Manner of Death Definition How Many Bones Does a Baby Have

Open up access peer-reviewed chapter

Autopsy in Foetal Infant Deaths

Submitted: Dec 11th, 2019 Reviewed: April 27th, 2020 Published: June 9th, 2020

DOI: 10.5772/intechopen.92673

Abstract

Child autopsies are not more difficult than adult autopsies, but do require a number of extra techniques to exist performed routinely. This chapter aims to encompass the bones techniques required for foetal, perinatal, and infant mail service mortems. Post mortem examinations of children older than 2 years of age do not differ profoundly from adult autopsies.

Keywords

dissection
incisions
paediatric
neonatal
pathology

Luv Sharma*
- Section of Forensic Medicine, Pt. B.D. Sharma Post-Graduate Establish of Medical Sciences, University of Wellness Sciences, Rohtak, Haryana, India

*Address all correspondence to: drluvksharma@yahoo.com

i. Introduction

At present, specialised foetal/kid autopsy is more in demand as parents want need to be informed about the cause of death of their child and its effect on future pregnancies. The post mortem test helps in planning better handling and caution for the future. The normal anatomy of the adult and child are like, differences do exist in foetal/neonate beefcake of the cardio-vascular system making the prenatal/paediatric autopsy significantly unlike from the adult ane. The presence of congenital anomalies constitute in perinatal and foetal autopsies is some other confounding gene making meticulous examination during dissection necessary for getting data to brainwash families concerning future pregnancies [i]. An dissection is not required in every example; though debates about the cause of death exercise necessitate an autopsy to be performed. Normally, a deceased'south torso is the holding of the relatives. However, in deaths that are unusual, unnatural or suspicious in nature the state has an overriding interest which supersedes the interests of the family unit; such circumstances fall into the category of md-legal cases. A death example with an obvious cause and mode of death may crave an autopsy for legal purposes. The usual classifications of death are: natural, accident, suicide, homicide or undetermined. A forensic autopsy is normally requested by the constabulary, the coroner or in the Latin countries by that quaint establishment 'the Investigating Judge' [2]. The age at which a foetus becomes legally viable is divers either by the gestational age or by the body weight, and varies from nation to nation. A foetus exhibiting one or more of the described signs of life are technically considered viable, nonetheless foetuses below intrauterine historic period of 180 days take negligible to no hazard of survival. Post mortem examinations are carried out on all foetuses, though the inferences fatigued from them are legally applicable but to feasible foetuses. Most of the foetal and neonatal autopsies are hospital admitted cases. However, infant post mortems may be medico-legal cases if the cause of death is not known.

2. Rules for dissection

(one) Conducted in mortuary merely, except spot post mortem. (ii) Requisition from constabulary or Magistrate necessary. (3) Avoid delay. (4) Collect information from inquest, accident register, instance sheet, etc. (v) Conducted in twenty-four hours-lite as far as possible, because colour changes, such as jaundice, P.Grand. hypostasis and colour of contusions cannot be fabricated out in artificial calorie-free. (6) Torso should be identified by the police officials. (7) No unauthorised person should be present. (viii) Banana should note findings. (9) Dissection must be consummate and never partial [3].

Important definitions [2]:

Embryo – 1–8 weeks of gestation.
Foetus – viii weeks of gestation to term.
Stillbirth intrauterine/intrapartum foetal death – after the age of legal viability, i.e., built-in with no "signs of life."
Perinatal – stillbirths + neonates in showtime week after birth.
Early neonate – first week after nativity.
Neonatal period – outset calendar month after birth.
Post neonatal period – between 28 days and i twelvemonth.
Infant – from i calendar month of age to i years of historic period.
Preterm – <37 weeks of gestation or weight less than <2500 gram at nascency.
Term – 37–41 weeks of gestation.
Post term – >42 weeks of gestation.
Small for dates weight at birth <10th centile expected for gestational historic period.
Very low birth weight – weight at birth <1500 gram.
Premature – preterm, small for dates and very low nascence weight.
Intrauterine growth retardation – weight/other parameters <10th centile expected for gestational age.

