Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature

Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.     

Neonatal freshwater drowning after birth in the bathroom

The macroscopic and microscopic findings in neonatal freshwater drowning are demonstrated on the basis of 3 exemplary cases of birth in the bathroom after concealed pregnancy. If the newborn is expelled under water and remains there until death, the lungs cannot be ventilated with air. In case of incomplete or only temporary submersion, aeration of the lungs may develop in the immediate postpartum period. The morphologic criteria of separate existence are critically discussed with respect to the presented findings.     

The epidemiology of sudden infant death syndrome in Finland in 1969-1980

SIDS cases were defined by examining all death certificates, in which sudden deaths were expected to be found from the years 1969-80 from the Central Statistical Office of Finland. The age limits were 28-364 days. If the death certificate did not give enough information as to whether the cause of death was explained or unexplained, autopsy records and microscopic specimens were examined. If the death was sudden, but no autopsy was done, no microscopic specimens were taken, or there were some slight findings which could have partly explained the death were classified as borderline cases. The mean annual incidence of SIDS in Finland was 0.41/1000 livebirths in 1969-80. In 1969-74 and 1975-80 the incidences were 0.31 and 0.51, respectively. The increasing tendency of SIDS was partly due to more borderline cases in the first period and partly due to more twins, and infants with small birth weight, dying of SIDS in the second period. Deaths at weekends and sleeping with parents in the second period were more common than in the first study period. In the SIDs group the young maternal age, low social class, family type unmarried couple or single mother, maternal anemia during pregnancy were more common than in the control group. Mothers of SIDS infants had more previous children and fewer visits and later first visit to prenatal clinics than control mothers. The duration of gestation was shorter and the mean birth weight and length were smaller in the SIDS case than in the control group. Twins were more common among SIDS infants than in the common population. The most important risk factor of SIDS was maternal smoking during pregnancy. The epidemiological results conform with the hypoxia hypotheses.     

Pregnancy-related maternal deaths

Pregnancy is a normal biologic process, but because of a variety of physiologic factors, it increases a woman's risk for death. Maternal deaths in pregnancy may be due to conditions unique to pregnancy, conditions associated with pregnancy, or conditions unrelated to but exacerbated by pregnancy. Death may occur during any trimester, during labor/birth, or postpartum. In this report, we present 45 cases of pregnancy-related maternal deaths that were investigated and autopsied at the Dallas County Medical Examiners office between 1977 and 1999, and we review the topic of pregnancy-related maternal death.     

Healthy law makes for healthy children: Cattanach v Melchior

When courts are forced to consider issues surrounding birth and the sanctity of life, it is inevitable that divergence of judicial, academic and public opinion will result. However, the issue of whether parents can recover the expenses of rearing a healthy child has long vexed judges and commentators of law, ethics and medicine both in Australia and globally, with considerable disunity. A cogent example is the recent High Court of Australia decision in Cattanach v Melchior (2003) 215 CLR 1, where the court split four to three and handed down no less than six individual judgments. The case involved the birth of a healthy child following an unplanned pregnancy resulting from a failed surgical sterilisation. By allowing parents to recover the reasonable expenses of rearing an unintended child until the age of 18 years, the decision has provided some limited and temporary legal clarity to the issue of wrongful pregnancy in Australia. It is seen by some as a victory for the reproductive freedom of women and the rights of the child. However, with uncertainty remaining on the issue of wrongful life claims in Australia and with legislative changes in Queensland and New South Wales that partly reverse the High Court's decision, there remains doubt about the future of such claims in Australia.     

PERINATAL COMPLICATIONS PREDICT VIOLENT OFFENDING

Pregnancy and birth complications are frequently treated as one variable, despite evidence that pregnancy events and birth events may have different impacts on the developing child. This paper studies the association between perinatal events and the development of violent and property crime. In the context of a prospective study of a sample of 216 subjects drawn from a Danish birth cohort, 15 violent criminals and 24 property criminals were compared with 177 nonoffenders on pregnancy and delivery events. Delivery events predicted adult violent offending, especially in high-risk subjects and recidivistically violent offenders. No other significant predictive results were found.     

Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.     

