDINGS OF PUTREFACTION.
• Nauseating unpleasant odor.
• Greenish coloration of skin.
• Formation of foul smelling gases.
• Rarely a child who has remained surrounded in
liquor amni may be converted into Adipocere.
• FINDINGS OF MUMMIFICATION.
• Fetus in dried and shriveled state due to:
• Deficient blood supply.
• Scantly liquor amni.
• Lack of air in uterus.
• WAS THE CHILD VIABLE?
• Fetus of less than seven months of intrauterine
life is termed as non viable.
• FETAL AGE DETERMINATION.
• FETAL AGE DETERMINATION.
WEIGHT DETERMINATION:
•Weight of unborn fetus of 20 weeks is
upto 400 grams.
•From 20th week onwards there is an
increase of 100 grams per week up to
36th weeks.
• In last months after 36 weeks rise of
weight is twice i.e. about 200 grams.
•In last week increase is 1 kilogram.
INTRAUTERINE
DEVELOPMENT OF FETUS
AT END OF 5th MONTH
•Length is 25 cms
•Lanugos is quite distinct on
the body.
•Centres of ossification in pubis,
Ischium, calcaneum.
INTRAUTERINE
DEVELOPMENT OF FETUS
AT END OF 6th MONTH
•Length is 30 cms
•Weight is 800 gms.
•Vernix caseosa appear as white
substance formed of epidermal scales,
thin fine hair on the body and
secretion of glands.
•Centers of ossification at Manubrium
Sterni, body and lamina of vertebrae
AT END OF 7th MONTH:
• Eyes open.
• Centers of ossification in Talus.
AT END OF 8th MONTH:
• Centers of ossification at upper end of tibia.
• Some say that centre of ossification in upper end of
tibia appear just after birth.
• Centre of ossification at lower end of femur,
and 4 centres in the body of sternum.
WHETHER CHILD WAS BORN ALIVE
• Evidence are:
• Circumstantial
• By doctor doing post mortem.
CIRCUMSTANTIAL:
• Circumstantial evidence is taken in civil cases. Witnesses
who saw the child having muscular movements,
twitching of eye lids, hearing heart beats and cry.
• Child may cry in uterus or vagina.
• If child cries in uterus -- VAGITUS UTERINALIS.
• If child cries in vagina --- VAGITUS VAGINALIS
• In criminal cases medical examiner is asked to prove by
post mortem.
SIGNS OF RESPIRATION:
• Before birth lungs receive small amount of blood which
is necessary. After birth pulmonary circulation is
established. This produce physical changes in the form
of.
• Changes in chest: Flat before birth and arched after birth.
• Changes in Diaphragm: Arched up to level of 3rd or 4th
rib if respiration has not taken place. Descends to the
level of 6th – 7th rib after respiration.
Hydrostatic test.
• Principle: the test is based on the fact that specific gravity
of non-respired lung is about 1050 (heavier than water)
and the sp gravity of respired lung is 950 (lighter than
water) owing to increase in volume due to presence of air,
non-respired lungs thus sink in water and respired lungs
float in water.
• Unexpanded Lung may float due to artificial respiration or
putrefaction. This is known as False +ve Hydrostatic test.
• STATIC TEST OR FODER’S TEST.
• Average weight of fetal lungs is 450 – 500 grams.
After respiration is 900 – 1000 grams. (Not used in
practice)
• PLOCQUET’S TEST:
• Before respiration 1/70 and after respiration 1/35 of
body weight
HOW LONG THE CHILD SURVIVED:
•We see changes in skin.
•Changes in circulation.
•Umbilical cord.
•Caput succedaneum
•Fetal Hemoglobin.
CHANGES IN SKIN:
•The skin of a newly born infant is
covered with vernix Caseosa.
Color is bright red at birth,
becomes darker on 2nd - 3rd day.
•Physiological jaundice appears
between 7 to 10 days.
CAPUT SUCCEDANEUM:
•Edematous swelling on
presenting part of head during
delivery which disappears from
24 hours to 7 days after birth.
UMBLICAL CORD:
• Clotting occurs in cut end of umbilical cord after 2
hours.
• Desiccation of umbilical cord on 1st day with
drying commencing at free end.
• Inflammatory zone near attached end in
36 hours.
• Cord mummifies in 3 days and complete in 5-6
days.
• Complete cicatrisation in 3 weeks.
CIRCULATION:
•Ductus arteriosis is obliterated in 7
to10 days.
•Foramen ovale closes by 2nd or
3rd month.
FETAL HEMOGLOBIN:
•At birth 55-58% of Hb is fetal.
•By about 6 months all Hb is adult type.
