INFANTICIDE

INFANTICIDE

INFANTICIDE Infanticide means killing of an infant within one year of age.

“Hence ,it is obvious that in a case of infanticide the matters to be proved are” Whether it was viable when born Whether the foetus was born alive. Whether it had separated existence for sometimes. That the cause of death was neither natural nor accidental but was due to some deliberate act of commission or omission That the dead infant examined belonged to the woman charged for commission of the offence of infanticide

Whether the foetus was born alive Viability or capacity to lead a separate life outside the body of mother, depends on many biological and physiological factors. The acceptable age of viability of a foetus is 210 days.

Whether it was viable when born Two other condition of newly born foetuses are recognised, when they are not born alive. These are: 1.Still born foetus 2.Dead born foetus

STILL BORN FOETUS According to WHO- “a still born child as one, which has issued forth from the mother , after 28 wks of pregnancy and didn’t at any time after being completely expelled, breathe or show any sign of life” In contrast to general conception, some still born foetuses may show signs of respiration, when they are still in the vagina or uterus. ( Vagitus vaginalis or Vagitus uterinus) Frequency of still birth rate is calculated as 1 in 18 births.

Medico legal aspects of still birth Charge of infanticide will not stand in still birth cases. In India, killing after live birth is considered as murder (302 IPC) and to prevent live birth under 315 IPC.

DEAD BORN Death of a foetus inside the uterus. Sign Of Dead Born Foetus 1.Rigor mortis 2.Intrauterine maceration (Autolytic decomposition) Overlapping of skull bones (Spalding sign) Soft tissue oedema: skin 5 mm 3. Intrauterine mummification 4.Putrifaction Gas shadow in foetal heart& vassels(Robert's sign)

LIVE BIRTH The foetus is alive, complete birth? OR at least one part of its body comes out of the mother’s body?.

Sign Of Live Birth As Recognised By Civil Law a. Cry of the baby- Vagitus vaginalis and Vagitus uterinus b. Movement of any part of body c. Sneezing and yawning d. Heartbeat

Sign Of Live Birth (As Recognised By Criminal Law) External Signs : 1.Shape of chest and its measurements: increase AP diameter and circumference 2.Changes in skin Colour -bright red at birth Brick red- 2nd to 3rd day Yellowish -3rd to 6th day Normal-7th to 10th day Desquamation of skin -begins over abdomen by 2nd day and is completed by 3rd to 4th day Vernix caseosa

3. Caput succedaneum 4. Cephalhaematoma 5.Change in the Umbilical cord Cut margin dries up by about 2 hrs. The cord dries up about 24 hrs. Red ring appears around umbilicus on the 2nd day. Cord falls off by 4th -5th day and complete healing of the surface occurs.

B. Sign of live birth and separate existence in dead infants Internal Examination 1.Position of highest point of diaphragm goes down from 3rd- 4th ribs to 6th / 7th ribs. 2. Examination of lungs Ploucquet’s test. Hydrostatic test. Histological examination of the lungs.

Character Unrespired Lungs Respired Lungs Weight in relation to 1/70 body weight Volume Consistency Extension Specific gravity 1/35 Small Large and covers the heart Liver Like: Dense firm Soft, spongy, elastic, non crepitant Crepitant Up to the level of 4th and 5thrib 1.04 Up to the level of 6th and 7thrib 0.94

Margin Sharp Rounded Color Uniform reddish Air vesicles Not inflated Mottled/ marbled appearance Inflated Section Little froth less blood Abundant frothy exudates on blood exudates pressure Breslau’s second life test Whole or part sinks in water Expanded parts or whole floats Microscopy Cuboidal lining Blood vessel Less patent Squamous Epithelium More Patent

3.Findings in the stomach and intestine Breaslau’s second life test. Demonstration of air in x ray. Presence of milk / honey in stomach. 4.Meconium - large intestine is completely free of meconium within 24 hrs after birth. 5.Change in the heartclosure of foramen ovale occurs within 3 months after birth.

6.Change in blood vessels Umbilical arteries – start contracting within 10 hrs after birth and obliteration completed by 3rd day. Umbilical vein -start contracting by 2nd to 3rd day after birth and completely obliterate by 4th to 6th day. Ductus arteriosus starts to obliterate by 2nd to 3rd day after birth and completed by 7 to 10 days. Ductus venosus- starts to obliterate by 3rd to 4th day after birth and completed by 10 days.

7. Incremental line in the enamel of the teethone of the surest sign of live birth. 8. Air in the middle ear. 9. Presence of some ossification centres e.g. at the lower end of radius, heads of humerus and femur and capitulum of humerus. 10.Changes in the blood Nucleated RBC is absent in peripheral circulation with in 24 hrs. Foetal haemoglobin 55 % to 60 % at birth. 11. Closure of fontanelle.

Cause of Infant death A-Natural B-Accidental C-Criminal

Natural causes : Prematurity Asphyxia Birth trauma Congenital malformation Haemolytic disease Neonatal infection Early separation of placenta Pre - eclamptic toxaemia in mother Infective condition during infancy Sudden infant death syndrome

Accidental causes during birth: Injury to mother on her abdomen Prolapse of cord Prolonged labour Twisting of cord around neck Premature separation of placenta. Mother’s death.

