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Medico Macha
  • 6/21/2025
Transcript
00:00:00Hello dreamers, my next very very important topic is infanticide. In this topic, we'll
00:00:07discuss all the important points of infanticide. Now, see, if you are conducting postmortem
00:00:13of fetus, newborn or infant, autopsy, what are the precautions we require? Number one,
00:00:19first cavity to be open. Friends, the first cavity to be open, it should be abdominal
00:00:27cavity. Why do you open abdomen as a first cavity to see the position of diaphragm? Because
00:00:36position of diaphragm is very very important parameter to see whether it's a live bone
00:00:43or dead bone. Okay, now as far as the autopsy methods are concerned, the most common method
00:00:52we use Rokitansky. Rokitansky. Rokitansky is an in-situ method. I told you in detail in postmortem
00:01:01techniques. So, no organ is taken out. We just open and dissect that the Rokitansky method
00:01:06because generally the other deaths like cirrhosis, myocardial infarction, these are not seen in
00:01:11newborn. So, we can adapt Rokitansky method. We can adapt Virtuose, Gons or Latule method
00:01:17also. Okay. Now, for cranial cavity opening, very very important, my dear friend. For cranial
00:01:26cavity opening in fetus, we use two methods. Number one is Benicke's method. Number one is
00:01:38Benicke's method and number two is Barr's method. So, two important methods. Again, I am telling you,
00:01:46my dear friend, it's Benicke's method or Barr's method. In Benicke's method, what we do, we divide
00:01:53cranial cavity or we divide brain in two parts. That is two half. And it is Barr's method. How
00:02:02would you remember Barr has four alphabet? It's a four part. It is divided in four parts, just like
00:02:09petals of flower. So, four part. It's a Barr method. You can remember Benicke's and Barr. And how would
00:02:16you remember? It's for BB. It is used for baby. That's a fetus. BB. This is Benicke's methods and
00:02:23Barr methods. These are for cranial cavity opening. These are for cranial cavity opening. Now, few
00:02:30important terminology. The first terminology is infanticide. What is infanticide? Infanticide is
00:02:38killing a child under the age of one year. So, if you are killing a child below one year of age,
00:02:45it is known as infanticide. Now, everyone knows neonatal period is up to 28 days after birth.
00:02:53Neonatal period is up to 28 days after birth. But the definition of neonaticide is very,
00:02:59very important. And it is different. Neonaticide is killing a child within 24 hours of birth. It is
00:03:10killing a child within 24 hours of birth. So, neonatal period is up to 28 days. But neonaticide is killing
00:03:17a child within 24 hours of birth. That's very, very important. Feticide is killing a fetus.
00:03:23Feticide is killing a fetus. Actually, the fetal terminology is given up to from 8 to 9 week of
00:03:33pregnancy till term. Okay. But you can remember, feticide is killing a fetus. Killing a fetus.
00:03:41Feticide is killing the child by its own parents. So, killing a child by its own parents. This is known as,
00:03:51this is known as, feticide. So, these all are some very, very important terminology.
00:03:59Infanticide, neonaticide, feticide, and feticide. Killing the fetus is feticide.
00:04:04Now, my dear friend, you must be thinking, sir, what is the IPC for infanticide? There is no separate
00:04:10IPC for infanticide. Infanticide is punishable under 302 IPC. Same IPC for murder.
00:04:20Murder. Same IPC for murder. So, it means that there is no separate IPC for murder of normal
00:04:27person or infanticide. So, there is no separation. The same IPC for murder is 302 and the same IPC
00:04:35is for infanticide. So, it's a very, very potential word. IPC for infanticide is 302 punishment.
00:04:41Same like murder. There is no separation. Now, I am coming to a highlighted part. That is,
00:04:46actually, I discussed this part in the criminal abortion. But, sir, I want to emphasize on this
00:04:52point also. 315 IPC and 316 IPC. Because these are related with fetal death or causing death.
00:05:02It's a kind of causing death. Now, what is 315 IPC? It's a with intent to prevent child being born
00:05:09alive. What does it mean? That the child is prevented to being born alive. Means, we are killing
00:05:15a child before delivery. Being born alive or causing death just after birth. Means, the fetus die after
00:05:23birth. Now, example. If someone gives poison to pregnant lady. Someone gives poison to the pregnant
00:05:33lady. Definitely, if the child is killed inside this uterus, that is 315 IPC. Very, very important.
00:05:42And I discussed this also. Generally, it is more than 28 weeks. It is. This child is. Okay. Now,
00:05:48what is 316 IPC? Now, you wanted to kill mother. Your aim is to kill mother. You wanted to kill mother.
00:05:57Like, mother is pregnant. And you stabbed that mother. You stabbed that mother. If mother is pregnant,
00:06:04you stabbed that mother. But mother survived. Very, very important.
00:06:10But mother survived. Mother survived. But fetus is killed. It means you wanted to kill mother.
00:06:17It is a kind of culpable homicide. It is a culpable homicide. It's not a murder.
00:06:23Why it is not a murder? Because your aim was to kill mother. But who is killed?
00:06:27Who is killed? Fetus is killed. This is 316 IPC. Wanted to kill mother. But fetus is killed.
00:06:35This is 316 IPC. So, just very, very two important IPC. Keep in mind. 315
00:06:42and 316. Which is comes under culpable homicide. 316. Very, very important.
00:06:46Now, viability of the fetus. I already discussed this terminology. My dear friend,
00:06:53viability of the fetus is the age of the fetus after this. Age of the fetus after this fetus is
00:07:03capable of survival outside. Fetus is capable of survival outside. Means after a certain age,
00:07:13if fetus is capable of survival outside. If the fetus comes out, he can survive. That is known as age of
00:07:24viability. And my dear friends, remember this thing very, very important. This age of viability is 28
00:07:32weeks. This age of viability, it is 28 weeks. A very, very potential excuse. This is 28 weeks.
00:07:40And sometime it is given as a 210 days. Okay. Now, after the age of viability, why we are discussing,
00:07:47my dear friend? Because before the age of viability, it is abortion. Before the age of
00:07:51viability, it is abortion. After the age of viability, we can decide the cause of death also.
00:07:56Now, at the age of viability, that is at 28 weeks, what are the parameters by which we can see?
00:08:02See, the length of fetus is around 35 centimeter, according to the rule of Hase, 35 centimeter.
00:08:11The weight of fetus is around 1000 gram, or you can write down the range 900 to 1200 gram,
00:08:19the weight of the fetus. The fingernails are thick. The fingernails are thick. These are the parameters
00:08:26by which we can say the fetus is seven months old, or like it's 28 weeks old, or more than this.
00:08:32Meconium. My dear friend, meconium is in large intestine. Meconium is in large intestine.
00:08:44Another important parameter. Eyelids are open. You will see the eyelids will open. And pupillary membrane,
00:08:50a very, very potential word. My dear friend, pupillary membrane disappears. The membrane,
00:08:55which is a pupillary membrane, this disappears. This disappears. The meconium are in large intestine.
00:09:02Testes are found, a very important MCQ, after seven months or at the age of seven months at external
00:09:09inguinal ring. At external inguinal ring at the age of seven months. And ossification center. My dear friend,
00:09:19two ossification center appears, not fused, appears. These are center of telus. Yes, center of telus.
00:09:30And second and third piece of sternum. Second and third piece of sternum. Now, how would you remember?
00:09:42I am telling you a very simple trick. Age of viability, that is seventh month. So, you can remember
00:09:47S, S for sternum. Second and third piece of sternum. And T for telus. T for telus. These are the two
00:10:00center. Telus and second and third piece of sternum. These appear at the age of viability, that is seven
00:10:06months, 28 weeks. So, these are the parameters by which we can say the fetus is viable or not.
00:10:11Now, after 28 weeks, as I told you, after 28 weeks, as I told you, the fetus is viable. Fetus is viable.