Objectives of a medico-legal autopsy are:

To institute the identity of a person.
To determine the crusade of death whether Natural or Unnatural.
If death is unnatural whether information technology is suicidal, accidental, or homicidal.
If death is homicidal, to decide if trace evidence was left backside by attacker.
To determine the time elapsed since death.

iii. Protocol to be followed at the time of receipt of dead trunk and dissection requisition papers

The basic procedures remain the same as with developed autopsies. However, the hospital records must exist gone through with peachy detail. A great deal of vital information tin be gathered from notes made by the gynaecologist and the paediatrician involved in the delivery process. The demographic details of the mother & family are also important. The number of pregnancies and their consequence, the method of delivery, any hereditary or congenital illnesses, antenatal records and investigations washed presume importance while dealing with an autopsy of a neonate. In add-on, if a termination of pregnancy (Meridian) for foetal abnormality has been done then the copy of the scan report for comparison with the mail mortem findings is necessary [1].

3.one Dissection protocol of child

A protocol is a signed document containing a written record which serves as proof of something. Autopsy protocol is used in two bones forms:

Narrative
Numerical

A numerical protocol is always amend to sum upwardly procedures to be followed at autopsy. It is a checklist of sorts and makes the work of the dissection surgeon more easy and orderly [3].

Steps to be done before the autopsy.
A summary of the clinical history.
A summary or the documents related to the instance in order of time sequence.
Gross external examination of the expressionless body.
Findings related to identification if the body is unknown or unclaimed.
Internal examination of the dead body in relation to pathological findings.
A full nautical chart of the viscera.
Details of wounds if any.
Exhibits to be preserved and sent for analysis.
Handing over of the exhibits to the constabulary for onward manual to concerned centres.

The relatives should place the body, and radiological examination should be done prior to autopsy. Whole-body radiographs (anteroposterior and lateral) are taken. Photographs of the external features—frontal pictures of the entire torso and close-ups of the face and side of the head, equally well as, any other unusual aspects are taken [4].

It is best to follow standard guidelines or protocols methodically in each case, whether they be national or have been produced locally as required. In this mode, mistakes of omission will be avoided. Although the basic autopsy varies little, there are various special investigations that may or may not be necessary, depending on the item case. Foetal/infant autopsies are having a slightly different protocol than adult autopsies every bit findings of the umbilicus and the cord, the placenta, scalp hairs, lanugo hairs, nails & their length, skin color & texture, scrotal sac wrinkling, as well as specific foetal measurements of the head, chest and abdominal circumference are to be noted.

3.ii Pathology encountered at autopsy

Amniotic infection sequence, oligohydramnios, growth restriction: symmetric, disproportionate (nutritional), viral/protozoal infection (CMV, Parvovirus, toxoplasmosis, other), built malformation (all systems), hydrops foetalis, foetal akinesia sequence, placental and umbilical string affliction, changes in the babe and placenta secondary to intrauterine death.

iv. External test

The torso should not be embalmed before the autopsy [3]. A careful external examination should be made to assess any external abnormality. The external features may provide the only information necessary to make the diagnosis of a malformation syndrome. In case of foetal bodies, the measurement of head circumference, breast circumference (at the level of the nipples) and abdominal girth should be measured. The full vertex to heel length has to be noted for an idea regarding maturity and intra-uterine age. The head profile assumes importance in such cases as instrumental delivery may produce trauma mimicking actual violence. Other important procedures include assessing the patency of natural orifices such as the olfactory organ, oral fissure, ears, anus. Prove of petechial haemorrhages should exist looked for in the optics. For hospital deaths or even in cases plant dead subsequently delivery, careful exam of the umbilical string is paramount; the edges should be checked for sharp cuts, show of tearing or gnawing. All puncture marks, needle marks and other injuries should be noted. The skin of the foetus should be examined for staining, discolouration and petechiae. Rodents gnaw away soft tissues of body peculiarly ear, olfactory organ, lips etc. They produce shallow craters with irregular border nibbling with leave long grooves and lacks vital reaction [five].