Accidental causes after birth : Non rupture of membrane. Cord around neck Head injury Non-availability of nursing care-neonate may die due to smothering, choking, suffocation, drowning. Precipitated labour-may cause death of the newborn due to head injury, suffocation or drowning or bleeding from umbilical stump.

Criminal causes May be divided into two groups : 1.Acts of Omission 2.Acts of Commission

1.Acts of Omission or deliberate neglect Intentional failure to extend those cares to the newborn, that may lead to its death and may amount to infanticide. ExamplesA)failure to tie the cord B)failure to protect the child from being suffocated by linens C)failure to protect it from exposure of cold or other adverse site.

2).Acts of commission to cause infant death Suffocation by Smothering , Gagging, pressure over chest wall Strangulation Drowning Poisoning Head injury Concealed punctured wound-may be caused by nail or needle through fontanelle, inner canthus of eye. Cut throat injury Burying of newborn alive Burning Twisting of neck –fracture dislocation of cervical vertebrae

Sudden infant death syndrome Sudden infant death syndrome (SIDS) also known as cot death or crib death is the sudden death of an infant that is not predicted by medical history and remains unexplained after a thorough forensic autopsy and detailed death scene investigation

Predisposing causes Season-commonly in rainy and winter season Premature birth Sex - M:F 3:2 Age – mid-infancy is most vulnerable Social status-lower and middle class Time of death-death possibly occurring at late night or after sometimes of 1st feeding of the infant in the morning.

Precipitating causes 1.Prolonged sleep apnoea-presently accepted as the most countable of the suggested cause 2.Pocal hypersensitivity of respiratory tract 3.Viral infection 4.Bed clothes and pillow falling accidently over mouth 5.Prone position 6.Overlying

Medico-legal importance of SIDS Cot death being natural or very occasionally accidental, the parent may be wrongfully linked for having criminal involvement or negligence. Some criminal infant death cases may be presented as natural cot death cases.

Non-Accidental Injury Of Childhood Battered Baby Syndrome Also known as maltreatment syndrome in children or Caffey’s syndrome or child abuse syndrome. A battered child is one who has received repetitive physical injuries as a result of non accidental violence, produced by parent or guardian. in addition to physical injuries there may be non-accidental deprivation of nutrition, care and affection.

Features of Battered Baby Syndrome Age-usually less than 3 years old Sex-slightly more in male(55 to 63%) Position in family-eldest or youngest and often unwanted Socio-economic factors-lower socioeconomic status History-difference between nature of injury and explanation given by parent Treatment-delay between injury and medical attention

Injuries in Battered Baby Syndrome Surface injuries-mainly head face and neck region. Mainly bruise, abrasion and laceration. Laceration of mucosa of upper lip, often tear of fraenulum is most characteristic lesion. Violent shaking lead to subdural haematoma(40% cases) and intraocular bleeding in battered babies, so called “Infantile Whiplash Syndrome”

Bite mark, traumatic alopecia, retinal haemorrhage, injuries to liver and spleen, small pitted burn of cigarette. Skull fracture are common in occipital-parietal area. Multiple rib fracture occur along posterior angle of ribs. after one to two weeks, callus is formed, and on X –ray “a string of beads” appearance is seen in the paravertebral gutter (NOBBING FRACTURE)

Diagnosis Diagnosis depends upon 1. Nature of injuries 2. Time taken to seek medical advice 3. Recurrent injuries

Differential diagnosis Scurvy Congenital syphilis Osteomyelitis Leukaemia Rickets Juvenile osteoporosis with stress fracture Osteogenic imperfecta

Munchausen’s Syndrome Munchausen syndrome is feigning illness or injury and going from hospital to hospital for unnecessary investigation and treatment.

Munchausen’s Syndrome By Proxy The term describe the action of one person (usually mother) who inflict harm against another person ( usually an infant or small child) in an attempt to gain sympathy and attention for both of her own and child’s suffering.

1. Spalding sign occurs because of: Mummification Maceration Adipocere Drowning

2. Caffey syndrome is another name of : Battered baby syndrome Battered wife Incest Death in cafeteria

3.breslau’s second life test is : Air in stomach and intestine Putrefaction Mummification Air in lungs

4. During hydrostatic test , unexpanded lung may float due to : Formation of putrefactive gases Air in stomach Air in the larynx Air in alveoli

5.Ploucquett’s test is for: Drowning Live birth Age with the help of teeth Range of a fire arm

6.Vagitus vaginalis means : Death of child in vagina Changes in the vagina during delivery Crying of the child in vagina Movements of child in vagina

7. Wredin’s test detects changes in : Lungs Brain Middle ear Heart

8. following are the act of commission in the case of infanticide: Strangulation Suffocation Burning All of the above

9. Crib death can be due to: Violence Poisoning Drowning Asphyxia

10. all of the following about maceration are correct , except: It is a sterile process Macerated fetus is flaccid and flattened Emits a sweetish but disagreeable odor Skin assumes a greenish color