Infant Deaths and Female Feticide

 Infanticide: It means unlawful destruction of a newly

born child and is regarded as murder in law. It is
punishable under Sec 302 of IPC

 Feticide: It means killing of fetus prior to birth

 Neonaticide: It means killing of neonate

 Filicide: It is defined as killing of a child or a step-

child,
aged between 0 and 18 years, by his or her parent
 Natural causes
Immaturity
Debility
Congenital malformation
Hemorrhage
Erythroblastosis fetalis
Neonatal jaundice

 Criminal causes (homicidal)

Acts of commission
Acts of omission
 Accidental causes
Prolonged labour
Prolapsed of cord
Injuries sustained during labour
Suffocation
Precipitated labour

 Other causes
Sudden infant death syndrome
Battered baby syndrome
 Acts of Commission
These are the willful acts done to cause the
death of infant.
1. Suffocation
2. Strangulation
3. Drowning
4. Head injury
5. Fracture-dislocation of cervical spine
6. Concealed puncture marks (pithing)
7. Poisoning
 Acts of Omission
Acts of omission refer to failure to take care
of child or negligent towards the child during
or after birth. It includes:
1. Failure to provide assistance during labor.
2. Failure to clear the air passage after birth.
3. Failure to cut and ligate the umbilical cord.
4. Failure to feed the child.
5. Failure to protect the child from heat or
cold.
Following questions are raised while doing
autopsy in infanticide case:
1. Was the child still-born or dead born?
2. Was the child born alive (i.e. live born)?
3. If born alive, how long did the child survive
the birth?
4. What was the cause of death?
A dead-born child is one, which had died in
uterus before the birth process begins and
may show rigor mortis, maceration or
mummification at birth.
Fetal death has been defined by World Health
Organization(WHO) as “death before complete
expulsion or extraction from its mother of a
product of conception, irrespective of the
duration of pregnancy”.
 Rigor Mortis
Rigor mortis may set in early stages of
death

Maceration
 It is a process of aseptic autolysis occurring
in fetus that remains dead in the uterus
surrounded by liquor amnii.
 Maceration in fetus is sign of death. The cells
of fetus break down after death and due to
enzymatic action (autolysis) body becomes
soft and flaccid.
 Unlike putrefaction or decomposition, there is
no bacterial action in maceration.
 Duration required: earliest sign of
maceration is seen at about 6 to 12hours in
form of areas of desquamation and
appearance of brown-red discolouration
 The macerated fetus is soft and flabby
 Emits sweetish disagreeable smell
 Abdomen is distended.
 Joints become abnormally mobile or flexible
 Skull bones show loss of alignment and they
override over each other due to shrinkage of
brain after death, known as Spalding sign.
Brain becomes pulpy and grayish-red in
colour
 Mummification
It is drying and shriveling of fetus occurring
in uterus after death
It results when liquor amnii is scanty and no
air enters the uterus

 Putrefaction
If the membranes are ruptured early and air
enters the uterus, then the dead fetus shows
signs of putrefaction instead of maceration.
“The child which has issued forth from the
mother after the 28th week of pregnancy and
did not any time, after being completely
expelled, breathes, or shows any other signs
of life”.
Thus, a still-born child is alive in uterus up to
the initiation of birth process and died during
the process (i.e.delivery) but did not show any
sign of life after being completely born.
 Fetal causes
Malposition of fetus
Congenital anomaly
 Maternal causes
Tuberculosis
Diabetes mellitus
Eclampsia
Placental abnormalities
 Combined causes
Pre-maturity
Birth hypoxia
Birth trauma
Malnutrition
A child showing a sign of life, even when only
part of the child is out of mother, though the
child has not breathed or completely born, is
considered as live-born child

Causing death of such child is treated in the

same manner as homicide.
 Viability means the ability of fetus to lead a
separate existence after birth by virtue of
certain degree of development

 A child is viable after 210 days

 The law in India presumes that every child
found dead was born dead unless the
contrary is proved. Proof of live birth is
required in civil or criminal cases
 Crying of baby

 Movement of body or hand or foot

 Muscle twitching or twitching of eyelid

These signs are sufficient to establish the

proof of live birth in civil cases
Crying of a child is considered as strong proof of
live birth but, at times, it is possible that (after
rupture of membrane) fetus may cry even when it
is in uterus or in vagina.