A rough classification exists to assist in estimation of maceration (hygienic autolysis) though the changes mentioned are variable depending on temperature and status of torso storage [2].

12 hours – slippage of skin is noted.
24 hours – blebs are formed on the skin.
48 hours – at that place is sloughing of the skin with blebs rupturing and haemolysis is noted in the viscera.
5 days – the encephalon liquefies, the cranial sutures overlap (Spalding'south sign) and the calvarium collapses.
vii days – the joints become lax and are dislocated.

4.1 External measurements

As already explained to a higher place, the post-obit careful measurements should be made with a ruler and a length of string, and compared to tables of normal values to aid assessment of gestational age and allow assessment of growth retardation:

Body weight in kg.
Crown-rump length (sitting summit) in cm.
Crown-heel length (standing height) in cm.
Human foot length in cm.
Head circumference in cm.
Intestinal girth (at the level of the umbilicus) in cm.
Chest circumference (at the level of the nipples) in cm.

If any abnormality is suspected, relevant radiological investigations (X-rays) and photography is done [2]. In situ photographs can be very helpful, preserving anatomic relationships and depicting visceral lesions before evisceration and fixation (Figure i).

Figure i.

Measuring the length of umbilical cord.

5. Internal examination

At that place are of three types of main incisions:

The 'I' shaped incision: extending from the mentum straight down to the pubic symphysis, passing either side of umbilicus because of excess fibrous tissue in omphalus which causes the hard penetration of needle during stitching of body later autopsy.
The 'Y' shaped incision: begins at a point close to the acromion process and carried downward to pubic symphysis.
Modified 'Y' shaped incision.

Opening of body cavities: preference given to cavities depending upon the findings. Initially open such cavities which give trace evidences and lastly open such crenel which give maximum prove it reduces the various artefacts.

5.1 Method of removal of organs

Evisceration and Block Dissection equipment : Information technology is essential to have a option of pocket-size forceps, scissors, and probes, in addition to a scalpel. A pair of scales accurate at low weights is also necessary. Of all the methods used for eviscerate a foetus, the well-nigh mutual would be the method of Letulle, in which all organs are removed en bloc with the advantage of keeping continuity if malformations are suspected [2]. Alternate techniques for evisceration and autopsy include Ghon, which removes the organs in functional "blocks" and Virchow and Rokitansky techniques [2]. Rokinansky method is an in-situ examination of viscera with removal of notable organs. Virchow method is an organ by organ removal.

Initial Stages of Evisceration: the best incision involves an inverted Y, with a central cut from below the mentum to just above the umbilicus and and then two branches, one down to each inguinal fossa which allows a good exposure of the umbilical arteries.

During reflection the scalp, annotation whether there is whatever subaponeurotic haemorrhage to exclude asphyxia or deep bruises (Effigy 2).

Procedure: In foetuses and infants, Beneke's technique is used to open up the skull. The cranium and dura on both the sides are cutting with blunt scissors starting at the lateral edge of the inductive fontanelle extending the incisions along the midline and the lateral sides of the skull. The midline strip about one cm wide containing the superior sagittal sinus and the falx is left, and also an intact area in the temporal squama on either side, which serves as a swivel when the bone is reflected in a 'butterfly' style [half dozen].

An alternative method of cutting which follows the cranial suture lines i.eastward. Rokitansky's method [iv]. Later advisedly inspecting the hemispheres, falx cerebri and tentorium cerebelli through the openings, the midline bone and sinus are removed. Injuries to fontanelles (e.g. punctured wounds through anterior fontanelle) and subdural/subarachnoid haemorrhages are looked for [6] (Figure 3).

