The Differences of Infanticide and Child Murder (Non Infanticide)Lecturerdr. Arif Rahman Sadad, Sp. F, Msi. Med, SH, DHMResident

dr. Ricka Brillianty Zaluchu

MEMBERS OF GROUP

Christy Imelda Margaretha M Ketut Suwadiaya Vania Petrina Febrina Ernawati Ketut Wida Komalasari Supri Suryadi

INFANTICIDE

Act of a mother who kill her baby at the time of birth or as soon as after birth because the mother fear that the other people will discover that the mother has given birth.

CRITERIA OF INFANTICIDE

The perpetrator must be biological mother The victim must be own baby The killing must be done at the time of birth

or shortly thereafter The motive is frightened of the other people

discovered she has given birth and do not want to be ashamed

THE BASIC LAW OF INFANTICIDE IN INDONESIA

Pasal 341. Seorang ibu yang karena takut akan ketahuan melahirkan anak pada saat anak dilahirkan atau tidak lama kemudian, dengan sengaja merampas nyawa anaknya, diancam karena membunuh anak sendiri dengan pidana penjara paling lama tujuh tahun.

Pasal 342. Seorang ibu yang untuk melaksanakan niat yang ditentukan karena takut akan ketahuan bahwa ia akan melahirkan anak, pada saat anak dilahirkan atau tidak lama kemudian merampas nyawa anak sendiri dengan rencana, dengan pidana penjara paling lama sembilan tahun.

Pasal 343. Bagi orang lain yang turut serta melakukan kejahatan yang diterangkan dalam pasal 342 KUHP diartikan sebagai pembunuhan atau pembunuhan berencana.

Forensic examinatio

n

Viable or not

the infant livebirth or

stillbirth

signs of nursing

Aterm or not

Sign of injuries

How long the baby has been

lived

Cause of death

1.Livebirth or Stillbirth

Livebirth: is a complete release of conception products, which after separation, baby breathe or show any other signs of life regardless of gestational age or condition of the placenta.

Stillbirth: is death of conceptus before exiting or incurred by the mother, regardless of gestational age (either before or after the age of 28 weeks gestation in the womb). Characterized by not breathing infants or there’s no signs of life, such as heart rate, umbilical cord pulse or skeletal muscle movements

SIGNS OF LIFE

a. Breathing Diaphragma position:

- breathing infants: diaphragma location at costae 5 or 6.

- not breathing infants : diaphragma location at costa 3 or 4.

Lungs macroscopic- Breathing infants: pink color, not

homogenous(mottled), sponge-like consistency, - Not breathing infants: red purples color,

homogenous, rubbery consistency

Lungs Floating test“no touch technique”Principle – Specific gravity of an unrespired lung is 1040

to 1056. it is heavier than a respired lung whose specific gravity is 940. The foetal lungs therefore sink in water and those that have breathed, float.

A negative result does not mean definitely stillbirth so that sometimes need a histopatologic examination to ensure stillbirth or livebirth

Pulmonary floating test less reliable if it was obviously decomposed, so the test is not recommended

1. Remove the tounge through

lower jaw2. pull towards ventrocaudal until palatum mole appear

then separated from the

palatum durum

3. Releas Faring, laring,

esophagus and trakea from fascia that

attached on vertebrae

4.Tied Esofagus and trakea

under cricoid cartilage

5. Organ expulsion of

the tongue to the lung by

using forceps or pincers and scalpel surgery

6. Tied esophagus

above diaphragma

then cut above the band

7. Put it in the water and

whether float or sink

8. Sequentialy separated and put in water: left and right lungs,each lobes, Five

small pieces of periphery of each lobes

9. If small pieces of lung are float, apply

pressure on small pieces of

lung with cardboard and then put them again in water

Lungs microscopicLungs preparat fixation with formalin 10%, and

histopatologic stain with Hematoxilin eosinGlands-like structure is sign that infant’s lung have

not yet reached 26 weeks gestationSpecific sign for unrespired lungs of infant is

projection of cushion-like form that increase with thin base that looks club-like.

Check for presence of meconeum and amnion fluid

NO. Unrespired lungs Respired lungs

1 Small volume, collapse, attach to the vertebra, dense consistency, no crackles

Volume 4-6x larger, partially covering the heart, such as the consistency of rubber foam (crackles positive)

2 Sharp edge Blunt edge

3 Homogeneous color, purplish red

Pink color

4 If the lungs are squeezed under water there isn’t gas bubbles came out or when there was a decay the bubble is large and different

Bubble gas soft and same size

5 No alveoli which expands on the surface

Visible alveoli, sometimes separated each other

6 If it is squeezed less blood come out and forthy (except when there is decay)

When it is squeezed a lot of frothy blood came out although decaying not yet shown (the blood volume is twice much than before breath)

7 Lung weight less than 1/70 BW

Lung weight approximately 1/35 BW

8 All parts of the lungs sank in water

Parts of the lungs that inflate floating in the water.

