INFANTICIDE

Dr Sagal Omar
Anatomical pathologist
 INFANTICIDE
• Infanticide means killing of an infant, within 1 year of
its live birth.
• In most of the countries, infanticide is homicide, which
may amount to murder, if ingredients of murder are
there.
• Infanticide committed by mother has been given a
different status. Giving consideration to the mental
state of the mother after child birth and even during
lactation period, if the mother kills her baby, then she
will be charged for committing felony which will
amount to manslaughter.
In a case of infanticide the questions to be proved are:

1. Whether the fetus was viable when born.

2. Whether it was born alive.
3. Whether it had separate existence for sometime.
4. That, the cause of death was neither natural nor accidental.
5. That, the dead infant examined belonged to the woman charged
for commission of the offence of infanticide.
• Hence, it is also seen that in a case of infanticide the medical
personal is the primary and the most important witness.
 1. Whether the fetus born was viable

• This is not an easy question to answer.

• VIABILITY or capacity to lead a separate life outside the body of
the mother, depends on many a biological and physiological
factors. However, the acceptable age of viability of a fetus has
been fixed to 210 days.
• It has been seen that, fetuses born much earlier can be made to
survive whereas more elderly normal fetus die after birth, even
after all precautionary life supporting steps are taken.
 2. Whether the child was born alive
• In this connection two other conditions of the newly born fetuses
are recognized, when they are not born alive. These are:
1. Still born fetus,
2. Dead born fetus.
STILL BORN FOETUS
• A still born fetus is a fetus, which is born between 20 and 28 weeks
of pregnancy and does not show any sign of life after complete
birth.
• It is very likely that fetuses dying inside the uterus are not
designated as still born and still birth thus essentially includes birth
where death occurs during the passage of the fetus from mother’s
womb to outside.
 Medicolegal aspects

• Charge of infanticide will not stand if it is seen that the baby was a
still born one and was not alive when fully born.
• But due to the confusional definition, problem may arise when a
fetus which was alive, when its head and neck was born and then
strangled to death before completely born.
 DEAD BIRTH
• This means death of a fetus inside the uterus without specific
mention of its intra-uterine age, and the fetus after birth should
show any of the signs described below, as a proof of death inside
the uterus.
Signs of intrauterine death –
1. Presence of rigor mortis in the muscles of the fetus born. This
indicates that death of the fetus must have occurred at least about
2-3 hours. Before birth and hence, most probably inside the uterus.
2. Intrauterine maceration this is a condition of autolytic
decomposition of the dead fetus in the aseptic environment in the
uterus, when the dead fetus remains inside the uterus for at least
2-3 days after death.
 Signs of intrauterine maceration

After birth the dead fetus lie flat and flaccid on the tray.
There is emission of sweetish disagreeable smell.
The color of the skin is reddish or reddish purple.
There may be P.M blisters on the skin containing fluid with reddish
tinge.
The internal organs show signs of autolytic decomposition.
The brain is pulpy. The skull vault bones may partly overlap each
other, a condition known as “Spalding sign”, which is also detectable
by X-ray examination before the birth of the dead fetus.
Fetal maceration
3. Intra uterine mummification – This
condition occurs in the dead fetus
inside the uterus due to scarcity or
absence of amniotic fluid for a
reasonable period. Normal delivery
may not occur and the fetus may have
to be extracted after diagnosis by X-
ray, sonography and physical
examination. Intra uterine
mummification indicates death of the
fetus long back, inside the uterus.
 Live Birth

• This, means that, the fetus was alive after complete birth or when at
least one part of its body come out of the mother’s body.
• This makes a difference with the term live birth, as defined by the law
of some countries, where live birth means the baby should be alive
after complete birth.
 Signs of Live birth
A. Signs during lifetime of the new born
1. Layman’s perception of live birth
(a) A baby cries after birth which is a strong evidence in favor of live
birth. People outside the labor-room may hear the cry. Cry of a
healthy newborn fetus is almost a certain phenomenon after
respiration has taken place. Crying by newborn fetus, helps
expansion of lung alveoli.
(b) Movement of the limbs or any member of the body of the fetus, is
another strong evidence of live birth.
(c) There may also be sneezing and yawning by the new born
2. Physical examination of the child by a doctor after birth This
includes:
a) Seeing and palpating the respiratory movement or heart beat of
the child and hearing of the respiratory and heart beat sound by
auscultation.
b) Pain sensation by pinching skin of any part of the body or by
testing
c) Muscular tone and activity (by trying to move a limb or finger).
B. Signs of live birth and separate existence
in dead infants
• A number of tests may be performed during postmortem
examination, to decide whether the child was born alive or
not.
• External signs
1. Shape of the chest and its measurements.
2. Changes on the body surface.
3. Changes in the umbilical cord
1. Shape of the chest and its measurements
Chest is more flat anteroposteriorly in fetuses born dead.
It is less flat with increase in the anteroposterior diameter
after respiration. The circumference of the chest is also
increased after respiration.
In a fetus born dead, the circumference of the chest is about
2-3 cm less than that of the abdomen at the level of the
umbilicus.
In a live-born fetus who has respired, the circumference of the
chest is 2-3cm more than that of the abdomen at the said
level.
 2. Changes on the body surface
(a) Vernix caseosa is present on the body surface of a new born
child. It is either cleaned or gets removed by itself within a
day or two in live birth cases.
(b) Immediately after live birth, the color of the skin is rather
bright red, which darkens after 2-3 days. The permanent
complexion of the skin comes by seven days after birth.
 3.Changes in the umbilical cord
• In case of live birth, free end of the umbilical cord attached with
the body of the child shows clean cut margins with presence of a
ligature.
• However, in unwanted live birth cases, cut margin of the umbilicus
may show ragging with no any ligature.
• The cut margin dries up by about 2 hours. The cord dries up by
about 24 hours.
• A red ring appears around the umbilicus on the second day. The
shriveled, dried cord falls off by 4th – 5th day and complete healing
of the surface of the umbilicus occurs by about 7 days.
 Internal examination

