CC BY
0FORENSIC MEDICAL CRITERIA FOR DETERMINING THE
BIRTH OF A CHILD
1Mansurova D., 2Eliyeva M.F., 3Ruziyev Sh.I., 4Ruzimetova Sh.O.
1,2,3,4Tashkent Institute of Pediatrics and Medicine, Tashkent, Uzbekistan https://doi.org/10.5281/zenodo.13883660
Abstract. The establishment of the gestational age is one of the most important issues to be resolved in the study of fetal and newborn corpses. In forensic medical expertise and autopsy practice for diagnosis of gestational age a set of fetometric indicators are usually used, including weight and length, a number of linear parameters of the head, trunk and limbs, and the mass of organs.
In each case, the submitted medical documentation was examined, including data from multiple prenatal echophetometry. In each case, the afterbirth was examined. Studies of the afterbirth, fetal corpses and newborns were conducted in accordance with generally accepted standards. The obstetric gestation period (post menstrualis) was considered as the gestational age. In one newborn whose life expectancy exceeded the perinatal period, postconceptual age was taken into account as an indicator of gestational age.
Keywords: gestational age, newborns, morphology.
Relevance: The establishment of the gestational age is one of the most important issues to be resolved in the study of fetal and newborn corpses. In forensic medical expertise and autopsy practice for diagnosis of gestational age a set of fetometric indicators are usually used, including weight and length, a number of linear parameters of the head, trunk and limbs, and the mass of organs.
It should be noted that these problems have always faced practical medicine, thanks to which methods for determining the gestational age of fetuses and newborns were created based on the study of the size of limbs and their parts, the length of long tubular bones and the size of a number of bones of the skull, chest and pelvis, the thickness of the bones of the cranial vault, the size and area of the anterior fontanel.
At the same time, fetal skeletal elements were mainly selected as objects of study. Probably, the refusal to use soft tissues for the determination of gestational age was caused by the existence of ideas about their instability to autolytic putrefactive processes. However, the present stage of the development of forensic medicine has been marked by increased interest in studying the dynamics of the development of postmortem processes in soft tissues and the possibilities of using their histostructures in order to determine the age of a person.
The results obtained showed the relative resistance of many soft tissues to autolysis, which makes it fundamentally possible to determine gestational age using morphometric examination of fragments of fetal organs. Meanwhile, such studies have not been conducted, although they are technically feasible and would be very useful for improving the accuracy and objectivity of the definition of gestational age by forensic doctors and pathologists.
The purpose of the study: to increase the objectivity and accuracy of determining the gestational age of fetuses and newborns in cases of difficult or impossible use of standard biometric indicators.
Research materials and methods: Analysis of forensic medical examination conclusions of 11 stillborn infants dead in different periods at Navoi regional branch of Republican scientific and practical center of forensic medical examination c.
As a research method, an analysis of the pathomorphological indicators of their corpses was carried out.
Research results: The observations of the main group were represented by fetuses and newborns both in physiologically occurring pregnancy and in various perinatal pathologies (congenital anomalies, intrauterine infections, fetal developmental delay syndrome, chronic intrauterine hypoxia, fetuses from multiple births).
The leading criterion for inclusion in this group was the absence of putrefactive changes and pronounced maceration in the cadaverous material.
In order to study the degree of resistance of the histostructure of fetal organs to autolysis, organ fragments from 23 stillborn fetuses with maceration of 2-3 degrees were additionally examined.
In each case, the submitted medical documentation was examined, including data from multiple prenatal echophetometry. In each case, the afterbirth was examined. Studies of the afterbirth, fetal corpses and newborns were conducted in accordance with generally accepted standards. The obstetric gestation period (post menstrualis) was considered as the gestational age. In one newborn whose life expectancy exceeded the perinatal period, postconceptual age was taken into account as an indicator of gestational age.
Liver morphogenesis in the middle and late fetal periods was characterized by an increase in the absolute volume of liver lobules against the background of progressive ingrowth of connective tissue along the branches of the portal vein. The growth of the country was accompanied by the growth and differentiation of the branches of the portal vein and hepatic artery, as well as the biliary system. The most important feature of the development of the fetal liver was a progressive decrease in the activity of its functioning as a pharmacological organ of hematopoiesis. Morphogenesis of the spleen in the same period was determined by the formation and further differentiation of white and red pulp, an increase in the volume of all stroma components. The noted qualitative nature of the development of fetal organs allowed only an approximate assessment of gestational age and did not provide the necessary level of objectivity and accuracy of its establishment, while the use of quantitative analysis made it possible to develop a rational methodology for determining gestational age.
An important feature of the morphogenesis of fetal organs was the pronounced gestational heterogeneity of the variance of all histometric indicators in the form of its decrease in indicators characterized by negative and increase in indicators with positive gestational dynamics. Despite the gestational heterogeneity of the variance of each of the histometric indicators studied, the ratio of estimates of its mean to the standard deviation remained approximately constant, while there was no correlation between gestational age and the ratio of estimates of the mean to the standard deviation (p > 0.190). This circumstance indicates the constancy of the form of distribution of the values of histometric indicators throughout the studied period of antenatal development.
Conclusion: The liver and spleen are quite informative objects for determining the gestational age of fetuses and newborns in forensic medical expertise and pathoanatomical practice. Morphometric indicators of these organs, such as the hematopoietic activity of the parenchyma and the thickness of the connective tissue capsule of the liver, have varying degrees
of pronounced gestational dynamics, the density and diameter of lymphoid nodules, the thickness
of the walls of the central arteries and the capsule of the spleen.
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