SIGNS OF LIFE

b. CryingCries that sounded not mean the baby is born alive

because crying sound can occur either in uterus or vagina

c. Muscle movementThis situation must be witnessed by witnesses,

because in post mortem could not be proven.d. blood circulation, heart beat and

haemoglobin changeIncludes functional evidence that is umbilical cord

pulse and heart rate (there must be a witnesses)and anatomical evidence that is changes in Hb and

changes in the ductus arteriosus, foramen ovale and the ductus venosus

e. gaster and intestine contentWhen there is foreign body found in gastric baby

which can only be entered due to swallowing reflex, then this is evidence of life (livebirth)

f. placenta condition- presence or absence of umbilical cord pulse after

birth(there must be a witnesses)- drying of umbilical cord, position and type of knot,

how umbilical cord was cutg. skin conditionMaceration can occur when a baby has died a few

day in the uterus(8-10 days)

Evidence of intra uterine fetal death:a. Ante partum rigor mortis which often cause

difficulties during childbirthb. Maceration, is softener of infant in amniotic fluid

marked by: Brownish-red color (green color on decaying) White cuticule, often made bulae with reddish fluid. Limber bones and detached from soft tissueMaceration occur when the infant was dead 8-10

days in uterus

NOT SIGNS OF NURSING

The body is still covered by blood

The placenta is still attached to the umbilical cord and still connected with umbilicus.

If the placenta does not exist, then the end of the cord seems irregular, it can be known by putting the end of the cord to the surface of the water.

There are vernix caseosa on the forehead and in the area there are crease skin, such as crease armpits, groin and the back of the buttocks.

VIABILITY

•Ages of gestation ≥28 weeks.•Body Length ≥ 35 cm.

•Body Weight ≥ 2500 gram.•Fronto-occipital circumference ≥ 32 cm.

•No severe birth defects. Example: anensefalus, esophageal stenosis

Aterm baby

Eksternal Characteristics

Center of Bone Reinforcement

Interpretation of age

gestation

EKSTERNAL CHARACTERISTIC Ears

Cartilage auricle was formed perfectly and when folded quickly returned to its original form.

Breast

Well defined nipple, areola protruding above the surface of the skin and areolas diameter > 7 mm.

Fingernails

Finger nails was passed over fingertips, and relatively hard so that the palm examiner firmly felt the scratch.

Foot Soles line

There are lines on the entire sole of the foot, from the front to the heel. We assessed lines that wide and deep.

Genitals eksterna

Male : testicles was move perfectly to scrotum, and scrotal skin rugae was perfectly form. Female: labia minora was well covered by labia majora

Hair

hair is relatively rough, each strand separated from each other and looked shiny. Hairline on forehead was obvious.

Skin opacity

In mature infants, the fat tissue under the skin is thick enough so that a rather large blood vessels in the abdominal wall does not look or seem vague.

Processus xiphoideus

In mature infants processus xiphoideus bent to dorsal.

Eyebrows

In mature infants, eyebrows was complete..

OSSIFICATION CENTER

• Distal femur, proximal tibia, and cuneiform cuboideum ossification appears at 36 weeks gestation.

• Talus and calcaneus ossification appears at 28 weeks gestation.

INTERPRETATION OF BONE AGE

De Haas Formula•First 5 months of head-heel length in centimeters is equal to the square of the number of months.

•Last 5 months, the length of the body is the same as the number of months multiplied by the number 5.

Arey Formula •Age (months) = length of the head - heels (cm) x 0.2•Age (months) = length of the head - buttocks (cm) x 0.3

Finnstrom Formula •Using length oksipito-frontal head circumference .•Gestational age = 11.03 + 7.75 (head circumference lenght)

Cause of natu

ral death

Bleeding

Solusio Plasenta

Malforma tion

Immaturity,

congenital disease

Larynx eous

spasm

Eritroblas tosis

foetalis

Accidental death

Mother death

Stranggulation of

umbilical cord

Long duration

of delivery

Traumatic

Homicide

STRANGULATION

BLUNT TRAUMA TO THE HEAD

DROWNING

SMOTHERING

SHARP TRAUMA

POISONED

EXAMINATION OF THE MOTHER

POST PARTUM SIGNS

•a. New rips on the genitals•b. Ostium uteri can be passed by fingertips•c. Bleeding from the uterus•d. Uterine size•e. Breasts secrete milk•f. Hyperpigmentation of aerola mamma•g. Striae gravidarum

HOW LONG THE BABY HAS BEEN

DELIVERED•a. size of the uterus return to its original size in 2-3 weeks•b. lochia: 1-3 days post partum coloured red, 4-9 days post partum coloured white, 10-14 days post partum there is no sap childbirth•c. genital laceration heals in 8-10 day

Sign of Partus Precipitatus

• a. rips on the genitals• b. invertio uterine• c. rips of umbilical cord• d. injuries to the baby's head that

may cause bleeding under the scalp or within the skull

Histopathology examination

HOW TO PROVE SUSPECT IS THE MOTHER OF THE BABY?