Assessment of exposure to opiates and cocaine during pregnancy in a Mediterranean city: preliminary results of the "Meconium Project"

For the first time in Europe, the "Meconium Project" aimed to estimate the prevalence of drug use by pregnant women and the effects of exposure to illicit drugs during pregnancy on the fetus and infant. Between October 2002 and February 2004, 1151 (79%) dyads among the 1439 mother-infant dyads from the Hospital del Mar, Barcelona, Spain, met eligibility criteria and agreed to participate in the study. We present preliminary results on the first 830 meconium samples and 549 mother-infant dyads, for which statistical analysis of socio-economic and demographic characteristics and newborn somatometry was completed. The meconium analysis showed an overall 7.9% positivity for drugs of abuse, with 6-monoacetylmorphine and cocaine being the analytes, most frequently found in samples positive for opiates and cocaine. Structured interview disclosed 1.3, 1.8 and 1.3% of mothers exposed to opiates, cocaine and both drugs, while only one mother declared ecstasy consumption. Meconium analysis showed that prevalence of opiates, cocaine and combined drugs exposure was 8.7, 4.4 and 2.2%, respectively, and confirmed the case of ecstasy use. Arecoline, the main areca nut alkaloid, was found in meconium specimens from four Asiatic newborns, whose mothers declared beetle nut consumption during pregnancy. Parental ethnicity was not associated with drug use, nor was the social class, although a higher tendency toward drug consumption was observed in professional and partly skilled mothers. Drug consuming mothers showed a higher number of previous pregnancies and abortions (p<0.05) when compared to non-consumer mothers (meconium negative test), probably due to a lack of family planning. Consumption of opiates and cocaine during pregnancy was associated with active tobacco smoking, a higher number of smoked cigarettes and cannabis use. Exposure status and smoking behavior correlated with significantly lower birth weight in newborns from mothers exposed only to cocaine and to opiates and cocaine simultaneously. Of the four newborns exposed to arecoline, one showed a low birth weight, low intrauterine growth, hyporeflexia and hypotonia.     

Neonaticides in Hamburg, Germany, from 1998 to 2008

In the analyzed period from 1998 to 2008, the autopsies performed at the Hamburg Institute of Legal Medicine included 13 cases in which an investigation for neonaticide had been initiated by the public prosecutor. The killed neonates showed a nearly equal distribution between both sexes. The most common method of neonaticide was suffocation. Most of the perpetrators were young, unmarried primipara with an average educational background. Almost all of them were suffering under psychological stress and had negated their pregnancy. In most cases, birth and neonaticide happened alone in their flat, and there was no medical attendance in any case. In the cases brought to court the women were charged with manslaughter (Section 212 German Criminal Code) and those found guilty were always granted a mitigated sentence pursuant to Section 213 Criminal Code.     

Wrongful birth in New Zealand

Wrongful birth cases have been a feature of the common law. In this article the author examines wrongful birth cases against the background of the New Zealand accident compensation scheme. Initially cases were accepted under the scheme, but after major changes to the legislation in 1992, wrongful birth cases were declined cover. The author argues that this should continue to be the case, and that, as a result, New Zealand courts will have to make the same policy decisions in this area as those made by other Commonwealth courts.     

The risk of birth defects: Jacobs v. Theimer and parents' right to know.

This Article discusses the Texas Supreme Court's holding in Jacobs v. Theimer that the parents of a defective child had a cause of action for damages against a physician for alleged negligent failure to inform the mother during pregnancy that she had contracted rubella and therefore might have a defective child, thereby causing her to lose the opportunity to have an abortion. The Article raises a number of questions that post-Jacobs courts probably will confront concerning the duty of physicians and genetic counselors to keep their clients informed; describes some social and medical developments--including recent progress in medical genetics and prenatal diagnosis--which are likely to make Jacobs a significant precedent; evaluates the court's decision to allow a damage suit only for the costs of treating and caring for the child's defects; and briefly addresses the question of whether the Jacobs case comes within the sphere of suits for what has come to be known as "wrongful birth" and "wrongful life."     