Figure 3.

Opening of skull and dissection of underlying dura and encephalon.

five.2 Removal of the brain of a macerated baby

If the dura is left intact when the skull plates are cut, and carefully dissected from the skull when the bone flaps are reflected, and so the unabridged brain tin can be removed while intact inside the dura.

5.3 Removal of the brain in a case of cystic congenital anomalies

It is better to set up the encephalon before removal of these anomalies. A CSF needle can be used to extract CSF from the ventricles which then tin can be filled with 50 ml of formalin. An 60 minutes of fixation of the encephalon would help it in maintaining its shape, whereupon removal of the bibelot tin can be done. If contrast mixture is mixed with the formalin and so X-ray films can exist taken that volition outline the ventricular system [2].

v.4 Removal of the spinal cord in a suspected neural tube defect

The all-time method is the posterior approach. The skin is incised and at the point of the defect an ellipse shaped piece of the pare is removed, which completely encircles the defect. When the pedicles have been cut above and below the defect with bony forceps, the cord is removed. In one case the cord has been removed above and below the defect, the vertebral column tin exist transacted. This can be fixed and examined histologically later on serial sectioning. The resulting skin defect should be covered.

5.5 Examination of the center

This may be necessary in cases of non accidental injury, to await for retinal haemorrhage, or in cases of intrauterine infection or suspected retrolental fibroplasia.

5.6 Examination of the musculoskeletal system

This may be necessary in cases of suspected nascency injury, other causes of trauma, congenital deformity, or tumours.

5.seven Test of the neuromuscular system

This would be necessary in cases of suspected neuromuscular disorders or metabolic storage disorders.

v.8 Dissection of pelvic organs with continuity of perineum and anus

This is sometimes when in that location is suspicion of a urinary tract anomaly or if the external genitalia are cryptic. The symphysis pubis is bisected with a sharp scalpel. All the connective tissues around the pelvic organs are dissected freeing them anteriorly, posteriorly and sideways. In males, the muscular function of the penis is denuded till the final office is reached. The attachment to the glans penis is cut so that the penis tin be removed in continuity to the float. In females, the skin of the vulva is incised every bit a circumvolve virtually the external os. Blunt dissection effectually the vagina frees the vagina and uterus to exist removed. The anus in both sexes, is removed by blunt dissection in a circular manner in the perineum around the anal aperture. Farther dissection would allow the anus to exist removed with the pelvic organs [2].

5.9 Organ dissection

All major organs should be accurately weighed after removal, and then compared to normal values. These are produced in terms of both gestational historic period and body weight, for both alive and stillborn babies.

5.10 The cardiovascular system

If congenital heart disease is suspected, the heart is dissected along the path of blood flow, as for the adult. Careful inspection of the chambers in the mode of blood catamenia is done. Any defects or asymmetrical findings are noted. Cardiac wall hypertrophy or dilatation is noted for each bedchamber. The openings of the valves are examined and their diameters are noted. Any fical myocardial lesions should be looked for during examination of the ostia. The whole eye must be preserved for histo-pathological examination.

5.11 The respiratory system

The hydrostatic test must be undertaken to come at a conclusion regarding life or dead birth. A piece of the liver acts as a command in such cases. If the liver piece floats when placed on water, it ways that putrefaction has set in and then in that location is no utility of this exam equally imitation positive results would be expected when the lungs are placed in the water container. The shape, consistency and weight of the lungs should be noted. It is always ameliorate to ship the lungs for histo-pathology in such cases where a clearer picture would emerge [1].

A crude estimate of foetal maturity tin be got from weight of the lungs: body weight ratio: Lung weight: body weight ratio < 0.012: 1 in gestations ≥28 weeks.

Lung weight: trunk weight ratio < 0.015: 1 in gestations<28 weeks.

