Friday, July 4, 2008
I performed a post-mortem today. He was an unwanted baby left by the streets.
Name : Unknown (Let’s just call him, Baby)
Age : Unknown
Race : Unknown
Parents : Unknown
Body found: 03/07/2008 0610
Autopsy on: 04/07/2008 0935
The umbilical cord and placental was still attached to Baby, when I saw him on the forensic table. The forensic room was unusually cold today. The layers of clothing wrapped around me did no help at all. I felt that the world was too cruel,.. how could anyone just abandon a baby on the street! With placental attached and cord unclamped… theorically, either the baby had died in-utero, or he was left to die by the streets…
We proceeded with forensic investigations. Baby was inspected for any injuries. His eyes were dark, staring back melancholy. His expression was stiff. He had a crooked jaw, and excessive caput and moulding. For the benefit of non-medical students, if the baby had caput(swelling at the head) or moulding (overlapping skull bones), this indicate that this baby was delivered SVD (spontaneous vertex delivery, head out first) and not a breech delivery. There were no injuries at the buttocks.
Then, we investigated the age of the baby. We concluded that he was a term baby evidenced by:
1. Creases on the hands and feet
2. Body hair measuring 10mm
3. Testes palpable in the scrotum (already descended)
4. Dark meconium passed out (passed motion)
5. When cut across the calcaneum (one of the bones at the heel), from the 3rd toe towards the middle of the heel, we could appreciate secondary ossification center of the bones (bone maturation). Secondary ossification takes place at the 8th months, therefore Baby was at least 8 month old(40weeks), term.
Measurements of Baby’s parameter were corresponding to a term baby. Placental 14cm x 17cm x 2.5cm, complete, with blood clots.
The brain was removed, weight and sliced. The brains did not appear hypoxic.
Later, we continued by autopsying the lungs, liver, spleen, heart and kidneys to look for any other pathological injury or disease. A suspension test was done: Baby’s lung was squeeze flat and put into a bowl of water. We found that the lungs floated on the water, which translates to -> there was air in Baby’s lung -> Baby breath first, then die -> this was a livebirth -> baby was delivered SVD and left dying…
Sigh, the world is a cruel world… I could not imagine any mother in this world who could have left a crying baby to die. Before this, I had witnessed many mothers in the labour room who would do ANYTHING to save their baby… different maneuvers, pushing as hard as possible, enduring the pain… But this mother, I really could not comprehend..
A teenage mother came across my mind. Perhaps she was young, confused and did not know what to do with the baby. Prof Adeeb said: Guys only know how to make the girl pregnant. But I suppose the father of Baby did not even know the existence of Baby.
Girls out there, for God’s sake, if you EVER had premarital sex, please use contraception. Condom not only protects you from pregnancies, it also protects you from STDs (Sexually Transmitted Diseases) and HIV.
And IF you missed that contraception, options are MORNING-AFTER-PILLS within 72hours after sex. The eithical issue in this was if morning-after pills became widely available through pharmacies, unscrupulous men could exploit vulnerable young women by saying: "you can always go to the chemist and get the morning-after pill." Do see a doctor to check health status and medical history for anything which might make taking such pills dangerous.
And IF you missed your period that month, please do a pregnancy test.
And IF the test was positive, please discuss with your partner or your family, whether should you continue with the pregnancy and raise the baby.
IF you plan to keep the baby, please ensure that you can mentally and financially support the baby. Raising a baby is not easy. If you are not capable of it, you can discuss with the social worker to give the baby up for adoption, either to a family member or by others.
AND PLEASE SEE A DOCTOR EARLY FOR BOOKING AND ANTENATAL SCREENING.
The first visit is the most important visit, where antenatal screening will be done (eg: Height, Weight, Blood Pressure, Hemoglobin level, Blood Grouping, VDRL/HIV/Hepatitis B Screening, Urine analysis). Any disease eg: Anemia, Diabetes Melitus, Hypertension, if detected early can be controlled and managed to optimize both mother and fetal throughout pregnancy and for delivery. An early dating scan (pelvic ultrasound scan) is very important before 20 weeks to know the age of the baby, the right time to deliver and to detect nuchal translucency (suggestive of down syndrome).
The risk of keeping the pregnancy to term without antenatal screening and follow up is increase morbidity and mortality to BOTH fetal and mother. And attempting to deliver a baby on your own is certainly VERY UNSMART! It’s not easy to deliver a baby and the pain is terrible (without analgesia). GO TO THE NEAREST HOSPITAL. Why else do you think medical student had to study 5years and midwifes 4years to understand that? YOU AND YOUR BABY COULD DIE
IF you wish to terminate the pregnancy, please go to a clinic and seek professional medical advice. Some might argue that a TOP (Termination Of Pregnancy) is unethical, but compared to bringing a baby to term and living it to die by the streets, I shall leave it for you to decide. According to WHO (World Health Organization), any pregnancy below 22 weeks is not yet a viable fetal. Religious and cultural beliefs may have a different opinions. The process of TOP, I shall leave it to another blog entry… I guess I should pen off here, this had been a long entry. Glad you made it to this line! :)
I hoped for a better world, still hoping…
My 1st Forensic Experience
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