Denial of pregnancy and neonaticide: A historical overview and case report

While denial of pregnancy and neonaticide are rare, they are potentially associated and share some risk factors. Neonaticide has been proposed as the extreme outcome of a denial of pregnancy. However, the process leading to such a possible outcome is not yet fully understood. The primary goal of this essay is to examine the various definitions and ambiguities surrounding the denial of pregnancy. The case of a young woman with a history of two denied pregnancies with diverse characteristics and outcomes, the latest of which resulted in neonaticide, is then reported and examined. A forensic psychiatric evaluation was also performed to reconstruct the woman's mental state at the time of the crime. The forensic pathological analysis of the newborn, abandoned near the sea while still alive, is described. The victim's body showed signs of shaken baby syndrome. We contend that differing levels of awareness during a denial of pregnancy might not be predictive of the potential delivery outcome in terms of threat to the newborn's survival, according to the forensic pathological and psychopathological data of the current case. Early identification of women affected by denial of pregnancy who pose a danger of committing infanticide is hampered by both intrinsic traits (dissimulation, unawareness, low propensity to seek assistance) and environmental factors (isolation, low socioeconomic level, poor education.). A previous history of denial of pregnancy should activate health and support services to reduce the potential risks for the mother and the child.     

“We weren't the sort that wanted intimacy every night”: Birth control and abstinence in England,c.1930–60

This article presents an exploration of qualitative evidence on the relationship between birth control and abstinence from an oral history project, which interviewed middle and working-class English men and women, who had married between the late 1920s and the early 1950s. Among the working classes the assumption that men were responsible for birth control choices and the disadvantages that contraceptive methods of all types posed, combined with the fear of pregnancy, acted as a disincentive to have sex and resulted in forms of partial abstinence. Among the middle classes, women had much more access to birth control information and as a consequence a greater range of methods was used, including more female methods. However, the reluctance of couples to discuss sexual matters, and some continued preference for male methods meant that while condoms were the most regularly used middle-class male method, both withdrawal and abstinence were also in evidence. Moreover, although partners were more likely to discuss birth control at the start of their marriages, they were less likely to agree that contraception was a male responsibility and there was greater potential for conflict over contraceptive methods, not infrequently resulting in abstinence. The evidence suggests that sexual and contraceptive practices in marriages in England at the end of the secular fertility decline do not present a picture which straightforwardly correlates with the assumptions represented by the popular thesis that this period of increased fertility control was closely associated with the rise of companionate marriage.     

论人工生殖子女父母身份之认定

传统民法中父母子女关系的建立,血缘与怀胎是母亲同时具备的要素,法律上兼以二者作为认定母子关系的指标。随着医学科技的发达,人工生殖技术使得血缘与怀胎间的相连性不再理所当然,不孕夫妻可以借用他人的精卵通过体内或体外受精,使妻孕育分娩子女,甚至可以将不孕夫妻的受精卵植入他人的子宫怀胎分娩,使得人类的繁衍可以在血缘之外的母体进行。生殖科技对现行法律制度提出了诸多挑战,人工生殖子女之父母身份的认定问题尤为突出。为避免因采用特殊规则形成人工生殖子女为特殊子女的不当认识,立法上应力求采用与自然生殖同样的父母认定标准确定人工授精子女的亲子关系,即依据出生事实确定谁是母亲,根据婚生推定及否认制度确定谁是父亲,丈夫的术前同意限制其对子女的婚生否认权的行使;立足于有限性开放代理孕母的观点,确定代孕子女的父母身份时,法律应突破传统的分娩者为母亲的观念,通过特殊立法规定遗传父母为代孕子女之法律父母。     

“We weren't the sort that wanted intimacy every night”: Birth control and abstinence in England,c.1930–60

This article presents an exploration of qualitative evidence on the relationship between birth control and abstinence from an oral history project, which interviewed middle and working-class English men and women, who had married between the late 1920s and the early 1950s. Among the working classes the assumption that men were responsible for birth control choices and the disadvantages that contraceptive methods of all types posed, combined with the fear of pregnancy, acted as a disincentive to have sex and resulted in forms of partial abstinence. Among the middle classes, women had much more access to birth control information and as a consequence a greater range of methods was used, including more female methods. However, the reluctance of couples to discuss sexual matters, and some continued preference for male methods meant that while condoms were the most regularly used middle-class male method, both withdrawal and abstinence were also in evidence. Moreover, although partners were more likely to discuss birth control at the start of their marriages, they were less likely to agree that contraception was a male responsibility and there was greater potential for conflict over contraceptive methods, not infrequently resulting in abstinence. The evidence suggests that sexual and contraceptive practices in marriages in England at the end of the secular fertility decline do not present a picture which straightforwardly correlates with the assumptions represented by the popular thesis that this period of increased fertility control was closely associated with the rise of companionate marriage.     

