Definition:

Law:
U.K. Only mother can be charged.
India No special law.
 Foeticide:

Filicide:

Neonaticide:
Post mortem examination of child:
The points to be decided are-
1. Stillborn/ dead born

2. Viable / Non viable

3. Born alive / not

4. Period of survival

5. Cause of death
Stillbirth:
Definition:
Incidence- 5%
Illegitimate & immature children of primiparae.
Signs of prolonged labour.
Causes:
1. Prematurity
2. Anoxia
3. Birth trauma
4. Placental abnormalities
5. Toxaemias of pregnancy
6. Erythroblastosis foetalis
7. Congenital defects.
 Dead birth:
Definition:

Signs-
1. Rigor mortis at delivery
2. Maceration Spaldings sign
3. Mummification
 Viability of the infant:
Definition:

Livebirth:
Signs of live birth:
A) Civil cases:
Hearing Cry of baby(even in utero), movements
of body, muscle contractions.
-Law presumes every newborn child found dead
was born dead until the contrary is proved.

B) Criminal Cases:
Post mortem examination
Signs of live birth:
1. Shape of chest
2. Position of diaphragm
3. Lungs
4. Changes in stomach & Intestine
5. Changes in the middle ear
6. Other signs.
I) Shape of chest:

Before respiration After respiration

Flat, Circumference-1 to 2 Arched, dome shaped
cm

II) Position of diaphragm:

- Open abdomen before thorax.

Before respiration After respiration

4-5th rib 6-7th rib
 III) Lungs:
Trait Before respiration After respiration
1. Volume Smaller, collapsed on to hilum Fill pleural cavities.

2. Margins Sharp Rounded

3. Consistency Dense, firm, non crepitant Soft, spongy, elastic,
crepitant
4. Color -Uniformly reddish-brown/bluish. -Fine mosaic appearance.
-On c/s, interior is uniform in color & -mottled/marbled.
texture, little blood oozes out. - On c/s, frothy blood oozes.
5. Blood in lungs Less Twice.

6. Weight-
a)Static/ Foederes -30-40gm -60-66gm
b)Ploucquets Test -1/70th of body weight -1/35th of body weight.

7. Hydrostatic -ve +ve

/Raygats Test
Hydrostatic Test:
Principle:
Respiration Lung volume Specific Gravity
(Sp. Gravity : Before respiration 1040-1050 & After respiration 940)
Procedure:
1. Ligature tied on bronchi & lungs separated.
2. Put lungs in water (separately). Float/sink.
3. If float Cut into 12-20 pieces Put in water Float/sink.
( Small piece of liver can be taken as a control)
4. If float Squeeze with fingers under water Float/sink.
5. If float wrap in cloth piece Squeeze by putting weight(to
remove tidal air) Float/sink.
6. If float Respiration has taken place.
If sink Respiration has not taken place.
 Fallacies of Hydrostatic Test:
A) Expanded lungs may sink:
1. Disease acute edema, pneumonia, congenital syphilis
2. Atelectasis due to a) Feeble respiration,
b) Complete Absorption of air
c) Expiration volume > Inspiration.
d) Obstruction by alveolar duct membrane.
B) Unexpanded lungs may float:
1. Putrefactive gases
2. Artificial respiration.

Hydrostatic Test not necessary:

1. Foetus is monster.
2. Macerated/mummified.
3. Born before 180 days of gestation
4. The stomach contains milk.
5. Umbilical cord separated & scar is formed.
 Respiration before & during birth:
1. Vagitus Uterinus- After rupture of the
membranes in the uterus.
2. Vagitus vaginalis In the vagina
3. When head is protruding from the outlet.

Proof of breathing is not absolute proof

of live birth:
1. Child has breathed in uterus or vagina & died
due to natural causes before completely born.
2. Poor respiration.
Live birth is probable Still birth is probable

1. All lobes are fully expanded. 1. Maceration of the foetus.

2. Oedema of the lungs. 2. Flooding of the lungs with

liquor amnii.
3. Alveolar duct membrane
present. 3. Desquamation of the
bronchial epithelium.
4. Pulmonary atelectasis due
to obstruction by Alveolar 4. Distension of the large
duct membrane. bowel with meconium.