1. The position of the highest point of diaphragm goes down

after respiration to the level of 6th/7th ribs from 3rd/4th
before respiration. This occurs due to expansion of lungs
after respiration. It is not a very clear and dependable sign
of live birth or respiration, as the lowering of the position is
the result only of full expansion of lungs which occurs after
a considerable period. There are other causes including
decomposition which alters the position of the dome of the
diaphragm.
Examination of Lungs
Different between respired and unrespired lungs

Features Respired lung Unrespired

lung
1. Volume Larger Smaller
2. Consistency Soft, spongy, Firm, non-
crepitant elastic crepitant, non-
elastic
3. Weight More than 60 gms Around 30 gms
in full term after in full term
full respiration
4. Ratio of the 1/35th of the body 1/70th of the
weight with weight body weight
body weight
5. Margins Roundish Sharp
 Features Respired lung Unrespired Lung

6. Appearance Mottled or marbled Uniform reddish

appearance brown in
appearance
7. Vessels Prominent with Not prominent to
increased circulation the extent of
respired lungs
8. Alveoli Expanded and rises Not so
above the surface
9. Anatomical Occupies almost the Not to that extent
position in whole of the cavity in in comparison with
the thoracic comparison with other other thoracic
cavity thoracic organs, extend structures; position
much in all directions is at the upper part
after respiration of posterior wall
near the vertebral
column
 Features Respired lung Unrespired Lung
10 Hydrostatic Squeezed pieces of Squeezed pieces
test lungs float on water due of lungs sink in
to increased buoyancy water due to
and lower specific higher specific
gravity gravity and lack of
buoyancy
11 Microscopic Alveolar sacs are dilated Alveolar sacs are
ally and lined with flat cells. closed and lined
Vascularity prominent with cuboidal or
columnar cells.
Vascularity less
prominent
12 M.L.I Significant of life-birth Indicates still-birth
or dead birth
when not to perform the hydrostatic test
1. When the fetus has gross congenital anomaly, incompatible
with life e.g. anencephaly.
2. When the fetus is below 28 weeks of age.
3. When the stomach contains food substance.
4. When the fetus shows signs of intra-uterine maceration or
mummification.
5. When the umbilical cord shows cicatrisation.
6. When there are bruises on lung surfaces, indicating efforts to
respirate the child.
Findings in the stomach and intestine
• In still born fetuses, the stomach will not show presence of food
(e.g. milk), saliva or air. However, gas may be present in the
stomach after decomposition. Thus, presence of milk and saliva
or saliva alone or air in non-decomposed new born (which a live
born fetus swallows during inspiration) are definite signs of live
birth. These substances, if present in the small intestine, further
confirms live birth and separate existence
 INFANT DEATHS
• The natural and accidental causes of infant deaths must be excluded and
the method adapted to kill the child, should be searched out.
Natural causes of death in a newborn/infant
1. Prematurity
2. Asphyxia due to central and local causes including atelectasis, hyaline
membrane disease.
3. Birth trauma
4. Congenital malformation
5. Hemolytic diseases including Rh-incompatibility
6. Neonatal infection
7. Early separation of placenta
8. Pre-eclamptic toxemia in mother
9. Infective conditions during infancy
10. Sudden infant death syndrome (crib or cot death).
 Accidental causes of death of newborn/infant
1. Injury to mother on her abdomen, may cause premature
separation of placenta or injury to the fetus and lead to delivery.
Death of the baby may occur soon after birth.
2. Prolapse of the cord may cause stoppage of fetal circulation
during birth and death of the newborn may occur during or just
after birth.
3. Prolonged labor – this may cause death of the fetus due to injury
to brain, due to compression effect on head or due to asphyxia.
4. Twisting of the cord around the neck – This may cause death of
the fetus during birth or occasionally, immediately after birth,
from asphyxia due to strangulation.
Accidental death of the newborn may also occur for pure
post-natal causes

1. Due to non-availability of nursing care, the neonate may

die due to smothering, or choking due to inhalation of
amniotic fluid or blood from the spot of delivery.
2. Non-rupture of membrane, even after delivery may cause
death of the newborn due to asphyxia.
3. Precipitated labor may cause death of the newborn due to
head injury, suffocation or drowning or occasionally due to
bleeding from torn end of attached umbilical cord.
 Medicolegal aspects of infanticide

