Signs of Live Birth of a Child

A child showing a sign of life, even when only a part of the child is out of the mother, though the child has not breathed or is not completely born, is considered as live birth. If the death of such a child happens then it is treated as a homicide. The law in India presumes that every child found dead was born dead unless the contrary is proved. Hence whether it be a civil case or criminal case, proof is required for proving it to be live birth.  

Live birth was defined by the World Health Organization in 1950. Not all pregnancies result in live births. A woman may choose to end her pregnancy by abortion, or miscarriage is also known as Spontaneous abortion and pregnancy loss is the natural death of an embryo or fetus before it can survive independently.

Some use the cut-off of 20 weeks of gestation after which fetal death is known as a stillbirth. The death of a fetus at the end of the pregnancy, during labor and delivery, or just after birth is counted as perinatal mortality. Proof of live birth is of major importance in suspected neonaticide cases.

Live Birth in Civil Cases

In a civil case, crying of a baby, movement of body/hand or foot, muscle twitching or twitching of the eyelid is considered as signs of live birth. But crying of the baby cannot be considered as conclusive proof because after the rupture of the membrane the fetus may cry even when it is inside the uterus or in the vagina. This is known as Vagitus Uterinus.

Live Birth in Criminal Cases

In a criminal case, an autopsy examination should be done to demonstrate signs of live birth. For this external changes related to chest, skin, and umbilicus are noted and internal changes of the lungs, diaphragm, heart, and circulation, gastrointestinal tract, middle ear, kidney, and blood are observed.  

External Changes

• When it is live birth, due to the act of respiration certain changes happen in the chest. There is an increase in the anteroposterior diameter. The circumference of the chest will be 1-2 cm more than that of the abdomen at the level of the umbilicus. The intercostal space increases. The shape of an unrespired chest will be flat but that of a respired chest will be arched or drum-shaped.
• The color of the skin turns pinkish-red and darkens after 2-3 days. Desquamation of the skin can be seen from the second day and physiologic jaundice manifests by the 2nd day.
• Changes in the umbilicus and the umbilical cord.

FEATURES	TIME
Shrinkage of the lumen of blood vessels	Just born
Cut margins of cord dry up with blood clot	2 hours
Contraction of umbilical arteries	10 hours
Drying of the cord	24 hours
The inflammatory line at the base of umbilical cord stump	48 hours
Shriveled and mummified cord	2-3 days
Obliteration in umbilical vein	4-5 days
Cord shrivels, dries, and falls off	5-6 days
Complete healing of the umbilicus	7-10 days

Internal Findings

• Due to respiration, there will be significant changes in the lungs. A respired lung will appear to be light red to pink, mottled. The volume of the lungs increases and it fills the chest cavity completely. The pleura will be taut and stretched. It will have a spongy, crepitant consistency with an uneven surface. The margins will be smooth and rounded. The cut surface is spongy and exudes frothy blood. The alveoli appear to be expanded with flattening of epithelium and increased vascularization. The specific gravity will be between 0.940-0.950. the amount of blood in the lung bed of a respired lung will be twice the amount of blood found in a stillborn child. Static test or fodere’s test reveals that the average weight of both the lungs increases and varies from 60-70gm in a respired lung. According to Ploucquet’s test, the weight of both the lungs of a respired lung is about 1/35^th of the weight of the whole fetus. On conducting a hydrostatic test a respired lung piece floats.
• In the kidney, deposition of uric acid in the form of brownish-yellow crystalline streaks is observed.
• The changes in the heart include ductus arteriosus obliteration during the 10^th day, foramen ovale closure by the second month, and closure of ductus venosus within 4-5 days.
• Nucleated RBCs disappear from the blood within 24 hours after birth.
• Fetal hemoglobin decreases to 7-8% at the 3^rd month.
• The presence of caput succedaneum indicates the fetus being alive during delivery.
• In a live birth, the gelatinous substance in the middle ear gets replaced by air within a few hours.
• The position of the diaphragm will lie at the level of the 4^th–5^th rib and will be in the shape of a concave arch.
• According to Breslau’s second life test, if the child has respired after birth, then the stomach and intestine will float when placed in water.
• The presence of air in the gastrointestinal tract also indicates live birth.   

Conclusion

It is important to know whether it was a stillbirth, dead birth, or live birth due to the increasing cases of neonaticide and female infanticide. Sometimes it is done by the parents themselves or by women who are under aged, illegal pregnancy and so on concealment of birth is a crime.

To properly understand the reason for death, it is necessary to look into the autopsy findings. Decomposition can severely increase the difficulty in determining the autopsy findings and chances of false positives exist so it is necessary to look into all possible features before drawing a conclusion.