Effects of Tennessee Medicaid managed care on obstetrical care and birth outcomes

A comparative study was conducted in two neighboring states, Tennessee and North Carolina, to determine whether Medicaid managed care (implemented in Tennessee as TennCare) affected prenatal care, care patterns at labor-delivery, and birth outcomes. A pre- and post-design coupled with a difference-in-difference approach--using North Carolina as a control--was used to assess TennCare's effects for all births and for three categories of high-risk mothers (under age eighteen, unwed, or living in high poverty areas). Data from 328,296 singleton births in birth files and matched birth-death files for 1993 and 1995 in both states were used to analyze a number of variables related to maternal behavior during pregnancy, utilization of care before and after labor-delivery, patterns of obstetrical care at delivery, and birth outcomes. Under TennCare, Tennessee mothers were relatively more likely to obtain no prenatal care or to wait and initiate third trimester care as compared to those in North Carolina. Relative utilization of specific prenatal procedures declined, Apgar scores fell very slightly, and birth abnormalities increased in the poverty subsample. TennCare had no significant effect on infant mortality. Utilization reductions in obstetrical services were achieved with apparent spillovers to non-TennCare births, but without adverse effects overall. TennCare was neither a panacea nor an unmitigated disaster. It is a model worth examining, but not uncritically.     

Diagnosis of pregnancy in bloodstains. Study of progesterone and luteinizing hormone levels

The objective of this work is to establish the diagnostic efficiency of the determination of progesterone and luteinizing hormone in bloodstains on an absorbent surface. In a stain consisting of woman's blood, the establishment of pregnancy or birth may be significant in cases of criminal abortion or infanticide, or to determine the probable date of the events. A total of 61 women between the ages of 16 and 47 years were studied (mean age 29.54 years; S.D. 7.82). Subjects were distributed in three groups: pregnant women, women in labour and non-pregnant women. We found statistically significant differences in progesterone and LH levels between the non-pregnant group and pregnant women in labour in 24 and 48-h bloodstains. We found no statistically significant differences between progesterone and LH levels in pregnant women in 24, 48 and 72-h stains and at 6 and 7 days. We can conclude that progesterone and LH measurements in bloodstains at least 1 week old and probably much older can be very useful in establishing the diagnosis of pregnancy up until and including the time of birth.     

Intimate partner violence and miscarriage: examination of the role of physical and psychological abuse and posttraumatic stress disorder

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.     

Can Birth Trauma Be Confused for Abuse?

Abstract: An unexpected infant death is usually investigated with a complete autopsy. If evidence of prior trauma is found at autopsy in these cases, suspicion is raised for nonaccidental trauma. In a young infant, the residua of trauma received during birth has the potential to be incorrectly interpreted as nonaccidental trauma. We report a the findings of a 4 1/2‐month‐old‐infant that died unexpectedly with a healing linear skull fracture and a circular lesion over the calvarium found at autopsy. Though this lesion was concerning, the remainder of the autopsy and the histological findings did not support a diagnosis of recent trauma. Review of the literature describing birth injuries made the diagnosis of healing, residual birth trauma more convincing in this case.     

Subcapsular hematoma in fatty liver of pregnancy

A case of fatty liver of pregnancy with subcapsular hematoma of the liver caused by intravenous heparin treatment is reported. The heparin was given for the thrombophlebitis of leg veins. The patient expired suddenly as a result of rupture of the subcapsular hematoma of the liver causing massive intraperitoneal hemorrhage. The pathophysiology and complications of the fatty liver of pregnancy are discussed.