FETAL AUTOPSY

FETAL AUTOPSY
OBJECTIVES
l)To know the infant has attained VIABILITY.
2)To know the infant has born ALIVE
3)To know the EXTRA UTERINE AGE of the fetus, if its born alive.
Apart from,
4)IDENTIFICATION of the infant.
5)TIME SINCE DEATH
FETAL AUTOPSY
6)CAUSE OF DEATH
•To know the stillborn and signs
•Dead born
•IUD
•Died after delivery
•Live born -exist for sometime since
death
•Infanticide
•foeticide
PROCEDURE OF AUTOPSY
1)Proper requisition from investigating officer to conduct postmortem examination on the
dead body is to be obtained
2)A copy of INQUEST is to be obtained.
3)Hospital notes regarding the birth or death of the fetus is to be obtained (if available)
EXTERNAL EXAMINATION OF THE FETUS
A)GENERAL
1. HEIGHT in cms (Crown to Heel)
2. Any gross CONGENITAL
ABNORMALITIES, which is not
compatible with life.
3. SCALP HAIR: Color, Length, Application of
oil, bathing etc
4. EYE LASHES AND EYE BROWS
5. PUPILLARY MEMBRANE
6. LANUGO HAIR
EXTERNAL EXAMINATION OF THE FETUS
7. VERNIX CASEOSA
8. NIPPLES AND AREOLA: color and development
9. PLANTAR AND PALMAR CREASES (their development).1
10. FINGER AND TOE NAILS
11. EXTERNAL GENITALIA FEMALE: Position of ovaries.MALE: Position of testes
12. UMBILICAL CORD: present or not, wet, dried or fallen, if present completely, its
length, and any abnormalities as knots and kink
13. PLACENTA: complete or not, fresh or macerated, any retro placental clots or infarcts..
EXTERNAL EXAMINATION OF THE FETUS

• B) INJURIES:
• Any injuries, antemortem or postmortem are to be noted.
 INTERNAL EXAMINATION OF THE FETUS
1) OPENING OF THE ABDOMEN:(From
xiphisternum to symphysis pubis)
a)Position of Diaphragm ( Unrespored lung- 3rd to 4th
intercostal space, Respired lung- 6th to 8th intercostal
space.
b)Stomach and its contents (milk or any feeding material)
c)Intestines and their contents (meconium and its position
in the GIT)
d)Development of internal genital organs (ovaries and
testes and their position)
INTERNAL EXAMINATION OF FETUS

2)OPEN THE SKULL: As opening the dura matter in adults.

a)Cephalohematoma
b)Blood clots in venous sinuses
c)Other injuries and abnormalities.
INTERNAL EXAMINATION OF FETUS
3) OPENING THE THORAX:(in the last)a
a)LUNGS: size, shape, margins,color, surface, consistency, and weight
b)HYDROSTATIC TEST:In four steps
i) Trachea tied by a double ligature method, both lungs along with heart put in Water tumbler.( if lungs
floats they are respired,here the heart acts as control
ii) Each bronchus is tied separately, and each lung us put in water tumbler
Iii)Each lung is made in to 10-20 pieces and each piece is put in water separately.
Iv)Each piece of lung is squeezed in between thumb and index finger under the water and looked for
escaping air as bubbles coming out.
HYDROSTATIC TEST
INTERNAL EXAMINATION OF FETUS
4) OSSIFICATION CENTERS
5)BLOOD:For estimation of HbF (fetal
Hemoglobin) and for the presence of nucleated
RBC, which will disappear with in 24 hours of
birth.
DEVELOPMENT OF THE FETUS

• DEVELOPING OVUM:7-10 Days after conception

• EMBRYO- 1week to end of 2nd month
• FOETUS- end of 2nd month to delivery
• NEONATE- first 28days (1 month) after birth
• INFANT - delivery to first 1year after birth.
DEVELOPMENT OF THE FETUS
END OF FIRST MONTH:(Intrauterine life)
1) Length is 1cm
2)Weight = 2.5 gms
3)Eyes are seen as two dark spots.
4)Mouth is a cleft
5)Limbs are bud like.
END OF SECOND MONTH
1)Length is 4cms
2)Weight is 10gms
3)Eyes and nose are recognizable.
4)Hands and feet are webbed.
5)Anus is seen as a dark spot.
6)Umbilical cord begins to develop.
7) sex us not distinguishable.
8)Ossification centers seen in the clavicle and lower jaw.
END OF THIRD MONTH