• Methods of deliberate killing of an infant – These

may be divided into two groups :
1. Acts of omission
2. Acts of commission
1. Acts of omission or deliberate neglect
After birth, a human newborn needs some care and attention for
its survival. Intentional failure to extend those cares to the
newborn, may lead to its death and may amount to infanticide.
Examples –
(a) Failure to tie the cord after it is cut, may cause death of the new
born due to hemorrhage.
(b) Failure to protect the child from being suffocated by linens or in
birth fluid.
(c) Failure to nourish the child with food and water.
(d) Failure to protect it from exposure to cold and other adversities.
2. Acts of commission to cause infant death
(Arranged according to frequency)
3. Smothering the baby to death with the help of hand or clothes,
which may not keep any local sign around the mouth and the
nose as no great force need to be used. But, as usually a greater
force is applied than required, local marks may be available in
many cases.
4. Strangulation Caused by a separate ligature material or the
umbilical cord (to simulate natural twisting of cord round the
neck) or by throttling or manual strangulation. In case of natural
twisting of the cord around the neck. Wharton’s jelly on the
surface of the cord, will not be disturbed. But in case of
deliberate twisting, the jelly will be displaced.
3. Poisoning –Now days any available poison may be used including
acids and insect poisons. Use of poison to kill an infant indicates
planned killing.
4. Head injury – the head of the fetus may be struck against a wall
or the floor, by holding it with its legs which may leave an
impression on the legs also. The head may be simply
compressed and crushed in between two hands or some other
hard objects. Some blunt weapon may also be used to strike the
head.
5. Concealed punctured wound – This may be caused by a nail or a
needle through the fontanelle, the nape of the neck, or the inner
canthus of one eye etc.
6. By cut throat injury – comparatively rare.
7. By burying the newborn alive.
8. By drowning – This method also serves the purpose of disposal of
the unwanted child in a river, lake or pond.
9. By burning – by disposing the living new born inside an oven.
10. By twisting the neck – Death occurs due to fracture dislocation of
the cervical vertebrae and injury to medulla.
• In case of examination of a dead new born child in connection with
an infanticide case, the suspected mother also should be examined
to see if the woman has actually delivered in the recent period and
if so, whether the extra-uterine age of the newborn tallies with the
period lapsed after the delivery of the woman. Blood group tests
for both the woman and the child are also recommended.
 Abandoning of a child

• Abandoning of an infant is committed by either or both

parents in such a way and with such a desire that, somebody
else will see the baby and will take care of it. In such cases,
the baby is left well protected with clothes and under a
shelter in a fairly common place.
Sudden infant death Syndrome (SIDS)
• Definition - SIDS (crib death) –
• The sudden death of an infant, usually under 1 year of age,
which remains unexplained after a complete postmortem
investigation, including an autopsy, examination of the death
scene and review of the case history.
(COT death or Crib death)
• Infants particularly in some specific age range, may carry a danger,
to die without presenting any apparent signs of any disease or
cause. The unfortunate parents of these infants discover their
babies lying dead in their crib or cot, though the parents cannot
find any alarming signs in the babies when they were last seen
alive.
• The most vulnerable age range of the infants are within 3-4
months of age, flanked by infants in ages within 2-6 months, the
accepted range for the condition being 2 weeks after birth to 2
years of age. Different statistical studies place the incidence of
SIDS from 0.2 – 0.4% of all live births.
 CAUSES OF SIDS
• No definite single cause or combination of causes, could yet be made
responsible. This has resulted in postulating various predisposing and
precipitating causes.
Predisposing Causes
1. Season – in most occasions, such deaths are seen to occur commonly in
rainy and winter seasons.
2. Premature birth
3. Sex – male infants have a proportionately higher death rate on this account
than females, with a higher proportionate rate of 3:2.
4. Age – mid infancy is the most vulnerable age.
5. Social status – Low and middle class family with their housing condition, size
of the family and lack of health consciousness, may have something to do
with it.
6. Time of death – In most cases, the infant is discovered dead either in the
early morning (death possibly occuring at late night) or after sometime of 1st
feeding of the infant in the morning.
 PRECIPITATING CAUSES
1. Prolonged sleep apnea is presently accepted as the most countable of the
suggested causes. This condition leads the infant to hypoxia. Hypoxic state
may be promoted by many allied factors, e.g. some infective condition of the
respiratory tract. A flaccid pharynx and fixed position of the neck during
sleep, may decrease the air movement. Further, the hypoxia, may cause
edema of the respiratory tract lumen which worsens the condition.
2. Viral infection of the respiratory tract.
3. Bed clothes and pillow falling accidentally over the mouth by the movement
of the child.
4. Accidental prone position of the child favoring it to be smothered.
5. Overlying of the baby, by a sleeping or intoxicated mother.
6. Criminal involvement of either or both parents.
 Medicolegal Importance

1. Cot death is essentially a natural death, in which the parents may

be wrongfully linked for having criminal involvement or negligence.
2. Some criminal infant death cases may be presented as natural cot
death cases.