Deep dissection of the brochial & pulmonary arteries should be carried out equally far as possible. The pulmonary lobes are best dissected in the coronal plane. The lung parenchyma should be examined for consolidation, abscess, haemorrhage, oedema & focal lesions. Small areas of collapse are seen as depressed reddish areas. All pulmonary lobes should be sampled for histology. If a tracheo-oesophageal fistula is suspected, the trachea should be opened anteriorly and the oesophagus dissected distally and fastened to the trachea. The trachea and oesophagus should be sampled for histo-pathology preferably at the level of the laryngeal cartilage so as to include thyroid gland in the same block.

5.12 The gastrointestinal system

It is always better to locate the caecum which forms the boundary between the small & large gut. The entire intestines should be opened and the mucosa examined. The distribution of meconium should also be assessed. The mesentery of the gut should also be examined during autopsy.

The liver should exist weighed after removal before being dissected in a coronal plane to allow comparison between the right and left lobes. Any colour change or focal lesions should be noted and both lobes should be sampled for histo-pathology [7].

The pancreas usually is machine digested before the body reaches the mortuary. Withal, if present it should too be sent for histo-pathology.

The Genitourinary System: Malformations of the urinary tract are quite common and should exist looked for. In males these anomalies are found with obstructive lesions of the urinary tract and may require special attention.

The kidneys should be weighed and dissected coronally. The cortices and medullae should be identified. The renal pelvis and calyces should besides be examined. Yellowish streaks of urate may exist seen and prove neonatal survival. Each kidney should be sampled for histo-pathology [4].

The testes normally lie within the scrotum from 32 weeks of gestation.

v.13 The lymphoreticular arrangement

The thymus is a part of the anterior mediastinum and is proportionately much larger than in adults and easier to place. The spleen should be weighed. Whatsoever focal lesions in the splenic parenchyma should exist identified. Splenic enlargement is seen in haemolytic syndromes. The spleen should be sampled for histo-pathology [1]. Whatsoever lymphadenopathy should obviously be identified and sampled for histo-pathology. Routine histology should include a block of minor bowel mesentery which will contain several lymph nodes.

Routine examination of os marrow is not necessary, but if haematopoietic disturbance is suspected, marrow should exist sampled for histology. The ribs is the nigh outgoing and convenient site.

five.14 Precautions

In regions of high maternal HIV prevalence, dissection exercise using universal precautions will significantly protect against accidental transmission.

5.15 The placenta examination

Placenta is a vital role of any foetal or perinatal post mortem. Examination of the placenta is besides an essential role of the dissection of a perinatal instance. Earlier starting the dissection, a bacteriological sample should exist taken from the placental membranes and parenchyma in cases of stillbirth, prematurity, or IUGR, or if generalised infection is noted. The site of cord insertion must be identified and the length of string noted. True knots, ruptured varices, and number of vessels must be noted. The vessels themselves should also exist sectioned to assess the possibility of thrombus, an important signal in identification is that all arterial branches cross superficial to venous branches. The foetal membranes should besides exist examined, and any meconium staining or discolouration (suggesting infection) noted. The size of the placental sac and the point of rupture should also exist noted. The maternal cotyledons should be examined closely. The membranes and cord should then exist removed, and the placental disc weighed and measured. Any blood clot received with the placenta should also be weighed. Serial slices should be fabricated through the placental disc at approximately 1-cm intervals, one of which should go through the insertion of the cord. Whatever focal lesions, such every bit infarction, thrombosis, and haemangiomata should of course be noted. For histo-pathology, sections of string, rolled up membranes, and placental parenchyma should exist taken, in addition to any lesions identified macroscopically. The placental sections should include string insertion, placental edge and membrane. In twin or other multiple placentae, the dividing membranes should be carefully examined to appraise the number of chorionic and amniotic membranes. Monochorionic placentae indicate monozygosity whereas dichorionic placentae tin can occur in both homozygous and heterozygous multiple pregnancies. Any apparent anastomoses of foetal vessels should also be noted. Histological samples should besides include the rolled upward dividing membrane(south) and/or the placenta at the point of the division(s).