Following two conditions are considered:

 Vagitus uterinus: Crying of a child even when it
is in uterus
 Vagitus vaginalis: Crying of a child even when it
is in vagina

So crying of child is not conclusive proof of live

birth.
In criminal cases, signs of live birth have to be
demonstrated by autopsy examination of the
child. Following are the external and internal
autopsy findings in live birth
 Changes in chest

 Changes in skin

 Changes in umbilicus
 Changes in lung

 Position of diaphragm

 Changes in heart and circulation

 Changes in gastrointestinal tract

 Changes in middle ear

External Changes
 After live birth, color of skin is pinkish red
and darkens after 2 to 3 days
 The permanent complexion of skin comes by
seven days after birth.
 Desquamation of skin is seen by 2nd day
onwards
 Physiologic jaundice manifests by 2nd day.
Internal Changes
 Also called as floatation test

 The test is used to differentiate between

respired and non-respired lungs and is based
on following

 Principle: If an infant breaths after birth, air

will enter in lungs and makes them lighter
and floats in water
 Procedure: Ligate the bronchi at hilum and
placed individual lung in water. If the lung
floats in water, remove lung and cut into
many pieces and then squeeze or press the
pieces between sponges and again place the
individual pieces into water. A piece of liver
may be used that will serve as control.
Inference: Depending on floatation or sinking
of lung/pieces following inference can be
drawn
 If lung pieces floats – respired lung
 If lung pieces sinks – unrespired lung
 If liver piece floats – inconclusive
Reason
 The specific gravity of lung before respiration
varies from 1040 to 1050. However, after
respiration, the specific gravity is about 0.940-
0.950, which is less than that of water. Thus the
floatation of lung in water indicates the act of
respiration and lung is respired one.
 The residual air cannot be squeezed out by
pressing. Thus due to presence of air in lung
pieces, the pieces will float. It indicates that child
has respired after birth.
1. Respired lung may sink in following
conditions:
Pulmonary edema
Pneumonia
Atelectasis – non-expansion of lung
Obstruction by alveolar duct membrane
Due to feeble respiration.
.
2. Non-respired lung may float in following
conditions:
Putrefaction – presence of gases of
decomposition may cause floatation of
unrespired lung
Artificial respiration
 Signs of maceration/mummification
 Non-viable
 Stomach contains milk
 Umbilical cord separated and scar formed
 Gross congenital anomalies incompatible with
life, for example, anencephaly, monster etc
 In fetal autopsy, abdomen is opened first to
note the position of diaphragm

 The position of diaphragm may be affected

by presence of gases of decomposition
developing with in the chest and abdominal
cavity
 The changes occurring in heart and
circulation of live birth child are
1. Radiological evidence
Presence of air, demonstrated on X-ray, in
gastrointestinal tract is a strong evidence of
respiration.
During the act of respiration, some air is
swallowed in stomach and due to peristaltic
movement; the air gradually descends
intestine
 The presence of air in GIT may be confused
with
Putrefaction gases in gastrointestinal tract
Artificial respiration
2. Breslau’s second life test or stomach-bowel
test
Air is swallowed in stomach during
respiration. Stomach and intestine will float in
water if air is present.
 Procedure: Stomach and intestine are
removed after tying ligature at each end.
Then they are placed in water.
 If stomach and intestine floats – it indicates
presence of air in GIT and suggest child has
respired after birth.
 If stomach and intestine sinks in water – it
indicates absence of air and suggest non-
establishment of respiration in a child after
birth

 Drawbacks: The test may be positive (i.e.

float in water): If air or gases is present in GIT
due to decomposition and artificialrespiration
3. Demonstration of air under water: if
stomach is dissected
under water, air bubbles will be released
from stomach if the child has respired.
4. Presence of milk or liquid food in stomach is
a definitive
evidence of live birth of child and establishes
that child had lived for some time.
 Middle ear contains gelatinous material
before birth. If child respires after birth, with
act of respiration, the sphincter at pharyngeal
end of Eustachian tube relaxes and air enters
in middle air replacing the gelatinous
substance within few hours
 Nucleated RBCs disappear from blood within
24 hours after birth