CHECK THE TIME OF HAVING GIVEN BIRTH CHECK BLOOD TYPE DNA EXAMINATION

CHILD MURDER

Murder of the child when his age more than 1 day in life by father, mother and step parents as perpetrator.

In Indonesia Infanticide vs Non infanticide Motive Perpetator Time of death Victim

THE FACT

In 2007 there are 470 cases child abuse in Indonesia, 67 were killed while 23 was a rape cases with family were the perpetator.

In 2004 there are 27 children were killed by their parents in Canada with father, mother and step parents as perpetator.

MOTIVEMOTIVE

RESNIK CLASSIFICATION

AltruismAcute

PsychosisUnwante

d children

Spousal revenge

Accidental

ALTRUISM Is a murder commited

out of love to reliave the real or imagined suffering of the children

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Jordan was a divorce mother kill her own son because of her financial problem.

She think after her death,her son will have sexual abuse by her ex-husband

Acute Psychosis

Major Depresive

Schizophrenia

Unwanted Children

SHE DIDN’T WANT YOU

ACCIDENTAL

Unintentional death due to child abuse

Generally following

with BATTERED

CHILD SYNDROME

Injuries sustained by a child as a

result of physical abuse

SPOUSAL

REVANGE!!!!

BOUGET AND GAGNE CLASIFFICATION

PerpetratorPerpetrator

CHILD MURDER BY MOTHER

It happen usually with depression and have a lack of mental and material support.

Many factor can lead mother to do child murder.

Factor

Financial problem

Conflict with family

member

Abusive adult

relationship

Being primary

caregiver

Limited social

support

POSTPARTUM DEPRESSION

New mother + Giving

a birth =JOYFULL

DEPRESSED

POSTPARTUM DEPRESSION

Baby blue

Postpartum

depression

Postpartum

psychosis

1. Sleep disorder

2. Mood swing3. Feeling of

vulnerability

1. Anxiety2. Irritabality3. Fatigue4. Felling Guillty

1. Extreme confussion

2. Agitation3. Feeling

hopeless4. Hallucination

s occur

CHILD MURDER BY FATHER

Bourget and Gagne found there is 77 case of child murder by his father in Quebec while in different

research they found there is 24 case of child murder by his mother in Quebec.

Father more often do a childmurder than mother

FACTOR

1.Financial Problem

2.Insecure Married

3.Afraid of Separation

THE FACT

There is lack of reseach of child murder by father

There is no spesific basic law about child murder (non infanticide) in Indonesia, then basic law of child murder refer to KUHP pasal 338, 339, 340, 344, and children law.

Pasal 338“ Barang siapa dengan sengaja merampas nyawa orang lain, diancam karena pembunuhan dengan pidana penjara paling lama lima belas tahun.”  Pasal 339“Pembunuhan yang diikuti, disertai atau didahului oleh suatu perbuatan pidana, yang dilakukan dengan maksud untuk mempersiapkan atau mempermudah pelaksanaannya, atau untuk melepaskan diri sendiri maupun peserta lainnya dari pidana dalam hal tertangkap tangan, ataupun untuk memastikan penguasaan barang yang diperolehnya secara melawan hukum, diancam dengan pidana penjara seumur hidup atau selama waktu tertentu, paling lama dua puluh tahun.”

Pasal 340Barang siapa dengan sengaja dan dengan rencana terle bih dahulu merampas nyawa orang lain, diancam karena pembunuhan dengan rencana, dengan pidana rnati atau pidana penjara seumur hidup atau selama waktu tertentu, paling lama dua puluh tahun.”  Pasal 344“Barang siapa merampas nyawa orang lain atas permintaan orang itu sendiri yang jelas dinyatakan dengan kesungguhan hati, diancam dengan pidana penjara paling lama dua belas tahun.”

UNDANG-UNDANG PERLINDUNGAN ANAK

 Pasal 13(1) Setiap anak selama dalam pengasuhan orang tua, wali, atau pihak lain mana pun yang bertanggung jawab atas pengasuhan, berhak mendapat perlindungan dari perlakuan:a. diskriminasi;b. eksploitasi, baik ekonomi maupun seksual;c. penelantaran;d. kekejaman, kekerasan, dan penganiayaan;e. ketidakadilan; danf. perlakuan salah lainnya.2) Dalam hal orang tua, wali atau pengasuh anak melakukan segala bentuk perlakuan sebagaimana dimaksud dalam ayat (1), maka pelaku dikenakan pemberatan hukuman.

CONCLUSION

We can see the differences of infanticide and child murder (non infanticide) from 4 aspects:- Perpetrator,- Victim- Time - Motive - Basic law

Forensic examination must be done to the suspect (biological mother) and the victim (the baby).

Purpose of the examination are to identify Baby is live birth or stillbirth. The baby is viable or not. The baby is aterm or not. There is sign of nursing or not. Cause of death