6. Estimation of gestational historic period and growth

It is important to make every bit accurate an estimation of gestational age as possible, and then to apply this estimation to make an assessment of intrauterine growth. Measurements of crown-rump, crown-heel, and foot lengths, together with whole body weights and organ weights are the all-time starting points as already discussed higher up (Figures 4–6).

Effigy four.

Vernix caseosa, scalp and body (lanugo) hairs and fingernails achieve fingertips.

Figure five.

Ossification centre of Talus bone i.eastward. 5 months.

Figure half-dozen.

Ossification eye of body of sternum.

To assess gestational age, the following points must be taken into consideration:

Fusion of palatal shelves and fingerprints is seen at around ten weeks.
Differentiated external genitalia are identifiable at 12 weeks.
Head is cock and lower limbs are well developed at fourteen weeks.
Ears stand out from head at around16 weeks.
Vernix caseosa is present and early toenail development is seen at 18 weeks.
Caput and body (lanugo) hairs are visible at 20 weeks.
Skin is wrinkled and red at 22 weeks.
Fingernails are present at 24 weeks.
Partial separation of eyelids; eyelashes nowadays at 26 weeks.
Optics are open, scalp hair well formed at 28 weeks.
Toe nails are nowadays at 30 weeks.
Fingernails attain fingertips, peel is smooth at 32 weeks.
Body plump, lanugo absent, toenails reach toe tips at 36 weeks.
Testes palpable, fingernails beyond tips at 38 weeks.
Diverse ossification centres: such as calcaneum at twenty weeks, talus at 28 weeks, lower cease of femur at nativity and upper end of tibia just later birth are also of import indicators of foetal maturity.

7. Crusade of expiry

While giving crusade of death the word 'probably' should exist avoided. The doctor must consider history, clarification of fatal surround and circumstances optimally provided by primary sources, treatment leading upwardly to death which can crusade injuries, before arriving an autopsy interpretation. Later completing the post mortem examination, a complete but concise written report should be prepared in duplicate. I copy is sent to investigating officeholder and another copy is retained for future references [3].

eight. Summarising the whole infant/foetal autopsy procedure

A whole body X-ray is recommended for each instance. This would help in assessing gestational age and congenital malformations in a better way. If need arises other radiological investigations can be carried out.
Photographic records of the instance; important for documentation of the findings and a recap of them if a subsequent opinion is required by the law enforcement agencies.
Specific external trunk measurements (trunk weight, crown-rump length, crown-heel length, foot length, occipito-frontal circumference, head circumference, chest circumference & abdominal girth) for assessing gestational age.
A detailed external test of the dead trunk for findings on the skin, eyes and for injuries if present.
Preferably T- or Y-shaped skin incision on body.
Cardio-vascular, Respiratory & Central nervous organization examination along with examination of the gastrointestinal system.

CNS test: if in that location is suspicion of a CNS malformation (including ventriculomegaly), then examination of posterior fossa structures past posterior approach is advised. I may consider sending the whole central nervous arrangement for neuropathological examination in appropriate cases. This may include sampling of peripheral nervous tissue (nerve root, peripheral nerve, muscle, etc.).
Detailed systematic examination of other internal organs, including: Umbilical arteries and vein, ductus venosus, in situ test of the middle and groovy vessels with sequential segmental analysis of malformations, in situ examination of thoracic and abdominal organs; consider removing in continuity to appraise abnormal structures crossing diaphragm, weights of internal organs (minimum: brain, heart, lungs, liver, kidneys, thymus, adrenals, spleen) is always advisable.
Detailed test of placenta and umbilical cord, including: dimensions of placenta umbilical string: length, diameter, insertion into placental disc, number of vessels, coiling, lesions, membranes: advent, foetal surface/chorionic vessels: appearance, infection, maternal surface: abyss, craters, etc.
An babe/foetal dissection may include clinical specialities for guidance & expertise such as paediatrics, neurology, neurosurgery, etc.