1)Length is 9cms
2)weight is 80gms
3)Nails begin to appear as then membranes on the
fingers and toes.
4)Sex is not yet distinguishable.
5)Placenta is formed and diffentiated.
6)Eyes are closed and papillary membrane appears.
END OF FOURTH MONTH
1)Length is 16cms
2)Weight is 120-200gms
3)Sex is easily recognized
4)Lanugo is visible on the body,Pupillary
membrane is visible.
5)Meconium is seen in the upper part if small
intestine.
END OF FIFTH MONTH
1)Length is 25cms
2)Weight is 400gms
3)Vernix caseosa appear on the body
4)Fine hair appears on the scalp.
5)Lanugo is quite distinct.
6)Meconium is seen at the beginning of the large intestine.
7)Placenta weights about 180gms.
8)Center if calcaneum is usually present.
END OF SIXTH MONTH
1)Length is 30cms
2)Weight is about 700-900gms.
3)Hair appears on the head.
4)Eye brow and eye lashes begin
to form,
5)Eyelids are adherent and
pupillary membrane is still
present.
END OF SIXTH MONTH
6)Skin is red and wrinkled.
7)Testicles are lying close to the kidney
8)Meconium is seen in the upper part of large intestine.
9)Ossification center for manubrium and first segment of mesosternum are present.
10)Placenta weights about 300gms.
END OF SEVENTH MONTH
1)Length is 35cms
2)Weight is 1kg-1.5kgs.
3)Subcutaneous fat begins to appear.
4)Nails are thick and do not extend to the tips of the fingers and
toes
5)Eyelids are open.
6)Pupillary membrane almost disappear
7)Testicles are found in the external inguinal ring.
END OF SEVENTH MONTH
7)Testicles are found in the external inguinal ring.
8)Meconium is seen in the whole large intestine.
9)Ossification center of talus appears.
10)Fetus attains VIABILITY.
11)Placenta weights about 350gms.
END OF EIGHTH MONTH:
1)Length is 40 cms
2)Weight is 2000 gms
3)Scalp hair is thicker
4)Skin is red but not wrinkled,covered with soft hair
5)Lanugo has disappeared from the face
6)Nails nearly reach end of fingers and toes
7)Left testicle has descended in to the scrotum
8)Placenta weighs 450 gms
END OF NINTH MONTH:
1)Length is 45 cms
2)Weight is about 2.5-3 kgs
3)Scalp is covered with dark hair
4)Lanugo is seen only on the shoulders
5)Vernix caseosa is present over the flexures of joints
and neck folds
6)Nails grown over the tips of the fingers and toes
.
END OF NINTH MONTH
7)Both the testicles have descended in to the scrotum
8)Meconium is seen at the end of large intestine
9)Ossification centre for lower end of femur appeared
10)Placenta weighs about 500 gms
11)Posterior fontanelle closed.
END OF TENTH MONTH
1)Length is 45-50 cms
2)Weight is 3-3.5 kgs
3)Head circumference is 28 cms
4)Well covered with hair
5)Lanugo hair is seen only on shoulder
6)Skin is red and covered with vernix caseosa
7)Nails project beyond fingers
END OF TENTH MONTH
8)Umbilicus is situated midway between the pubic symphysis and xiphoid.
9)Umbilical cord is fleshy glistening and about 45-50 cms1
10)Both the testicles have descended in to the scrotum
11)Meconium is seen in the large intestine
12)Ossification centre formed in the lower end of femur and cuboid and upper end of
tibia
13)Placenta is 22 cms in diameter,1.5cms in thickness and weighs 500 to 700 gms
FETAL AUTOPSY

Q)Write autopsy findings(external examination) for given fetus specimen?

PROFORMA

DATE :
PLACE:
TIME: ACA,COMPLETD AT………………….
ON OBSERVATION/EXTERNAL EXAMINATION
AGE: BY RULE OF HASSE/HASSE
Ex; 16 cm square root of 16 = 4 months
MORRISON’S law: 35 cm square root of 35=7 months
I)EXTERNAL APPEARANCE
• Clothing:clothed/or not clothed
• Injuries:(mainly nostrils/over the neck)
• Sutures:present/absent
• Incisions over joints(for exclude previous autopsy)
PROFORMA

II)HEAD:
1. SCALP HAIR: absent/present-length?
2. CAPUT SUCCEDANEUM:absent/present
3. EYE BROWS:absent/present
4. EYELIDS: open/closed

TRUNK
5. CHEST; compressed/flat
6. LANUGO HAIR:present/absent
7. VERNIX CASEOSA:cleaned/or not
8. SKIN:colour /appearance
9. POSITION OF UMBLICUS
10. UMBLICAL CORD:length.ligated or not ligated
III)GENITALIA(SEX)
LABIA MAJORA/SCROTAL SAC

IV)LIMBS:
NAILS:absent/present
if present extension to the tip of the fetus.
V)REPORT:
1. THE BAGE OF THE FETUS: viable/not viable
2. FETUS IS STILL BORN/DEAD BORN/LIVE BORN.
signature………………..
name of the medical officer…………………
designation…………………..
regd no………………
address………………