00:10:21Now, on the place of death, we can say whether it's a dead bone, stillbirth or live birth. See,
00:10:27if after 28 weeks, fetus died. This is uterus. If fetus died inside the uterus. So, here, death is
00:10:39in uterus. Death is in uterus. My dear friend, it is a dead bone. And we can use a word dead bone. It is
00:10:49intrauterine death. IUD. It is intrauterine death. Okay? Now, what is stillbirth? This is dead bone.
00:10:58Fetus died inside the uterus. So, let me cross this. Fetus died inside the uterus. Now, what is
00:11:04stillbirth? If you see, stillbirth is a fetus. See, this is uterus. And this is the process of delivery,
00:11:13the passage, the birth passage. If the fetus died, if the fetus died during the process of delivery,
00:11:26during the process of delivery during the process of delivery, or in birth passage, if fetus died during
00:11:33the process of delivery, or in birth passage, this is known as stillbirth. Now, what is live birth?
00:11:41life birth is fetus has come out. Fetus has come out. Expulsion of fetus has been there
00:11:49and there is a sign of life. There is a sign of life. This is known as life birth. So we can see
00:12:00fetus died inside the uterus is dead bone. Fetus died during the process of delivery or in birth
00:12:06passage. It's a stillborn and fetus has come out and has shown the sign of life. This is known as
00:12:12life birth. These are after the age of viability. After the age of viability all are all are more
00:12:20than 28 weeks. Very very important. These are three very very important things. Now sir as I told you
00:12:27what is dead bone? A very simple explanation I told you dead bone is a fetus who died inside the uterus
00:12:34IUD. And what are the important sign of the dead bone? I am telling you a very very simple trick
00:12:41Shurma. What is this? This is number one sign which is known as spalding sign. One sign is spalding sign.
00:12:51Very very important. Second sign is hyperflexion of spine. Second sign is hyperflexion of spine. We can
00:13:04remember or we can remember hello sign. Dual hello sign. This is known as dual hello sign. Second. Third
00:13:15overcrowding of ribs. Overcrowding of ribs. S-H-O done. Fourth. Rigor mortis. Rigor mortis is actually
00:13:33stiffening of muscle. Rigor mortis can be present. Yes my dear friend. And a very very important
00:13:40radiological sign which is known as Robert's sign. Robert's sign. Fourth is. Fourth is done. Rigor mortis
00:13:48and Robert's sign. Fifth is mummification. In few condition. In few condition there can be mummification.
00:13:58And sixth is aseptic autolysis. Sixth is aseptic autolysis. Aseptic autolysis is
00:14:10also known as maceration. Aseptic autolysis is also known as maceration. So these are the sign of dead
00:14:18bone. I just made a trick. That is shorma. Spalding. H-Hyperflexion of spine. Dual hello sign. Overcrowding
00:14:27of ribs. Rigor mortis can be present. Very very important Robert's sign. Mummification and aseptic
00:14:33autolysis. These are the finding of dead bone. We can decide like if these finding are present this is dead
00:14:38dead bone. Now I am coming to maceration. My dear friend if you got a question which is the most
00:14:46important sign without any doubt it is a maceration. Maceration is also known as aseptic autolysis.
00:14:57Maceration is also known as aseptic autolysis. Now by the word we can decide what is aseptic autolysis.
00:15:05What is aseptic autolysis? Aseptic means no bacteria is involved.
00:15:12Aseptic means no bacteria is involved. Autolysis means self-lysis. Self-lysis.
00:15:19No other factor are there. It is a self-lysis. Aseptic autolysis. Now what climate or conditions is
00:15:27required sir? If you see. What condition is required? The condition required is see this is a uterus
00:15:37and this is having a intact amniotic shake. Intact
00:15:45amniotic shake. Intact amniotic shake.
00:15:50You should be intact and there should be the plenty of amniotic fluid. So there should be the plenty of
00:15:59amniotic fluid. Amniotic fluid should be in good amount. So intact amniotic shake and plenty of the
00:16:09amniotic fluid. Good amount of amniotic fluid. If there is the liquor and now we can use a word. If these
00:16:15two criteria are there my dear friend. If these two criteria are there that is sufficient to produce
00:16:20aseptic autolysis. Intact shake and this is a plenty of plenty of liquor amni that is the amniotic fluid.
00:16:28There is no bacteria entry. It is a aseptic autolysis. Now my dear friend what are the changes which take
00:16:38place in the maceration and I made a very simple trick. Most of the changes are S. Most of the changes
00:16:45are S and starting with number one very very important skin slippage. First one is
00:16:52skin slippage. Your skin will be slippery. Second reddening of the skin. The red color of the skin.
00:17:05The third peeling of the skin. All these three are very important changes. Skin slippage, reddening of
00:17:12the skin and peeling of the skin. How would you see the peeling of the skin? When you apply the pressure
00:17:18my dear friend. When you apply the pressure on the skin. When you apply the pressure on the skin. The
00:17:26skin will be peeled off. The skin will be peeled off. And my dear friend. This sign skin slippage,
00:17:35peeling and reddening. This is seen in 12 hours after death. 12 hours. And I can see this is the earliest
00:17:44sign of dead bone. Of maceration. The earliest sign is skin slippage. Very very potential.
00:17:55The second important word if you want to do. See S for skin slippage. Second skin blister.
00:18:05Skin blister. B second skin blister. Or you can write down the better word skin blebs.
00:18:10So first was in 12 hours. So 12 hours is done. It will be seen in 24 hours. Skin blister or this one.
00:18:18Very very important. Third one is softening
00:18:26of joint. Softening of the joint. This can be seen. And my dear friend. Softening of the joint. This can
00:18:36produce flaccid body. Softening of the joint. This can produce flaccid body. So if you see.
00:18:44Two are done. Yes. 24 hours. And 12 hours. So definitely 12 hours. Skin slippage. Then skin blister. Then
00:18:51softening of the joint. Or flaccid body. Very very important. Now dear friends. Here if you see softening of
00:19:00the body. And this one. There will be. It is seen in 48 hours. Or you can write down. It is equal to two days.
00:19:0748 hours. Or two days. Now my dear friend. Another important S. Swedish
00:19:13or disagreeable odour. This is another important one. Another very very important. Now after this you can write down.
00:19:29Hyper mobile joint. Hyper mobile joint. As you can see. It is very common. Softening of the joint can lead to hyper mobility of the joint.
00:19:39Another very very important one. Now that's very S. Subcutaneous edema.
00:19:49Subcutaneous edema. You can remember E for edema. It is. E is the fifth alphabet. It is seen on
00:19:57five day onwards. You can see the thickness. More than five mm. Five days onwards. E is the fifth alphabet.
00:20:04It is a five days. And the last but not the least. Abdominal distension. Abdominal distension.
00:20:14So my dear friend. I have made a very very simple trick. S. Skin slippage. S. Skin blister.
00:20:22S. Another very very important. That's a softening of the joint of flaccid body.
00:20:26S. Swedish or disagreeable odour. S. Subcutaneous edema.
00:20:31These are the findings which are seen. And out of this skin sleep is reddening.
00:20:35And this peeling of the skin is the earliest sign. 12 hours.
00:20:40Then 24 hours. Blister. Then it's said. Very very important. 48 hours. Two days.
00:20:46Okay. These are the signs of maceration. You can see the body which is macerated. You can see the skin
00:20:51is peeled off. Reddening of the skin. These all are featured. These are seen. Skin slippery and this can be seen.
00:20:56Okay. So when you. How the skin sleep is seen. When you apply the pressure. Skin is peeled off. It is
00:21:02skin sleepers. Now my dear friend. Maceration can be classified in three categories. The mild category.
00:21:09The moderate category. The moderate category. And my dear friend. It's a severe category.
00:21:17Mild, moderate, severe. In mild category. What you see? Only and only skin sleepers.
00:21:23Skin sleepers. Only and only. What you see? Skin sleepers. In moderate category. You see the skin
00:21:31sleepers plus softening of organ. Skin sleepers plus softening of the organ. In the severe category.
00:21:42You see skin sleepers plus softening of the organ plus hyper mobile joint.
00:21:51So my dear friend. As you can see. In mild category. What do you see? The skin sleepers only.
