autopsy technique - 1st perinatal & paediatric forensic ...€˜autopsy technique ’ dr khairul...
TRANSCRIPT
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‘Autopsy Technique’
Dr Khairul Anuar Zainun
Forensic Pathologist
Hospital Sungai Buloh
Selangor
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Outline
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PAEDIATRIC DEATH
CATEGORY
1. NATURAL DISEASES
2. ACCIDENTAL DEATH
3. ABANDONED FETUS
4. NON-ACCIDENTAL
INJURIES
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Purpose of perinatal autopsy
Determine cause of death & extent of disease process
▪ clinical autopsy
Investigation of possible neonaticide
▪ section 309A of Penal Code
▪ forensic autopsy
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Guidelines, Protocols, Reports
VALUE OF DEATH
INVESTIGATION
QUALITY AUTOPSY
MINIMUM STANDARDS
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Perinatal Autopsy
WHAT DO YOU NEED?
INFORMATION
EQUIPMENTS
ANCILLARY INVESTIGATIONS
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Designated trolley
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Pre-autopsy x-ray
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Investigation of neonaticide‘abandoned baby’
Identification of mother
Age of gestation Viability
Live birth Cause of death
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Dysmorphysm
1. Inner canthal distance
2. Outer canthal distance
3. Interpupillary distance
4. Philtrum length
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• Ear position
• Patency of nasal passage
• Digit & crease
• Genitalia, anus & spine
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Why examine placenta?
A variety of placental conditions may result in stillbirth of otherwise completely normal fetuses.
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The incision
Measurement of subcutaneous fat thicknessSampling of skin for fibroblast culture
Detection of occult injuriesGood preservation
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Opening of thoracic cavity
Signs of congenital or infectious disease.
Assessment of lung for presence of air
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Thoracic cavity
Sampling for microbiology tests
Sterile techniques
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Heart examination in-situ
Orientation & dimensionAtrioventricular connection
Morphology of chambers & great vesselsSequential segmental analysis
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Occult Injuries
Complete dissection of the posterior trunk to detect subcutaneous
or intramuscular hemorrhage from trauma
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Sampling for histology
Adequate preservationFrozen section with oil-red O staining
Special stainsExtra tissues
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Ancillary investigations
Toxicology & DNA profiling
Metabolic & Genetic
Microbiology
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Estimation age of gestation
Ossification centre
Weight & parameters
Gross & histology of organs
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Investigation of neonaticide‘abandoned baby’
Identification of mother
Age of gestation Viability
Live birth Cause of death
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Stillborn or born alive?
• Food in stomach.
• Injuries
• Vital reaction of umbilical cord
• Air in lungs
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Air in lungs
• Gross appearance of lungs
• Floatation test
• Histology of lungs
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Floatation Test
• The hypothesis - lungs from a neonate who has breathed will be expanded and filled with air and therefore will float in water
• ‘Routine test’
• ‘Suggestive pointer’
• The method– Lungs and heart
– With liver in decomposed body
– GI tract (estimates of survival)
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Postmortem CT
• Differentiation between live birth and stillbirth
• Differentiation between complete aeration of lungs and partial artificially aerated lungs as a result of resuscitation attempts.
• Detect the presence or absence of putrefactive gases within the vascular system.
• Estimation age of gestation.Guddat et al 2013
Sieswerda-Hoogendoorn et al 2013
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Cause of death
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Postmortem microbiology
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Section 318 Penal Code
• Concealment of birth by secret disposal of dead body.
• Could be of an aborted fetus or stillbirth of higher gestation.
• Identification of mother the utmost importance.