![]() ![]() Standard measurements include crown-rump (CR), crown-heel (CH), head circumference, and foot length additionally, thoracic circumference (at the level of the nipples) and abdominal circumference (at the level of the umbilicus) may be helpful to compare with measurements taken by ultrasound and to help estimation of the gestational age. ![]() These should be compared against appropriate gestation-related normal values, which preferably should be customized to maternal ethnicity and country ( 4). In any perinatal postmortem, the external examination includes recording the body weight and external measurements. This article will address autopsy, developmental, macroscopic, and histologic features that can help the forensic pathologist to estimate 1) fetal age 2) time elapsed between intrauterine death and delivery 3) stillbirth versus born alive and 4) common causes of perinatal death. Careful clinical-pathological correlation and scene investigation is therefore recommended in all cases ( 3). Similarly, lungs sinking in water may represent a false negative result, as it may happen with lungs with severe bronchopneumonia or hyaline membrane disease. Therefore, a positive flotation test or a positive radiographic finding should be interpreted with caution, as air may be introduced into the lungs or stomach during cardiopulmonary resuscitation, secondary to decomposition, and/or postmortem overgrowth of gas-producing organisms. Although the features described above may be helpful, they are influenced by postmortem changes. Postmortem imaging can be extremely useful in providing guidance (see below under radiology) ( 2). If there is no decomposition, identifying air in the lungs, middle ears, or stomach may also be an indication of a live birth ( 1). Several factors should be considered at autopsy when assessing the probability that a baby has been born alive, including: degree of maceration, gestational age, fetal growth, presence of congenital abnormalities, histological and microbiological evidence of infection, and significant placental abnormalities (if it is available for examination). Assessing at autopsy whether an infant was alive at the time of delivery may be difficult, particularly if there has been a delay in retrieving the body, or if it has been affected by the environment (i.e., temperature, water immersion, damaged by predatory fauna, etc.).
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