00:22:01Then in moderate category. You have skin sleepers plus softening of the organ. As I told you the
00:22:05flaccid body. And you can see in severe category. Skin sleepers plus softening of the organ plus hyper
00:22:11mobile joint. This is the classification of maceration. Very very important. Now my dear friend. I am coming to
00:22:17the next point. Mummification. When do we see the mummification? When you have the intact sac,
00:22:23sac and sufficient amniotic fluid. It's a maceration. But see. When you have. This is intact shape.
00:22:33Intact amniotic sac. With some feature. See. What are these features? Deficient blood supply.
00:22:44Of the fetus. Deficient blood supply. Of the fetus. Deficient blood supply. Of the fetus. Now.
00:22:51In maceration. It was good amount of amniotic fluid. Here.
00:22:57Scanty. Amount of the amniotic fluid. Amniotic fluid is scanty. Less.
00:23:02And no air. No air. No air. These are the condition. Which is required for mummification.
00:23:11In these condition. Because of the amniotic sac. Intact with these condition. It will be the dehydrated
00:23:19fetus. It will be the dehydrated fetus. This dehydrated fetus is known as mummified fetus.
00:23:28As you can see in this picture. This is mummification. This is mummification. Now.
00:23:34Sometime. We can see the putrefaction. Putrefaction is a kind of decomposition.
00:23:41Here. Your amniotic sac is not intact. See. This is your amniotic sac. But this is not intact.
00:23:48This is ruptured. This amniotic sac is ruptured. If amniotic sac is ruptured.
00:23:55There will be bacterial entry. Yes. My dear friend.
00:23:59There will be bacterial entry. This can cause putrefaction. This can cause putrefaction.
00:24:05So. I explained everything in a very simple way. First. Remember the dead bone finding. That
00:24:10is shurma. Then. Remember the most important finding maceration. The earliest is skin sleepers.
00:24:16Then we can see the very simple S, S, S, S. Then we can see. Maceration. As I told you. This is the
00:24:22classification of the maceration. Skin sleepers plus softening of the organ plus hypermobile joint.
00:24:29And this is mummification. In what condition we see the mummification and in what condition we see
00:24:34the putrefaction. You have to remember. If bacteria enters. It is a putrefaction. Scanty
00:24:39liquid amniotic. Less blood supply. And lack of air. That will cause mummification. This is dehydration.
00:24:46These are some very very important point. Now. What are the radiological signs of the dead bone?
00:24:51I am talking about the dead bone. Radiological sign. Sir. The first sign is Robert's sign.
00:24:58What is Robert's sign? First of all. Just remember. Robert's sign is gas
00:25:02S. In aorta. In pulmonary artery. In cardiac chamber. That is a heart chamber.
00:25:16Or in umbilical artery. This sign is Robert's sign. Now. First question. What is the Robert's sign?
00:25:22This is a radiological sign. The second. Robert. It is seen in 12 hours after death. And my dear friend.
00:25:32It is the earliest radiological sign. It is earliest radiological sign. Or earliest sign of the death.
00:25:41It will be the Robert's sign. So, if you have a question. What is the earliest sign of the death?
00:25:47The answer will be Robert's sign. Robert's sign. Now. Sir. I am coming to Spalding sign. How would you
00:25:52remember the duration of the Spalding sign? S for 7. D for 4. It is seen 4 to 7 days after death.
00:26:02Spalding sign. It is overriding. My dear friend. It is overriding of cranial bones.
00:26:18It is overriding of cranial vault or cranial bones or skull bones. Or you can say the loss of alignment.
00:26:25The loss of alignment of this. Why this happens sir? Because I told you the softening of organ is seen.
00:26:35So, it is because of liquefaction of the brain.
00:26:42It is because of liquefaction of the brain. And once the brain is liquefied. The support of the
00:26:48cranial bones are lost. So, they can override or loss of alignment. There can be like this cranial
00:26:53bones. There can be the overriding or loss of alignment. This is because of liquefaction of the
00:26:59brain. My dear friend. So, it is more common
00:27:05in vertex presentation. And it is Spalding sign is a pathognomic sign of that bone.
00:27:11So, just remember all this point. This is Spalding sign is a pathognomic sign. And it is more common in
00:27:17vertex presentation. So, my dear friend. We have discussed two radiological signs. Robert's sign
00:27:22and Spalding sign. Now, I am coming to the next radiological sign. Sign number 3. This is hyperflexion of
00:27:30spine. This is hyperflexion of spine. Now, sir, this is a normal spine or vertebral column. This is normal
00:27:43flexion of the fetus. Normal flexion. But because of the hypermobility of the joint. Because of the
00:27:52hypermobile joint. This becomes hyperflexion. This becomes hyperflexion. Hyperflexion. So, this is the
00:28:05normal flexion. This becomes hyperflexion. Because of the hypermobility of the joint. This is known as
00:28:10hyperflexion of spine. This is seen as a radiological sign in x-ray. And my dear friend. It look like a ball.
00:28:15It look like a ball. So, ultimately what happens? Because of the hypermobility of the joint. Your
00:28:22vertebral column collapses.
00:28:31This is known as hyperflexion of spine. Now, fourth sign. Very, very important my dear friend. It is
00:28:37overcrowding of ribs. It is overcrowding of ribs. Why overcrowding of ribs is seen? I already told you.
00:28:50There is a softening of the organ. There is a softening of organ. Because of the softening of
00:28:59organ. The ribs are overcrowded. The ribs are overcrowded. So, overcrowding of ribs is another
00:29:05radiological sign. Now, I am coming to another one that is hello sign. Hello sign. And my dear friend. It is
00:29:15known as dual hello sign. Dual's hello sign. It is known as dual's hello sign. It is a hello. It is a
00:29:23hello in the fetal head. It is hello in the fetal head. And this hello is because of separation. It is this
00:29:37of subcutaneous fat. It is a separation of subcutaneous fat. It is a separation of
00:29:54subcutaneous fat from skull. Separation of subcutaneous fat from skull or cranial world. This separation
00:30:03of subcutaneous fat from skull. It is known as dual hello sign. So, another very, very important dual hello sign.
00:30:09So, there will be hello surrounding the fetus head. Fetal head. This one. Separation of subcutaneous fat
00:30:14from the skull or cranial world. This is known as dual hello sign. Now, I am coming to live birth.
00:30:22My dear friend. Live birth is any sign of life after complete birth of the child. Complete birth of
00:30:31the child. Means completely expulsion of. Completely expulsion of product of conception.
00:30:45Product of conception. That is the meaning of this. So, whenever your product of conception is completely
00:30:52out and you see the sign. This is known as live birth after the age of 5. Any sign.
00:30:59This sign could be the most important sign is respiration. Breathing. So, the most important sign
00:31:06of live birth is breathing. Second, it could be cry of the baby. Third, it could be movements of the baby.
00:31:15Fourth, it could be any other sign like pulsation, cardiac activity you can see. So, these are
00:31:21these are any sign after complete birth of the child. This is known as live birth.
00:31:27Life birth. Life birth. And my dear friend. This definition is given in registration of birth and death act.
00:31:37Registration of birth and
00:31:43death act. 1969. This act. This live birth definition is given.
00:31:51So, any sign of the life if present after expulsion of product of conception. This is known as live birth.
00:31:58This is known as live birth. Now, sir, how would you differentiate that no respiration has taken place
00:32:05or respiration has taken place? How would you differentiate like you've got a child fetus and how
00:32:12would you differentiate respiration has taken place or no respiration? First, very, very important level of
00:32:17diaphragm. No respiration. Level of diaphragm is on the fourth to fifth ribs. If respiration has taken place,
00:32:27sixth to seventh ribs. That's very simple. Level of the diaphragm after respiration, it goes down.
00:32:33Chest. Chest, it will be flat and it would be expended.
00:32:40Flat and expended. Volume. It will be voluminous. Less voluminous. And it will be more voluminous.
00:32:51More voluminous. Size. It is small. And it is bigger. Small, bigger.
00:33:00Margins. It is sharp margin, my dear friend.