5. Contusions of the lungs.

V) Changes in the middle ear:
(Wredins Test) :

Before birth After birth

Middle ear contains Replaced by air within few
gelatinous embryonic hours to 5 days.
connective tissue
IV) Changes in the stomach & intestine:

Test Live birth Still birth

Breslaus second Float Sink
life or Stomach-
bowel test

Air, amniotic fluid, Present Only mucus

blood, meconium

Milk May be present Absent

VI) Other signs:
1. Blood Nucleated RBCs disappear within 24 hours
2. Meconium Excreted within 24 hours
3. Caput Succedaneum Disappears within a week
4. Skin Bright red Darker Brick red/ yellow Normal (week)
Vernix caseosa lost in 2-3 days.
5. Air In GIT Stomach 15min, Small intestine 1-2 hours, Colon - 5-6
hours, Rectum 12 hours .
6.Umbilical cord 2 hours blood clots, 24 hours vessels closed, cord dries,
36-48 hours inflammatory ring at the base, 5-6 days cord
falls off leaving ulcer, 10-12 days Ulcer heals.

7. Circulation 10 hours contraction of umbilical artery starts, 4th day

umbilical vein & ductus venosus close, 10th day ductus
arteriosus close, 2nd/3rd month foramen vale closes.
Causes of Infant Deaths:
A) Natural
B) Unnatural
(I) Accidental
a) During birth
b) After birth
(II) Criminal causes
a) Acts of Commission
b) Acts of ommission
A) Natural Causes:
1. Immaturity
2. Debility due to lack of development
3. Congenital diseases
4. Malformations
5. Haemorrhage from umbilical cord
6. Post maturity
7. Pre-eclamptic toxaemia
8. Diseases of placenta, placenta praevia.
9. Neonatal infections
10. Anoxia
 Accidental causes:
A) During birth
1. Prolonged labour
2. Prolapse of / Pressure on cord
3. Strangulation by cord
4. Injuries to mother
5. Death of mother
B) After birth
1. Suffocation Precipitate labour.
2. Injuries
Criminal causes:
A) Acts of commission:
1. Suffocation
2. Strangulation
3. Drowning
4. Burns
5. Head injury
6. Fractures & dislocations of cervical vertebrae
7. Wounds
8. Poison
B) Acts of Omission:
1. Lack of assistance during labour
2. Failure to tie the cord
3. Failure to clear air passages
4. Failure to protect from Heat/cold
5. Failure to supply food
Legal Aspects:

The abandoning of child: 317 IPC

1. Age of child < 12 years abandoned 7 years
2. If child is girl 10 years

Concealment of birth: 318 IPC

1. Conceals birth 2 years
2. If child is girl 5 years
Battered baby syndrome / Non
accidental injuries of childhood:
Definition:
Features:
1. Age - < 3years
2. Sex Males
3. Position in family Eldest/youngest.
4. Socio-ecomomic factors
5. History
6. Treatment
7. Precipitating factors
Injuries:
A) Surface injuries:
- Bruises, abrasions, lacerations of different ages.
Infantile whiplash syndrome
-Knuckle punches
- Pinch marks
B) Visceral injuries
- Subdural haemorrhage
- Liver/spleen bursting injuries
C) Burns
- Stubbing of cigarette
- sitting on hot stove
D) Skeletal Injuries
- Periosteal haematoma
- Transverse/spiral #
- Squeezing Multiple rib # (Nobbing #)
- Metaphyseal avulsion.

-
Munchausens syndrome by proxy:
Features
- Age Few weeks- 21 years
1. Illness produced/alleged by parent
2. Repeated requests of medical care.
3. Parental denial of knowledge of cause of
symptoms.
4. Regression of symptoms when child
separated from parents.

Method of simulation/production of illness:

Sudden Infant Death Syndrome
(SIDS):
Definition-
Features-
1. Incidence 0.6/1000 live births
2. Age 2wk 2 yrs
3. Sex Males
4. Twins
5. Time of death
6. Prematurity
7. Socioeconomic condition
8. Addictions of the mother
Theories:
1. Sleep apnoea
2. Respiratory infections Staph Aureus
3. Larygospasm
4. Brain damage
5. Other
Conduction system anomalies, adrenal
insufficiency, hypersensitivity to cows milk, etc.