 Fetal hemoglobin, which is 80 percent at

birth, decreases to 7 to 8 percent at 3rd
month
 Caput succedaneum is an edematous swelling
occurring in the scalp at the presenting part
of head in vertex presentation of fetus. This
swelling occurs due to compression of head
during delivery and causes extravasation of
fluid in the subcutaneous tissue. The swelling
is diffuse, boggy and is not limited by the
suture line.
 It disappears spontaneously within 24 hours
after birth.
 Presence of caput succedaneum indicates
fetus being alive during delivery.
 This swelling has to be differentiated from
cephalhematoma
 Section 317 of IPC deals with abandonment of a
child, and as per this section exposure and
abandonment of child under 12 years by parent
or person having care of it is punishable offense.
Whoever being the father or mother of a child
under the age of 12 years or having care of such
child, shall expose or leave such child in any
place with the intention of wholly abandoning
such child, shall be punished with imprisonment
of either description for a term, which may
extend to seven years or with fine or with both.
 Intentional concealment of birth is a punishable
crime in India
 Section 318 of IPC deals with it
The section states that “whoever, by secretly
burying or otherwise disposing of the dead body
of a child, whether such child die before or after
or during its birth, intentionally conceals or
endeavours to conceal the birth of such child,
shall be punished with imprisonment of either
description for a term, which may extend to two
years or with fine or with both”.
 Also Called as Cot Death, Crib Death or SIDS

“the sudden death of any infant or young child

which is unexpected by history and in whom
a thorough necropsy fails to demonstrate an
adequatecause of death”.
1. The death of infant occurs up to the age of 1
year of age
2. A thorough postmortem examination fails to
demonstrate an adequate cause of death.
3. A death scene investigation is conducted
and yields no evidence of unnatural cause of
death and
4. A review of the infant and the mother’s
medical records reveal no history of medical
condition that might have caused death.
1. Age: Death is common between 2 weeks to
2 years with peak incidence occurs at around
three month
2. Sex: The incidence is more with male baby
and most surveys show the ratio of 1:1.3
3. Twins :The incidence is more in a member of
a twin pair as opposed to singletons
 Allergy to cow’s milk, house-mite
 Spinal hemorrhages
 Calcium deficiency, Selenium deficiency,
Magnesium deficiency
 Biotin deficiency, Vitamin C deficiency,
Vitamin D deficiency, Vitamin E deficiency
 Overlying
 Metabolic enzymes defect
 Prone sleeping position
 Hypoxic conduction defect in heart etc.
 External findings are almost none
 occasionally inconstant froth at mouth and
nostrils
 Stomach contents may be present in mouth,
nostrils or on the face
 The hands of child are found to be clenched
around fibers from the bedclothes.
 Internal examination may show petechial
hemorrhages in visceral pleura and thymus
gland
 There may be some petechial hemorrhages or
larger ecchymoses on the epicardial surface
of heart
 There may be evidence of laryngitis,
tracheitis, tracheobronchitis or congenital
heart disease in some case
 The SIDS may be mistaken for infanticide

 May be perplexed with battered baby

syndrome
 Also called as Caffey’s syndrome, child abuse
syndrome, maltreatment syndrome, non-
accidental injury of childhood

 A battered child is one that suffers repetitive

physical injuries inflicted by parent or
guardian, which are non-accidental in nature
 Caffey (1946) first reported the unusual
combination of recurrent subdural hematoma
with fracture of long bones but thought that
the phenomenon could be due to metabolic
abnormality

 Silverman (1953) was the first to point out

that both, subdural hematoma and bone
fracturewere the result of severe recurrent
trauma.
 Age usually less than 2 years
 Seen slightly more in male sexes
 general neglect in child
 Disproportionate amount of soft tissue injury
and history is inconsistent with pattern of
injury
 Occurrence of injuries at different times
 History given by parents are incompatible
with clinical findings
 History of multiple admission to hospital
 Children usually belong to broken families,
low socioeconomic strata or the child may be
result of unwanted pregnancy or as a result
of illegitimate sexual relationship
 Battering of child is result of sudden loss of
temper by parents or may be due to
psychiatric problems associated with parents
 The child may be scared and under fear.
 Multiple surface injuries may be present over
body with different age
 History do not corroborate with the physical
findings or injuries.
 Multiple contusions seen at cheeks, mouth,
neck, and wrist, forearms, at chest, abdomen
or thigh. Buttocks and back may shows
multiple superficial burn injuries or whip
injuries.
 Periosteal hematoma are common.
 Limb fracture may be present in the region of
metaphysis and epiphysial part of growing
bones or may have multiple rib fractures.
 The X-ray detects old fractures, healing
fractures or fresh fractures of different age
 There may be injury to eyelid, posterior
subcapsular cataract, choroidoretinal atrophy,
pre-retinal and retinal hemorrhages, optic
atrophy, retinal detachment, and papilledema
Nature of injuries inconsistent with history
provided by parents
 Recurrent injuries and injuries of different
age with different stage of healing
 Purposeful delay in seeking medical aid by
parents.
 If death of child occurs, a charge of homicide
may be labeled against offending parent