00:33:03It will have sharp margin. It will be round margin. Round margin. You can remember R for respiration.
00:33:12It will be R for round margin. That is very simple. Consistency. Consistency. It is solid, firm,
00:33:24not aspiration. Solid, firm or dense. It is spongy. It is spongy and crepitant.
00:33:37There will be crepitus, crepitant, spongy. Weight around 30 gram, around 60 gram.
00:33:47And it can be in the proportion of the body weight also. It is 1 by 70 of the body weight. 1 by 70 of the body weight.
00:33:58Yes. And it would be 1 by 35 of body weight. 1 by 70 of the body weight. 1 by 35. You can
00:34:13see 30 gram and 60 gram. 1 by 70 of the body weight. Total body weight 1 by 70 of the body weight.
00:34:20It will be 1 by 35. Okay. Color. So, this color is generally bluish white. Sorry, not bluish white.
00:34:28This color is generally bluish violet. Bluish violet. It is light red.
00:34:35It is light red. And it will be showing the mottled area. Mottling.
00:34:44Mottled area. The dark and light area. So, this would be the mottled lung.
00:34:49Epithelium. It is cuboidal. Epithelium. It is cuboidal. It is squamous.
00:34:58It is squamous. And specific gravity, my dear friend, very, very potential one. Specific gravity.
00:35:07Lungs after respiration, float. So, specific gravity after respiration is 0.94.
00:35:18But specific gravity here is 1.04. That's a more in non-respired lung.
00:35:23So, again, I am revising my dear friend. Level of the diaphragm. You can get a question. It's very,
00:35:27very important. Chest are flayed and expanded. Volume. More voluminous in respiration. Size.
00:35:33Bigger in respiration. The lungs become more size. Margins are round after respiration. RR.
00:35:39You can remember. Weight. 30 gram. 60 gram. Solid, firm and dense. Spongy and crepitant.
00:35:44Blue violet color. Uniform color. Blue violet and uniform color. You can write down one more thing.
00:35:49It is uniform color. But light red and motel. Dark and light area. Epithelium cuboidal squamous.
00:35:57Specific gravity. 1.04. And it is 0.940. Very, very important. Now, sir, what are the tests for
00:36:05live birth? And how do you remember? I have made some tricks to remember. Very simple tricks.
00:36:09Redene test. Sir, Redene has E and E. So, that's a very simple trick. E and E. The trick is,
00:36:16it is air in ear. E-E. Air in ear. Which ear? Middle ear. So, if after respiration,
00:36:26air present in middle ear, it is live birth. Because some amount of the air goes to the middle
00:36:33ear by a eustachian tube. Air in middle ear. E-E. Very simple trick. Redene test.
00:36:37If you have not respired, the middle ear. No respiration present. No respiration present. The
00:36:45middle ear will have gelatinous tissue. The middle ear will have gelatinous tissue without respiration.
00:36:55But with respiration, as we are talking about the live birth, there will be air in the middle ear.
00:37:00Redene. Redene. Fodere. Fodere. How to remember? Fodere. The trick is F for Fodere. The lung weight,
00:37:10lung weight become two-fold. Yes, two-fold. F for Fodere. Lung weight become two-fold. See,
00:37:17without respiration and after respiration. Without respiration, it is around
00:37:2530 gram. After respiration, it is around 60 gram. So, lung weight become two-fold. The trick is
00:37:33F for Fodere. Yes, my dear friend. F for Fodere. F for two-fold. Two-fold. Redene. Air in middle ear.
00:37:40Done. Okay. Simple trick. Without respiration, the middle ear has a gelatinous tissue.
00:37:46Now, Plock weight. What is the trick to remember? Plock weight. P for Plock weight. P for its kind of
00:37:53proportion. It is a kind of proportion of lung weight divided by body weight. It is a kind of
00:38:06proportion. Lung weight divided by body weight. Without respiration, it is 1 by 70 and with respiration
00:38:17of live bone, it will be 1 by 35. That is a very simple trick. P for Plock weight. It is a proportion
00:38:23of lung weight divided by body weight. Now, sir, very, very important. Breslau first life test or
00:38:30Breslau second life test. How would you remember? What is your first life? If I ask one question,
00:38:37what is your first life? Lung or stomach? Now, your first life is lung. So, Breslau first life test is
00:38:44related with lung. If air present in lung, this is Breslau first life test. Your second life is food,
00:38:52that is stomach or intestine. So, if air present in stomach and intestine, this is known as Breslau
00:39:05second life test. This is known as Breslau second life test. The trick is very simple. What is your
00:39:11first life? Your first life is your lung and second life is your stomach or intestine? Very simple.
00:39:18So, Breslau first life and Breslau second life. Now, what is a Breslau second life test? It is also
00:39:24known as stomach bowel test. Air in stomach or bowel. How would you do this one? See, this is your stomach.
00:39:34Yes. You will double ligate the stomach. Same as I discussed in the post-martem techniques. So,
00:39:40this is your stomach. You will use a double ligature method. Double ligature. Now, what you will do?
00:39:50After this, you will cut the stomach between two ligature. Yes. Then what you will do? You will put the
00:39:57stomach. You will put the stomach in water. You will put the stomach in water, water, tub or whatever,
00:40:08water bucket. Now, after this, you will open the stomach in bucket, in water, inside the water. You
00:40:18will open this. If air present, there will be bubble. If air present, there will be bubble formation.
00:40:28This is a very, very important test. Breslau second life test for stomach and intestine. Air is because
00:40:35like some amount of air swallowed. If you are live birth respiration, there's some amount of air
00:40:41swallowed in your stomach and intestine. If that air is present, there will be formation of bubble.
00:40:46This is known as Breslau second life test. Now, what about the Breslau first life test? As I told you,
00:40:55it is a test of lung. So, it is also known as lung flot test. It is also known as lung flot test.
00:41:06But sir, there are some other name also. Lung flotation test. Some other name also. It is also known as
00:41:14Regath test. It is also known as Regath test. And the last but not the least, it is also known as
00:41:24hydrostatic test. It is also known as hydrostatic test. It is hydrostatic. The Fodere test is known
00:41:33as static test. So, just remember Fodere is a static. It is a hydrostatic test. So, what are the three
00:41:39names of Breslau? First life test, lung flotation test, Regath test and hydrostatic test. And before
00:41:48coming to a very, very important conclusion, just remember few things. The specific gravity of water
00:41:54is 1. Specific gravity of water is 1. Specific gravity of respired lung is 0.940, 0.94. And specific
00:42:08gravity of non-respired lung is 1.04. Now, see if specific gravity of water is 1. This is water, 1.
00:42:19Water is 1. Anyone who is having specific gravity more than water, yes. Specific gravity more than water
00:42:31that will sink down and specific gravity less than water that will float. That is a very simple
00:42:40explanation. So, it means, sir, respired lung, respired lung flot because specific gravity is
00:42:48less than 1. And non-respired lungs sink because specific gravity is more than 1. So, here I am
00:42:54explaining my dear friend. Specific gravity of water is 1. This is water, yes. Any object where specific
00:43:02gravity is less than 1 that will flot, that is a respired lung and specific gravity more than 1. If
00:43:10specific gravity is more than 1, that will sink down. So, this is a simple explanation. I will explain it
00:43:17again. Now, hydrostatic test. First, it is based on the specific gravity. Second, it is based on residual
00:43:25air or residual volume. Residual air, not tidal volume. It is not based on the tidal volume. It is based on
00:43:37residual air or residual volume. Residual air is an air which comes after respiration in lung and in
00:43:44physiology. You must have gone through. It cannot be expired. It cannot be expired even with forceful
00:43:52expiration. Even with this, you cannot expire. So, this is known as residual air or residual volume. So,
00:43:59it is a test of residual air or residual volume. I will explain it again. Anyways, this is the simple
00:44:06principle. So, there are two important concepts. Specific gravity after respiration becomes less
00:44:11than 1 that is 0.94 and presence of the residual volume in respiration, in respired lung. These are
00:44:20the two reasons. These are the two reasons. That is why your hydrostatic test is positive. I will tell
00:44:25you the mechanism also. Don't worry. Now, how will you do hydrostatic test or Breslau first type test?
