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AUTOPSY OF A NEW BORN

Click to edit Master subtitle style Chetan Dr.

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Few Definitions

New born -recently born Foeticide- destruction of fetus at any time prior to birth Neonaticide- is destruction of child in the first month Infanticide- is the unlawful destruction of a child under one year of age.
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Filicide-is the killing of a foetus by its

Live birth mean the child showed signs of life when only part of the child was out of mother though the child may not have breathed or completely born.
Dead born- one which has died in utero and shows one of the following signs after completely born

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Rigor mortis, maceration,

Viability
Means the physical ability of fetus to lead separate existence after birth apart from its mother by virtue of certain degree of development. Viable after 210 days of IU life

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Age of New born


Crown heel length Weight Midpoint of body in relation to sternum and umbilicus Nails- appeared or not and extent of growth Scalp hairs appeared or not Eyelashes and eyebrows appeared or 4/21/12 not

Ossification centre's

Knee joint Ankle bones Sternum Sacral segments

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Signs of Dead Born


Rigor mortis Maceration Mummification

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Maceration
Maceration-is the aseptic autolysis of a new born in utero. It occurs due to absence of air. Skin is coppery red in color. Body parts are flaccid and flat when placed on a table, separated bones.

"parboiled" reddened skin < 8 hours (I) skin slippage and peeling > 8 hours 4/21/12 (II)

signs of live birth


Milk in stomach Absence of meconium in large bowel, exception being breech delivery Exfoliation of skin Closure of foetal channels changes in umbilical cord

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Abandoning of infant
IPC-317 -If the parent of a child under 12 yrs of age or anyone having the care of such a child, leaves the child in any place with the intention of abandoning it, shall be punished with imprisonment up to 7yrs. And if the child is a girl child then rigorous imprisonment for upto 10 yrs and fine upto 1 lakh.
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Concealment of birth

IPC-318 Whoever secretly buries or dispose of the dead body of child, whether such child dies before or after or during its birth, intentionally conceals the birth , shall be punished with imprisonment up to 2 yrs and if its a girl child than 5yrs and fine of 50000 Rs
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Causes of death of a newborn


Natural causes prematurity, debility due to lack of general development congential diseases Malformations Postmaturity Preeclampsia, neonatal infection, 4/21/12

Accidental causes

During birth -prolonged labour, prolapse and or twisting of cord, injuries or death of mother.

After birth- suffocation due to when the membranes cover the head during birth, or face is pressed accidentally. Precipitate labor-one which takes less than average time. child is born suddenly without usual labour pains.
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Criminal causes

Acts of commission- suffocation, strangulation, drowning, burning, blunt head injury, fractures and dislocation and wounds

Acts of omission or neglect


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Objectives of autopsy

To know the intra uterine age of the fetus Viable or not If viable is it live born or not? If live born how long did it survive ? Special objectives in case of infanticide requires special examinations and tests to be done besides routine dissection to find the 4/21/12

External examination

Clothes and wrappings PM changes Malformations and birth injuries State of umbilical cord and placenta

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Appearance of body

Presence or absence of Vernix caseosa Any Marks of violence Foreign body in the respiratory passage Caput succedaneum

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Umbilical cord

Length whether unduly long or short.

whether it is cut, tied, torn or still attached to placenta.

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Normally 50-55 cm long, spiral twist, fleshy and glistening surface- length is not sufficient to allow the child to fall and sufficiently strong to withstand the weight of the baby.

Changes in umbilical cord


Contains 2 arteries and 1 vein Blood clots in cut end- 2 hrs after birth Vessels begin to closed in 24 hrs Cord attached to child shrinks and dries in 12-24 hrs Cord falls off after 5th-6th day and leaves a ulcer which heals and forms a scar in 10-12 days 4/21/12

Placenta

About 22 cm in diameter with central thickness of 1.5 cm, and 500 gms Still birth- abnormalities can include Placental infarcts, hemorrhagic endovasculitis, retro placental hematomas, acute chorioamnionitis and hydrops

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Internal examination

Removing of skull by cutting along the membranous connections of the skull bones. Incise the abdomen before the thorax to know the position of diaphragm corresponding to the ribs level. (at 4th or 5th rib if no respiration and 6th or 7th after breathing) Ligate the trachea halfway to its

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Heart transverse section of heart through ventricles to note difference in color of blood on both sides Lungs- weight, color, consistency, edges.

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Difference in lung Before respiration After respiration Wt 1/35 1/70 of body wt

Volume normal or small larger and cover heart Consistency dense, firm soft, spongy, elastic, crepitant 4/21/12

Hydrostatic test (Raygats test)

To confirm if lungs are of a respired newborn or not. Fallacies- putrefaction, edema of lungs, collapse of lungs, atelactasis, alveolar proteinosis etc

Stomach bowel test (Breslaus 2nd life test)

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To determine live birth or not

Various changes in fetus helpful in determining IU age

Finding 7m Length 35c 45c

5m 8m 25c 40c -

6m 9m 30c

Midpoint xiphoid midway umbilicus Skin wrinkled 4/21/12 fat, vernix -

vernix

Vagitus uterinus Vagitus vaginalis Changes in middle ear(wredins test)

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Live birth is probable when


All Lung lobes are fully expanded Gross edema of lungs seen contusions of lungs present Nucleated red cells disappear in 24 hrs Meconium completely excreted from 4/21/12

Other signs of live birth

Caput succedaneum- area of soft swelling that forms in scalp over the presenting part of head in vertex presentation. Most often over the parietal region, asymmetrically. Seen even in buttocks and scrotum and labia. It gradually diminishes in 24hrs(within a week). Cephalheamtoma-localised accumulation of blood deep to scalp, 4/21/12

Foetal circulation

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Bruise Found

Head injury Due to labor Due to blunt force


Present in

presenting part anywhere on scalp Laceration- Not present on scalp Present on scalp Fractures - Fissured, usually on Comminuted and
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parietal bone

Caput succedaneum

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cephalhematoma

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Sudden Infant Death Syndrome (SIDS)

Sudden infant

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SIDS is suspected when a previously healthy infant, usually younger than 6 months of age, is found dead in bed. In most cases, no sign of distress is identifiable. The baby typically feeds normally prior to being placed in bed to sleep. The infant is then discovered lifeless, without pulse or respiration. 4/21/12

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Apnea of prematurity and apnea

Infant development: A leading hypothesis is that SIDS may reflect a delay in the development of nerve cells within the brain that are critical to normal heart and lung function Hyperthermia: Overdressing, using excessive coverings, or increasing the air temperature may lead to an increased metabolic rate in these infants and eventual loss of breathing 4/21/12

Rebreathing asphyxia: When a baby is facedown, air movement around the mouth may be impaired. At autopsy- trachea shows edematous fluid, presence of petechial hemorrhages over pleura, pericardium, and thymus. Microscopic evidence of respiratory inflammation.
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Leg showing centre of ossification

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Centre of ossification of sternum

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Microscopic picture of lung before and after respiration

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X-ray of a full term showing centre of ossification

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