 In India, the incidence of battered baby

syndrome is less
 Shaken baby syndrome is violent act of
abuse that can cause myriad neurological,
cognitive and other functional deficits. In the
most serious cases, deaths can result

 It is a form of child abuse characterized by

retinal, subdural and/or subarachnoid
hemorrhage caused by severe shaking.
 Infant is generally held by thorax and shaken,
causing repetitive acceleration-deceleration
trauma, leading to typical para vertebral rib
fracture, intracranial hemorrhage and eye
injuries. Intracranial hemorrhages are produced
without obvious external injuries and are due to
whiplash action
 In children, head is relatively heavy and skull
bones are immature and partially membranous
 Brain is soft and immature and has relatively a
larger subarachnoid space. The neck muscles are
weak. When baby is held, the heavy head moves
due to weak neck muscles
 Less than 2 years old
 The shaking injury may be induced by parent
or child caretaker who may get irritated with
child’s cry or due to psychiatric disorder
 Retinal hemorrhages may be noted and may
be unilateral or bilateral
 There may be bilateral vitreous hemorrhage
 CT scan or MRI show Intracranial hemorrhage
 Intracranial hemorrhage may be in form of
subdural hematoma, commonly located in the
interhemispheric fissure, or cerebral edema
with subarachnoid hemorrhage
 Typical para vertebral rib fracture
 There may be brain stem damage
 Optic nerve sheath and optic nerve intradural
hemorrhagesare also noted
 also called as Factitious illness by Proxy

 It is a form of child abuse where parent brought the

child to Doctor for false or induced signs and
symptoms of illness with a fictitious (fabricated)
history

 Usually mothers are involved for inducing the illness

in child

 The child is admitted in many hospitals for non-

existing disease or illness and parent causes their
children needless hospital investigations and
operation
 The syndrome involves three forms of
abnormal illness behavior as:

1. False accounts of symptoms

2. Fabricated symptoms
3. Induction of symptoms
 A mother may give insulin to child and then
take the child to doctor for hypoglycemic
symptoms

 A mother may give laxative to child to induce

or produce diarrhea in child and then take to
doctor for treatment of diarrhea
 FEMALE FOETICIDE

“Disappearing Girls”
 Preconception and prenatal Diagnostic
Techniques Act 2003(PCPNDT) prohibits sex
selection before or after conception and the
use of pre-natal diagnostic techniques to
determine sex of fetus.
 Sex can be Determined By:
1. Amniocentesis
2. Chorionic villous biopsy
3. Ultrasonography scan and imaging
techniques
 The health department officials, auxiliary
nurses and midwives are also alleged of being
involved in helping pregnant women abort
female foetuses
 Act prohibits sex selection before or after
conception
 Regulates the use of prenatal diagnostic
techniques
 Gynecologist or RMP have to conduct pre-
natal diagnostic techniques at recognized
place
 Nursing home or RMP or hospital where
ultrasonography is used have to display the
board stating “hospital does not do sex
determination test”.
 Prenatal diagnostic techniques can be
conducted for purpose of determination of
chromosomal or genetic or congenital
abnormalities.
 Written consent of pregnant woman is must
to undergo PC and PND technique
 Doctor contravening the provisions of Act
shall be punished for 3 years imprisonment
and fine of Rs. 10,000.
 Any person seeking help for sex selection
shall also be held guilty and a provision of
punishment for 3 years and fine of Rs.
50,000 is made under the Act

 Doing sex determination test amounts to

misconduct by Medical Council of India
PCPNDT should not be carried out unless any
one or more conditions, mentioned below,
are fulfilled:
1. History of two or more spontaneous
abortion.
2. Age of pregnant female is above 35 years
3. History of exposure to teratogenic drug,
radiation or infections.
4. History of mental or physical deformities or
genetic disease in family
PCPNDT is carried out only to detect:
1. Chromosomal abnormalities
2. Genetic or metabolic abnormalities
3. Hemoglobinopathies
4. Sex-linked genetic diseases
5. Congenital anomalies