00:44:31It is also known as hydrostatic test. How will you do? Now, sir, what you will do, the first step,
00:44:39what you will do, the first step, you will put lung in bucket of water. Okay? If lung pieces are, see,
00:44:50this is your lung. If lung pieces are floating, this I mentioned, this is bucket of water. You are putting
00:44:57the lung. If lung pieces are floating. If lung pieces are floating, that means it could be a case
00:45:06of respiration. But sir, here along with this, you will do control test. And doctor, how will you get
00:45:13the lung? You just tie up the bronchi. You just tie up the bronchi and take the lung out. And you put the
00:45:19lung in bucket of water. But again, I am telling you, simultaneously, you will do the control test.
00:45:25Because everyone knows, the liver is solid in consistency. If this is bucket, yes. And you are
00:45:35putting liver. If you are putting liver inside the bucket. And if liver is floating, my dear friend, if
00:45:46liver is floating, very, very important concept I am coming to. If liver is floating, that means,
00:45:53my dear friend, liver should not float. Normally, normally, liver sinks. Normally,
00:46:02liver sinks. Because liver is a solid organ. But if liver is floating,
00:46:07that means, it's a case of putrefaction. It's a case of putrefaction. Putrefaction is a gas formation
00:46:22in the organ. So, if why do I am doing this particular test as a control test? If liver is
00:46:29floating, it's a case of putrefaction. No need to go for hydrostatic test. This is a, this lung always
00:46:35will float. It doesn't indicate about the respiration. So, that is a very, very important. If liver is
00:46:39floating, no need to go for the hydrostatic test. Because that doesn't give the idea about the
00:46:45respiration or residual air. Okay. Now, second. Second step of this. First, if lung is floating,
00:46:53it may be positive. Simultaneously, you will do this test. Second, what you will do, you will take
00:46:59multiple, almost 12 to 20 pieces of lung. Then, you will put these pieces, yes, on water surface.
00:47:11If these are floating, you will go for the next step. If these are sinking, it's a negative. Lung
00:47:17pieces are sinking, it's a negative. Lung pieces are sinking, it's a negative. But if these are
00:47:21floating, you will go for the next step. So, this is the step number one. The lung pieces,
00:47:25this is step number two. Now, the step number three. What you have done, you have squeezed the
00:47:32lung pieces. You can squeeze the lung pieces between thumb or index finger. Why are you squeezing the
00:47:41lung pieces? To remove the tidal air. To remove the tidal air or tidal volume. It can be by stone,
00:47:51you can squeeze, you can squeeze between thumb and index finger. Even after this, squeezing,
00:48:00if lung pieces are floating. Yes, my dear friend. If lung pieces are floating, then you would say that
00:48:08this is positive hydrostatic test that indicate the fetus has respired. Respiration was present.
00:48:16Again, I'm telling you. Take the lung, put in water. If it's floating, yes. Okay, it may be a respired
00:48:23lung. But just take a control because liver is a control. If liver is floating, it's a putrefied
00:48:29liver. If putrefaction has taken place, the lung will also have some air. No need to go for hydrostatic
00:48:37test. Because lung will have a putrefaction gases. No need to go for the hydrostatic test. Now, after this,
00:48:43take some lung pieces, put in water. If these are floating, it may be a case of respiration.
00:48:47But, but, how to confirm? Squeeze the lung pieces to remove tidal volume. Because we want to test
00:48:53residual air. I may consider it as kind of residual air. And after this, if the lung pieces are floating,
00:48:59it's a positive test. And yes, so no my dear friend. If some pieces of lung are floating, that means it
00:49:06could be a case of feeble respiration. It could be a case of feeble respiration. Some lung pieces are
00:49:15floating. So, next up, two things you have to keep in mind. Control test has to be done. Control test has
00:49:21to be done by liver, liver part. And you have to squeeze to remove the tidal volume. Because we want
00:49:29to test two things. Number one, after respiration, specific gravity decreases. Second, presence of
00:49:35residual air. Presence of residual air. Now, sir, what are the false positive hydrostatic tests?
00:49:41False positive. False positive means respiration was absent. Respiration was absent. Fetus didn't respire.
00:49:49But, but, but, but. Still, lung pieces are floating. Still, lung pieces are floating.
00:49:59It could be due to two reasons. Number one, as I told you, putrefaction. And I told you,
00:50:09to remove this mistake, I told you take the liver as a control. Okay. The looks of lung pieces are
00:50:16floating. Fetus didn't respire. It could be putrefaction. Or it could be artificial respiration.
00:50:23It could be artificial respiration. So, these are the two cases where fetus didn't respire,
00:50:32but still lung pieces are floating. One, because of putrefaction, there is a formation of gases
00:50:37in the lung. So, lung will just float. Yes. And artificial respiration, you are putting some gases
00:50:44in the lung. So, there can be a lung species floating. So, to remove this mistake, you just
00:50:50squeeze out to remove the tidal air. To remove the tidal air. False negative, my dear friend. What is
00:50:55the meaning of false negative? Fetus respired. Yes, yes, yes. But still lung pieces are sinking.
00:51:04That is a negative test. False negative. Now, it could be due to some important things. Number one,
00:51:11pneumonia. Fetal lung pneumonia. Everyone knows. In pneumonia, there is a formation of inflammatory
00:51:19solid patches. Solid patches. Number two condition. Alveolar duct membrane. Alveolar duct membrane.
00:51:29Because of the alveolar duct membrane, there can be a false positive. In fact, false negative.
00:51:35Third, pulmonary edema. Pulmonary edema. The fluid is there.
00:51:42Inside the lung. Pulmonary edema. This is also another example. Pneumonia alveolar duct membrane.
00:51:47Pulmonary edema. Number four, collapse of the alveoli. This is known as
00:51:53atelectasis. Atelectasis is the cause. There is a collapse of the alveoli. There may be there.
00:52:00And sometime complete absorption of air by lung. Sometime complete absorption
00:52:12of air by lung. If lung completely absorb the air, there will be no air. So, there will be false
00:52:26negative. So, these are the example. And as I told you, liver take as a control and squeeze the lung to
00:52:33remove the tidal volume. It is a test of specific gravity and residual volume. These are the example
00:52:39where you have false positive and false negative. Okay? Now, sir, hydrostatic test is not necessary.
00:52:46In which cases? Yes. Very, very important.
00:52:48Very, very important. Number one, if the fetus is non-viable. If the fetus is non-viable, we know
00:52:58like the fetus is not viable. Why would you do this hydrostatic test? Like less than 28 weeks,
00:53:04we are not going to do hydrostatic test. Second, if we know the fetus is dead bone.
00:53:13If we know the fetus is dead bone. Now, if there is a macerated fetus, maceration is there. We already
00:53:22know it is a dead bone. There is no problem. If we have mummification, no need to go for the hydrostatic
00:53:28test. If we know the monster fetus, all three M. All three M. Maceration, very, very important, sir.
00:53:39Mummification and monster. Monster is a congenital anomaly. Monster fetus cannot survive.
00:53:46Monster fetus cannot survive. If it is a case of anencephaly, that cannot survive.
00:53:54So, any congenital problem which cannot survive, we already know it is a dead bone. So, 3M you have
00:54:01to keep in your mind. Maceration, mummification and monster fetus. So, these are the findings of
00:54:07dead bone. No need to go for hydrostatic test. Non-viable fetus, no need. Already we know it is a
00:54:12non-viable. No need to go. Gestational age is very less. Now, if it is a clear cut case of the live
00:54:20bone. Yes, no need to go for hydrostatic test. Milk is present in stomach. Milk is present in stomach.
00:54:32We know the milk is present in stomach. It is a live bone. Second, umbilical cord has separated and
00:54:40there is a formation of umbilical scar. Umbilical scar. That generally forms in one to two weeks.