Limited dissection: a state of affairs in which consent for a total autopsy is not given past the legal heirs of the dead trunk. This limited test may be of some value for arriving at an opinion. The types of such limited autopsy are:

Autopsy limited to 1 or more body cavities simply.
Open or needle biopsy of specific internal organs.
External examination of the body with X-ray, photography in specific situations such equally highly infected dead bodies.
Placental examination only with genetic sampling if indicated.
Imaging (CT, MRI) solitary or in combination with biopsy samples.
Specific significant organ systems.

For histological examination, the recommended organs include: thymus, eye (septum and free walls), lungs (right and left, each lobe), liver (both major lobes), pancreas, spleen, adrenal glands, kidneys, muscle, diaphragm, breadbasket, small and big bowels, larynx/trachea and thyroid. Sometimes samples of bone i.e. ribs including growth plate in stillbirth; long bone (including growth plate), vertebral body and skull mandatory for suspected skeletal dysplasia are required to be taken in specific conditions.

Bacteriology may be helpful when there is amniotic infection. In such cases, lung (swab/tissue) & claret (swab/formal culture) are to taken & sent for further assay. Other samples may as well be required depending upon the history & clinical grade of the affliction.

Genetic samples: genetic samples do assume importance for detailed written report of acquired conditions in the young. Skin, muscle, blood from the heart, placenta, etc. tin can exist sampled. 1 can consider retention of frozen tissue sample (liver/lung/other) as further DNA resources.

Virology – Virology samples as indicated by clinical history or macroscopic findings tin also be taken & sent for analysis in suspected conditions.

Biochemistry &electron microscopy – Biochemical samples can be considered in cases of fetal akinesia and hydrops feotalis. Fibroblast culture and/or snap frozen liver/musculus for metabolic biochemistry can likewise be taken if indicated [four].

References

1. Barness EG, Spicer DE, Steffensen TS. Pediatric. In: Handbook of Pediatric Autopsy Pathology. 2nd ed. London: Springer New York Heidelberg Dordrecht; 2014
ii. Sheaff MT, Hopster DJ. Fetal. In: Postal service Mortem Technique Handbook. 2d ed. London: Springer-Verlag London Express; 2005
iii. Reddy KSN, Murty OP. Medicilegal autopsy. In: The Essentials of Forensic Medicine & Toxicology. 34th ed. New Delhi: Jaypee Brother Medical Publisher (P) Ltd; 2017
iv. Osborn Thousand, Cox P, Hargitai B, Marton T. Guidelines on Autopsy Do: Foetal Autopsy (second Trimester Foetal Loss and Termination of Pregnancy for Built Anomaly). London: The Royal College of Pathologists; 2017. Available from:www.rcpath.org
5. Bardale R. Principles of Forensic Medicine and Toxicology. New Delhi, Panama City, London: Jaypee Brothers Medical Publisher (P) Ltd; 2011
vi. Biswas Thousand, Paul G, Verma SK. Review of Forensic Medicine and Toxicology. tertiary ed. New Delhi, London, Philadelphia and Panama: Jaypee Brothers Medical Publishers (P) Ltd; 2015
7. Knudsen PJT, Thomsen JL, Ampanozi K, Thali MJ. Autopsy. In: Madea B, editor. Handbook of Forensic Medicine. Deutschland: John Wiley & Sons, Ltd; 2014

Submitted: December 11th, 2019 Reviewed: April 27th, 2020 Published: June 9th, 2020

© 2020 The Author(south). Licensee IntechOpen. This affiliate is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted utilise, distribution, and reproduction in any medium, provided the original piece of work is properly cited.

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