•Fetal Hb is recognized by its isoelectric point,
alkali resistance, spectrogram and fractional
crystallization.
Precipitate labour
• Precipitate labour is when a labour is very quick
and short, and the baby is born less than 3 hours
after the start of contractions.
Precipitate labour complications
• Physically, precipitous labor can cause: Increased
risk of hemorrhage. Increased risk of vaginal
and/or cervical tearing or laceration. Risk of
infection in baby or mother if birth takes place in
an unsterilized environment.
Unconscious delivery
• It's very rare, but it happens: a woman going
through labour and delivering a baby
while unconscious
CAUSE OF DEATH:
•Natural
•Accidental
•Criminal
1 NATURAL CAUSES.
•Prematurity.
•Debility
•Congenital Diseases.
•Hemorrhage from umbilical cord.
•Malformation.
•Placental disease
•Laryngeal spasm.
•Abnormal gestation.
•Erythroblastosis fetalis.
ACCIDENTAL CAUSES:
During Birth
• Prolonged labor
• Prolapse of cord.
• Knots or twists in cord.
• Premature separation of placenta.
• Death of the mother.
AFTER BIRTH:
• Suffocation.
• Unconscious labor.
• Precipitate Labor.
CRIMINAL CAUSES:
- Acts of commission i.e. use of
mechanical violence and poisoning
- Act of Omission or neglect
ACTS OF COMMISSION:
• Suffocation (smothering)
• Strangulation.
• Drowning.
• Fracture of skull
• Fracture and dislocation of cervical
vertebrae
• Other injuries as pithing
• Poisons.
ACT OF OMISSION:
• Law presumes that a woman about to deliver
should take delivery precautions to save her child
after birth. She is charged with negligence if she
does not take care, i.e.
• Necessary help of doctor and nurse.
• Inform her relatives.
• Failure to tie cord after cutting because it causes
fatal hemorrhage.
ACT OF OMISSION:
•Omission to remove child from mothers
discharges or sucking of discharges.
•To save child from heat or cold.
•Omission to feed child causing starvation.
•Separation from mother may cause shock.
Postmortem Examination of
Infants
The relatives should identify the body, and radiological
examination should be done prior to autopsy.
Whole-body radiographs .
Photographs of the external features-frontal pictures of the
entire body and close-ups of the face and side of the head.
The procedure for autopsy is nearly the same as in adults,
except for certain variations. The presence of malformations
is often the major consideration, and the dissection should
be made to preserve anatomic relationships in order to
define the abnormal anatomy.
External Examination
Clothings and Wrappings should be examined and
retained for identification of the mother.
Measurements: Head, chest and abdominal
circumferences, length (crown-rump, crown-heel, and foot
for fetuses) and weight of the body helps to assess the
gestational age.
General features: The presence of dysmorphic features
should be documented, and karyotyping should be
considered, if significant abnormal features are noted.
• Head: The distribution and quality of hair over the head
and rest of the body are noted. Abnormalities of the
shape of the head related to molding, trauma, soft tissue
edema, hemorrhage or autolysis are noted.
• Face: The facial features are examined and abnormalities
recorded. Configuration of the ear is examined, and
plasticity (indicating amount of cartilage) evaluated as an
index to developmental stage. By late Intrauterine
development, the crest of the external ear should be
superior to the level of the lateral canthus.
• Extremities: The position of the hands and feet, as
well as the fingers and nails must be noted.
• Genital Area: The perineal area is inspected and
checked for the patency of anal opening. In males,
position of meatus, and scrotal sac and its contents
are palpated. In females, the position of the meatus,
and configuration and relative size of the labia and
clitoris are observed.
• Changes of putrefaction: It helps in ascertaining the
time since death. Bodies of the newborn infants are
normally sterile. When they breathe and swallow,
microorganisms enter into the body. Therefore, in the
stillborn, and in liveborn infants, from outside to
inwards. Decomposition must be differentiated from
maceration, as the latter is a sure sign of a dead-born
fetus. If the fetus is decomposed, it will almost
certainly be impossible to determine whether live
birth had occurred.
• Injuries: All the injuries and bruises (particularly
around nose, mouth and frenulum) should be noted
and photographed. Inflicted injuries owing to birth
trauma, normal anatomical features and
postmortem damage.
• Placenta: Placenta should be weighed to evaluate
maturity, and any abnormality should also be
observed (about 15-20 cm in diameter, central
thickness 205 cm, weighs 500 g at term). Various
placental conditions may result in the stillbirth of
otherwise completely normal infants. Abruptio
placenta may be associated with extensive
retroplacental bleeding and compromise placental
and fetal oxygenation. Placenta previa may lead to
massive hemorrhage on labor is initiated, with death
of both mother and infant, unless urgent medical
intervention has occurred.