00:54:51One to two weeks. If umbilical cord is separated, there is a formation of umbilical scar. This suggests
00:54:56it is a live bone. So, these are the cases. We can say if the fetus is non-viable, if the finding of
00:55:03dead bone or their maceration, mummification and this monster fetus, monster fetus. And if the milk is
00:55:08present in stomach or umbilical scar is formed, no need to go for hydrostatic test. My dear friend,
00:55:14just remember this part. Very, very important. So, my dear friends, we have seen the sign of the live
00:55:21birth. But few more important signs of the live birth. Number one is caput succedenium. Caput succedenium.
00:55:29It is an edema of scalp or congestion of scalp. Edema of congestion of scalp. And it crosses the
00:55:44cranial suture. It crosses the suture line. It crosses the suture line.
00:55:52It crosses the suture line. And it is seen because of like the vaginal ring formation and there is a
00:55:59compression of the scalp. It is due to compression on the scalp that produces
00:56:08compression of the scalp that produces caput succedenium as a edema or congestion of the scalp.
00:56:14Now, how do you remember? I am telling you one trick. Caput. In this caput, pit formation is seen.
00:56:21Pit present. Caput, pit is present. When you pressurize, pit formation is seen. Caput, it is a
00:56:26scalpedema. Succedenium, it is successful in crossing the suture line. Successful, it is successful in
00:56:33crossing the suture line. That is a very simple trick. Cephalohematoma, it is a hematoma. Yes,
00:56:40as the name suggests, it is a hematoma between periosteum and skull.
00:56:49Between periosteum and skull. This is some periosteal hematoma. You can remember
00:56:56this is sub periosteal hematoma. But just remember there is no pit formation. So, there is no word.
00:57:03Caput has a pit. There is no pit formation. And my dear friend, it does not cross the suture.
00:57:08Do not cross the suture line. So, you can remember by this trick also. It is a very simple trick.
00:57:17Now, few more signs. So, this is a very simple. It is a scalp congestion and edema is a caput
00:57:21succedenium. And sub periosteal hematoma, that is a cephalohematoma. These are two important points
00:57:26which can be seen in live birth. Now, after birth, three structures which are umbilical
00:57:31structure, umbilical artery number one, umbilical vein number two and umbilical cord. These closes
00:57:45at different age. Artery, umbilical artery, umbilical vein, this you can remember umbilical artery,
00:57:51umbilical vein and umbilical cord. Umbilical artery closes on third day.
00:57:57Umbilical vein closes on fourth day. You can remember by take AVC, AVC and cord fall on fifth
00:58:05to sixth days. So, umbilical artery closes on third day. It forms medial umbilical fold or medial umbilical
00:58:18ligament. Medial, not median. Median is a different. Medial umbilical fold. Umbilical vein closes on fourth
00:58:26day after birth. These after birth, these are the sign after birth. It forms ligamentum teres.
00:58:36Ligamentum teres. And umbilical cord fall on fifth to sixth days after birth. So, that is very simple trick.
00:58:43A, V, C. Third day, fourth day, fifth to sixth days. Medial umbilical fold, ligamentum teres and
00:58:51umbilical cord fall on fifth to sixth days after birth. So, we are coming to it. Now, sir, I told
00:58:56you if you remember a very simple trick. Criminal abortion trick for IBC. I told you the trick to
00:59:02remember criminal abortion. What trick I told you? C is number third alphabet. A is number one alphabet
00:59:08and B is number two alphabet. 312. And I told you this IPC will be 312 to 316. I discussed this in
00:59:17abortion chapter. 312, 313, 314, 315, 316. How to remember? C is the third alphabet. A is the first
00:59:27alphabet and B is second alphabet 312. So, we have discussed these IPC. So, it was CAB. Now, I am
00:59:35converting A, B, C. A, B, C. CAB 312 to 316. A, B, C. A, B is 317 IPC and C is 318 IPC. 317 IPC and very
00:59:53simple 389 IPC. C, A, B, A, B, C. What is A, B, C? A for abandoning the child.
01:00:02If you abandon, abandon means you are living at any place. Living at any place like temple, mosque
01:00:09or orphanage. Abandoning the child. If you are living or abandoning the child at any place,
01:00:22child is punishable under 317 IPC. A, B is done, abandoning. A, B, abandoning. Done. C,
01:00:38concealment of birth. If you conceal any kind of birth, concealment of birth comes under 318
01:00:50IPC. C, A, B, criminal abortion. A, B, C after this 317 and 318. Here, punishment could be 2 year
01:00:58plus minus fine. Up to 2 year plus minus fine. So, that is a very simple tip to remember. C,
01:01:03A, B, A, B, A, B, C. Now, if the child is unborn, my dear friend, unborn child.
01:01:13If the fetus or child is unborn and if you see or if you listen intrauterine crying,
01:01:21unborn child, intrauterine crying, this is known as vagitus uterine. That is the intrauterine
01:01:36crying of unborn child. Same, unborn child, the crying from vaginal canal. It is an intravaginal
01:01:45crying or you can see the crying from vagina or vaginal canal. This will be vagitus vaginalis.
01:01:55It is vagitus uterine and it is vagitus vaginalis. What is this? For unborn child intrauterine crying
01:02:02or unborn child intravaginal crying. These two are very, very important. Crying from the vagina,
01:02:07vaginalis or crying from the uterus. It is a uterine. Now, I am coming to a simple word SIDS. First,
01:02:15you have to give the full form of this. What is SIDS? Sudden infant death syndrome. Sudden infant death
01:02:29syndrome. Sudden infant died. He was a healthy infant, but there is an unexplained death. So,
01:02:38the infant was healthy. Otherwise, he was healthy. But, unexplained sudden death,
01:02:50unexplained sudden death, this is known as SIDS. Sudden infant death syndrome.
01:02:56Sudden infant death. Now, this sudden infant death syndrome is also known as CRIB death
01:03:06or CAUT death. It is known as CRIB death or CAUT death. In CAUT, suddenly died.
01:03:16Now, in this case, if you go for autopsy, there will be negative finding. It would be a case of
01:03:22negative autopsy. It would be a case of negative autopsy. Now, what are the predisposing factors?
01:03:29Very, very important, sir. It is common in male. First of all, it is common in male.
01:03:37The age group, it may be two week to two year, but it is very, very common within six months of the life.
01:03:47Within six months. Most common in six months of the life.
01:03:54Infant. Generally, it is infant. Less than one year, it is very commonly seen. Less than six months,
01:03:58most commonly seen. The incidence are 0.2 to 0.4 percent incidences.
01:04:07Another very, very important point. Now, it is common in male, infant. And my dear friend,
01:04:14if first twin has this problem, if first twin has this problem, the second twin have more chances
01:04:24of this sudden infant death syndrome. First twin has the same problem, the second twin has the chances.
01:04:30The death is seen in early morning.
01:04:33Death is seen in early morning. Another important word. My dear friend, if mother or parents,
01:04:44mother or parents are smoker or alcoholic, it also having more chances.
01:04:58Even prematurity increases risk. Even prematurity increases risk.
01:05:10So, generally it is common in infant. Yes, it is common in infant. It is sudden death,
01:05:15infant syndrome. Male, it is more common. If the first twin, there is a problem. Second twin have
01:05:21more problem. Time early in the morning death. Mother or parents, if smoker or alcoholic, more chances.
01:05:28And prematurity increases the risk. This is sudden infant death syndrome.
01:05:34Sudden infant death syndrome. Very, very important. Now, my dear friend, as I told you,
01:05:38in autopsy, as I told you, it is negative autopsy. Generally, there is no cause of death. What is negative
01:05:47autopsy? I already told you. You have gone through all the gross finding, histopathological finding,
01:05:53toxicological analysis, laboratory investigations, still no cause of death. Now, if you see the finding,
01:06:00but these are not significant. The face is cyanotic. The milk or blood stain fraud,
01:06:13milk or blood stain fraud from oral cavity and nostrils and nostrils. Petitial hemorrhages,
01:06:24some small, small pinpoint hemorrhages, petitial hemorrhages are seen in different organs.
01:06:33Your lung, liver, intestine, thymus, petitial hemorrhages are seen. But again, I am telling you,
01:06:38it is not a significant finding which gives 100% idea about the cause of death.
01:06:44Now, so what are the probable cause of death? There is a deficiency of calcium.
01:06:50There is a deficiency of magnesium. There is a deficiency of selenium. This could be one cause.
01:07:01Second, most common accepted cause is prolonged. Most common accepted cause is prolonged
01:07:12sleep apnea. Sleep apnea. Sleep apnea. Number three, it could be some viral cause,
01:07:21viremia, which causes respiratory depression.
01:07:30Which causes respiratory depression, viremia. Cow milk allergy. Another theory which is given,
01:07:36it is cow milk allergy. So, there are many theories given, but most accepted is prolonged
01:07:47sleep apnea. The most accepted is prolonged sleep apnea. Ah, and suddenly the infant dies like
01:07:55medical legal issue is whether it's infanticide or not. So, the issue comes whether it's a murder
01:08:00or infanticide. So, medical legal issue is all about infanticide. Medical legal issue is it is presumed to
01:08:08be a case of infanticide. It is presumed to be case of infanticide. So, this was SIDS, sudden infant death
01:08:16syndrome, crib death or crib death or cot death. Crib death or cot death. It's a negative autopsy. It's a
01:08:24negative autopsy. Now, one question you can get in your exam is Munchausen syndrome of proxy.
01:08:31Munchausen syndrome of proxy. What is this, sir? Actually, first remember, it is an example of child abuse.
01:08:41Parents are abusing the child. And actually, sir, child doesn't have any problem. No problem in the
01:08:47child. The parents had psychological problem. So, here the problem is in parents.
01:08:57Psychological problem in parents, this is Munchausen syndrome of the proxy. What parents do here?
01:09:06They get the repeated frivolous complaints by the parents. Parents used to say, my child is having
01:09:11this problem, this problem, this problem, this problem. And these problems may be created by parents
01:09:15also. And unnecessary investigation and treatment they are going for. They want medical attention.
01:09:24They want medical attention for the child. Unnecessary treatment. Unnecessary procedures
01:09:28are being done. So, it's a problem in parents. It's kind of child abuse. And even these problems
01:09:36may be produced or alleged by parents. Very, very important, sir.
01:09:39These problems may be alleged or produced by parents. Example, the parents give
01:09:50luxative to the child and they complain of diarrhea. They go to the hospital and they complain diarrhea.
01:09:59Parents give emetic to the child. Emetic is vomiting causing as an emetic to the child.
01:10:08And they complain of vomiting for the child. Parents prick the finger, put the blood in urine,
01:10:18prick the finger and put the blood in urine and saying in the hospital, it is a hematuria. So,
01:10:23it is the parents can give a hematuria history. Parents give insulin to the child and there is a
01:10:34hypoglycemia. So, it means, sir, it can be produced by parents or it is alleged by parents, one of the
01:10:42parents or both parents. Now, actually, sir, for Manchewasen syndrome of proxy, for diagnosis,
01:10:50we have a criteria which is known as Rosenberg criteria. For diagnosis, we have a criteria which
01:11:01is Rosenberg criteria. And out of these, the first I already discussed, illness is produced or alleged
01:11:08by parents. Second, repeated request of medical care of child. They are going for the treatment and
01:11:15investigation and procedure repeated multiple times for the child, leading to multiple medical
01:11:20procedures. So, two things I told you. First, these are produced or alleged by parents. Second,
01:11:25multiple medical procedures. Repeated medical procedures are being done.
01:11:29Three, parents says, we don't have any knowledge. They say denial of the knowledge of the cause of
01:11:36of the symptom. If you ask why there is a like hematuria or this very important image is vomiting,
01:11:42they don't say, we don't know. We don't know. Denial of the knowledge.
01:11:47Denial of the knowledge. And the last but not the least, regression of the symptom when the child is
01:11:53separated from the parents. When child is separated in a separated place, the symptoms will go down.
01:11:58Regression of the symptom. Four important Rosenberg criteria.
01:12:01Reduced symptom. Reduced or alleged by parents. First one. Second, multiple procedures are being
01:12:10done. Unnecessary investigation are being done. Third, denial of the knowledge of cause of the
01:12:17symptom by parents. And the fourth, which is very, very important, sir. Regression of the symptom when
01:12:21you separate the child from the parents. That's a very, very important manchewation syndrome of the
01:12:26proxy. It's a kind of child abuse. A problem in parents. A psychological problem in parents. My
01:12:31dear friend. Hello dreamers. Now, the next very, very important topic is
01:12:38bettered baby syndrome. Bettered baby syndrome. Friends, bettered baby syndrome is also known as
01:12:48cafe syndrome. It is also known as cafe syndrome. And it is also known as cafe
01:12:56Kempis syndrome. It is also known as maltreatment of a child. That's a maltreatment syndrome.
01:13:12Maltreatment syndrome. A parent's child stress traumatic syndrome.
01:13:19Parents child stress traumatic syndrome. What is the meaning of this? Friends, it is
01:13:27the child is inflicted some physical injuries by parents or guardian. So, physical injuries on baby
01:13:38are inflicted by parents or guardian. These physical injuries are very, very important for bettered
01:13:45baby syndrome. Other name are cafe syndrome, cafe Kempis syndrome and maltreatment syndrome. Now, three
01:13:52important D. D, D, D, D. What are these three important D? Friends, the first D is discrepancy
01:14:03in the injuries on the body. Discrepancy between injuries on the body. First discrepancy will be
01:14:13injuries of the body on the child and history given by parents
01:14:18and history given by parents or explanation given by parents. That's the first thing.
01:14:27The parents are saying like it's a fall from stairs, but the injuries are different. So,
01:14:31this is a discrepancy between injuries on the body and history given by parents. Second,
01:14:38delay. There is a second D. That's a delay.
01:14:40Delay. Delay in the production of the injuries. Injuries are produced and between medical attention.
01:14:53Medical attention. It means there is a delay between injury and medical attention. The medical
01:14:59treatment which has to be provided. The medical treatment you have to give, there is a delay.
01:15:04Second D. So, first discrepancy. Second is delay. The third very, very important,
01:15:10different stages of healing of injuries.
01:15:15Different stages of healing of injury. Like one injury is almost one day old. Second injury is one
01:15:22week old. Second injury is one month old. These are different stages of healing. This is third very,
01:15:29very, very important D. Third very, very important D. So, just remember it's a discrepancy. First D
01:15:37between the injury and history given by parents or guardian. Second D, delay in the medical attention.
01:15:43And the third D is a different stages of healing of the injuries, as I told you. Now, it is common
01:15:50in a child below three years of age. Very common. It is more common in male child. Male child.
01:15:58It is more common in male child. It is more common in the eldest
01:16:07or youngest child. Eldest or youngest child. It is more common in unwanted child or you can say
01:16:18illegitimate child. Unwanted child or illegitimate child. It's more common. It is more common in
01:16:28in the parents who are of low socioeconomic status. Low socioeconomic status. Poor parents.
01:16:37It is more common in the parents who are illiterate or literacy rate is very low. Illiterate or literacy
01:16:46rate is very low. It is more common in unemployed parents. Unemployed parents. It is more common
01:16:56common in unmarried parents. Unmarried parents. So, these are common important. It is more common
01:17:05in the parents who are smoker, alcoholic or drug abuser. Smoker, alcoholic or drug abuser.
01:17:18And it is more common in the parents who are having the same history of battered baby. So, the same kind
01:17:27of history is there. These parents have more chances of battered baby syndrome. So, these are some common
01:17:35predisposing factor. Now, the most common method is direct manual violence. Directly beating the child or
01:17:45physically hurting the child. So, most common method is direct manual violence. Just very, very important
01:17:53part. These are for cafe syndrome or cafe-campe syndrome. Now, most characteristic reason might
01:17:59different. Most characteristic reason of battered baby syndrome. Like because when you close the mouth,
01:18:05when you close the mouth, the child is crying. So, when you close the mouth,
01:18:09first thing or when you slap the child, when you slap the child, slapping, that is tear inside the lip,
01:18:22tear inside upper lips, upper lips, tear inside upper lips. And it is near frenulum. It is near
01:18:35frenulum. So, this is the most characteristic reason. Tear inside the upper lips, that is near frenulum.