• Umbilical Cord: The cord length is 54-61 cm with
short cords measuring <30 cm and long cords
measuring> 100 cm. Long cords may cause blood
flow obstruction if prolapse, torsion or knotting
occurs, and may also warp around the neck causing
asphyxia. True knots are tight, with congestion of
vessels on one side and pallor on the other.
Conversely, blood flow in short cords may also be
compromised if there is excessive traction during
delivery.
• Preservation of Sample: Blood and tissue samples
should be taken for matching with maternal blood
groups and DNA, if these become available. Full
microbiological workup of the both the fetus/infant
and the placenta should be undertaken, along with
histological examination of all major organ/tissues
and specialized testing for metabolic abnormalities.
Swabs should be taken of every orifice, like that of a
case of sexual assault.
• Internal Examination: The modified Y-shaped incision
from both mastoid to the top of the sternum is used,
extending down the midline to the pubis. The ear-to-
ear incision is used for the removal of the vault of the
cranium.
• Brain: While reflecting the scalp, note whether
there is any subaponeurotic hemorrhage to
exclude asphyxia or deep bruises.
• Procedure: In fetuses and infants, Beneke’s
technique is used to open the skull. The cranium
and dura on both the sides are cut with blunt
scissors starting at the lateral edge of the anterior
fontanelle extending the incisions along the
midline and the lateral sides of the skull. The
midline strip about 1 cm wide containing the
superior sagittal sinus and the falx is left, and also
an intact area in the temporal squama on either
side, which serves as hinge when the bone is
reflected in a butterfly manner (Fig. 21.1A).
• An alternative method of cutting which follows the
cranial suture lines is shown in figure .B.
• After carefully inspecting the hemispheres falx
cerebri and tentorium cerebelli through the
openings, the midline bone and sinus are removed.
Injuries to fontanelles (e.g. punctured wounds
through anterior fontanelle) and
subdural/subarachnoid hemorrhages are looked for.
• Neck: This is examined for internal injuries, and the
trachea for foreign body, froth, mucus or amniotic
fluid.
• Thorax: Before opening the thorax, the abdomen is
opened first and position of diaphragm is noted by
passing a finger.
• The whole chest cavity can be opened under water
in order to demonstrate a pneumothorax.
• In infants and fetuses, Letulle’s technique of en
masse removal is the preferred in most cases so
that certain rare malformations can be properly
preserved, e.g. pulmonary venous connections.
• Note is made of whether there is free blood or fluid,
pus or stomach contents present in the thoracic or
abdominal cavity, or whether the diaphragm is
ruptured or not. If there is any fracture of the ribs, it
should be noted.
• Any evidence for malformations or birth-injuries
should be meticulously searched which may reveal
obvious incompatibility with the continuation of life.
• The lungs, stomach, heart, genitalia and other viscera
are examined for different parameters as outlined
below.
• Limbs and Sternum: They are examined for
presence of ossification centers to determine the
age of the fetus. Center of ossification for the
calcaneum appears by the 5th month, four divisions
of sternum by the 6th mouth, talus by the 7th mouth
and lower end of femur by the 9th mouth (36th
week). At birth, a center of ossification is usually
present for the cuboid and upper end of tribia .
MACERATED FETUS
Reddish color not green (in putrefaction)
These spectacle hemorrhages (raccoon’s eyes) were caused
by blows to the side of the head. There do not have to be
fractures of the skull to have spectacle hemorrhages.
Bite marks. These should be recognized and measured, as
well as swabbed for DNA testing.
Blunt trauma to
the buttocks may
not be easily
detected.
Incisions into the
buttocks should
be performed to
adequately
evaluate the
degree of trauma.
See next photo.
The buttocks were incised and blood in the soft tissues
revealed. Microscopic sections may be helpful in determining
the age of the trauma.
The burn on this
girl’s buttock was
caused by placing
her on a stove as
punishment for a
minor offense.
These are cigarette burns of the arm.
Multiple recent
bruises at or
near the
genitalia
are considered
sexual abuse
unless there is
a compelling
story to
account for
these injuries
The scarring and
resultant abnormal
positioning
of the penis is a
sign of sexual
abuse.
The rectum has a
reddened and
reactive surface
caused by
sodomy.
A fracture in a young child who cannot walk is suggestive of
abuse, especially if the fracture is a spiral one as in this case.
This type of fracture suggests the leg was twisted.
Autopsy
revealed a
fracture of the
skull which
was not
picked up on
X-ray in the
ER.
Healing rib
fractures were
apparent. This
child was
abused more
than once. He
died of blunt
trauma to the
head.