01:18:43That is the most characteristic reason. Now, apart from this, it is lips I have discussed.
01:18:50Second, there are injury common in eyes. Apart from lips, eyes because of the frequent slapping,
01:18:56the eye injuries are very common. There can be retinal hemorrhages
01:19:02or there may be retinal detachment, retinal hemorrhages or retinal detachment. Another very,
01:19:10very important question, which comes in exam. Now, pinch mark or bruises. Now, two types of bruises
01:19:17are produced. Number one is by fingertip pressure. Number one is by fingertip pressure. And number one,
01:19:27second, number second is by pinching. So, I am coming to these two bruises. Very, very important.
01:19:33Because of the pinches or pinch mark, because of the pinch mark, there is a production of
01:19:44butterfly bruises. There is production of butterfly bruises. And because of fingertip pressure,
01:19:51so there will be butterfly bruises because of the pinch mark. And because of the fingertip pressure,
01:19:58because of the fingertip pressure, finger pulp pressure, there will be coin shape bruises.
01:20:05Coin shape bruises. These coin shape bruises are known as a very, very important MCQ.
01:20:11These are known as six penny bruises. Penny is a coin. So, you can say both are example.
01:20:20One is pinching produces butterfly bruises. Finger tip production. Finger tip pressure causes this,
01:20:25this bruises, six penny bruises. Both are example of pattern bruises. Both are examples of pattern bruises
01:20:36because these are forming the pattern. These are forming the pattern. Now, apart from this,
01:20:43there can be few injuries by burn. By burn. There may be multiple injuries caused by burn.
01:20:50There will be circular burn caused by cigarette. So, there can be the burn which is caused by cigarette.
01:20:58There can be scald. There can be scald. What is scald? If you are putting the hand of the baby
01:21:06in hot water. If you are putting the hand of the baby in hot water, there are chances of scald.
01:21:15And especially, the hand or legs or feet are put in the hot water. So, these scald, because hand and
01:21:24feet are immersed in the hot water. This will be showing hand. So, this will be showing glove.
01:21:34Glove pattern of the scald. And if the feet are in the hot water, it is stocking pattern.
01:21:39So, the glove and stocking pattern of the injuries are common in the hand and feet because of immersion
01:21:47in the hot water. And this injury is known as scald. This injury is known as scald. Now, one very,
01:21:54very important finding is infantile V plus syndrome. And I would have put a very important word,
01:22:00shaking baby syndrome. It is frequently shaking the baby. It is because of frequently shaking the baby.
01:22:12And my dear friend, if you frequently shake the baby, there are chances of this one,
01:22:17there are chances of this movement of the head. So, there are chances of this movement of the head
01:22:24that can produce subdural hematoma, SDH, subdural hematoma. Second, there are chances of,
01:22:35there are chances of retinal detachment. There are chances of retinal detachment or retinal hemorrhage.
01:22:45And third, listen very, very carefully. There are chances of periocular bleeding,
01:22:52periocular bleeding. There are chances of periocular bleeding. And my dear friend,
01:23:04this periocular bleeding is known as dot and blot hemorrhage. This periocular bleeding is known as
01:23:13dot and blot hemorrhage, dot and blot hemorrhage, a very, very potential one. Okay. And third thing,
01:23:20which is common by this, this is encephalopathy, this is encephalopathy because of this
01:23:30encephalopathy. So, this combination of subdural hematoma, everyone knows subdural hematoma is due
01:23:35to rupture of bridging veins. It is due to rupture of bridging veins. It is due to rupture of bridging veins.
01:23:43It is due to rupture of bridging veins. So, this particular triad is known as a very, very important
01:23:49shaking baby syndrome or infantile V plus syndrome. Okay. Now, my dear friend, skull fracture.
01:23:57Let's see, this is skull. And there are very, very common fracture, which are known as linear fracture
01:24:05fracture or fissured fracture. Linear fracture and fissured fracture, like the line radiating towards
01:24:15like the periphery, linear fracture or fissured fracture. This is known as egg shell fracture.
01:24:24This is known as egg shell fracture, a very, very potential word, egg shell fracture. So, my dear
01:24:29friends, there are multiple rib fracture, multiple rib fractures. Now, multiple fracture, it may be
01:24:39because of anteroposterior compression. It may be because of anteroposterior compression. This is
01:24:46an anteroposterior compression. If this is there, anteroposterior compression, this will cause fracture
01:24:52laterally, lateral fracture of the ribs in lateral part of the ribs in mid axillary line, in mid axillary line.
01:25:08Or if it is a lateral compression,
01:25:13if it is a lateral compression of the ribs, lateral compression of the ribs, the ribs are fractured.
01:25:18If it is a lateral compression of the ribs, the ribs are fractured,
01:25:26ribs are fractured at posterior angle, posterior angle. And my dear friend, there is a para vertebral,
01:25:39there is a para vertebral, this is para vertebral, posterior angle, para vertebral
01:25:48gutter formation. And my dear friend, this fracture is known as knobbing fracture.
01:26:03This fracture is known as knobbing fracture. So, my dear friend, it is very simple. Knobbing fracture is
01:26:09at the posterior angle of the ribs, para vertebral gutter fracture. It is a knobbing fracture. And my dear
01:26:14friends, in this rib fracture, there is a formation of callus. Callus is a part of fracture healing,
01:26:22formation of callus. These callus in the x-ray, these healed callus in the x-ray, it is showing the
01:26:30appearance, it is showing the appearance, which is known as string of bead appearance.
01:26:36This is known as string of bead appearance. So, you can get both question, the knobbing fracture
01:26:44and string of bead appearance. These are seen as a very important rib fracture findings.
01:26:49String of bead is a callus formation and the knobbing fracture is at para vertebral gutter fracture.
01:26:54Knobbing fracture are the fracture of ribs. Metaphysial fracture,
01:26:58metaphysial fracture are mainly of the long bones. These are mainly of the long bones, like lower end
01:27:08of the tibia, lower end of the tibia, upper end of the femur. These are the common site of metaphysial
01:27:15fracture. And my dear friend, these metaphysial fracture are also known as corner fracture,
01:27:22fracture, corner fracture or bucket handle fracture. Corner fracture or bucket handle fracture. So,
01:27:35you can get a question, corner fracture and bucket handle fracture we use for metaphysial fracture.
01:27:41Traumatic alopecia, it is very common. Traumatic alopecia, trauma leading alopecia,
01:27:46it can produce subgalial hematoma. Subgalial hematoma. These are causing traumatic alopecia
01:27:58and there is a subgalial hematoma. These are common findings of battered baby syndrome.
01:28:02Now, two question comes in exam. What is the most common cause of death in battered baby syndrome?
01:28:08Cafe-Campus syndrome, sub-secommon finding on CIO. This is head injury.
01:28:13The most common cause of death. Most common cause of death. So, listen carefully. The most common cause
01:28:21of death in battered baby syndrome is head injury followed by blunt trauma to the abdominal organ.
01:28:30Blunt trauma or blunt traumatic injury of abdominal organ. Abdominal organ. So, this is head injury.
01:28:39Now, a single x-ray of the whole baby is done where we can find the fracture and everything. This single
01:28:46x-ray of the whole baby, it is known as baby gram. So, the most characteristic one, we can get the baby
01:28:56gram. So, again, I am telling you the most common cause of death. Most common cause of death is head injury.
01:29:01But please differentiate. Most characteristic lesion. Most characteristic lesion is a tear inside the
01:29:08lip. There is a laceration. There is a laceration or tear inside the lips near frenulum. Frenulum is
01:29:15the mid part. Frenulum. So, this is a very, very important topic. Battered baby syndrome or Cafe-Campe
01:29:22syndrome. Cafe-Campe. Campe discovered this. This is known as Cafe-Campe syndrome. So, this is all about a very,
01:29:30very, very important topic. Infanticide and old related topics of the Infanticide.