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Accidental decapitation during delivery
Egyptian Journal of Forensic Sciences (2014) xxx, xxx–xxx
Contents lists available at ScienceDirect
Egyptian Journal of Forensic Sciences journal homepage: www.ejfs.org
LETTER TO THE EDITOR
Accidental decapitation during delivery Dear Sir, Complete or incomplete decapitation is a rare consequence of suicidal hanging,1,2 vehicle-assisted suicide,3 road traffic accidents4–8 and post-mortem decapitation by domestic animals.9 Blunt trauma to the head and neck of a newborn during delivery leading to decapitation is a rare and unfortunate event.10 32 year old female from a low socio-economic family suffering from epilepsy for the last 9 years was on irregular treatment. She had previously three healthy children (2 male and 1 female). She was having amenorrhea for 8 months and 12 days. In the early morning she experienced lower abdominal pain and had an urge to pass stool. The pain continued to increase and she noticed a watery discharge from the vagina. Spontaneous labor was precipitated with severe lower abdominal pain. The baby started coming out of the uterus legs first, however when it was delivered till the chest the mother got exhausted. There was no immediate availability of medical support. At the same time she had an episode of generalized tonic-clonic seizures. During the event somehow she got hold of the legs of the fetus and dragged her violently resulting in an ante-mortem decapitation of the fetus. Following that she was in altered sensorium probably due to postictal confusion. Her son cried for help and the neighbors came to the rescue. She was taken to the hospital and forceps delivery was carried out to deliver the head and evacuation of the placenta. The mother was well nourished (height-164 cm, weight 59 kg). Postmortem examination of the neonate was performed after around 6 h of the event (Figs. 1 and 2). Intrapartum seizures are challenging emergencies that increase the risk of adverse outcomes for the mother as well as for the fetus.11,12 Also an episode of seizures can result in fetal hypoxemia and cause the fetal stress that can initiate labor.12 Decapitation injuries occur due to overstretching of the neck structures10,13 and associated head movements.13 The factors responsible for the decapitation in the present case were similar to the circumstances described for decapitation in the literature1,5–7 i.e. opposing forces at a fixed point (in the present case
the head was inside the uterus and the torso was lying outside the uterus and a constriction ring was formed at the level of cervix during the seizure episode) resulting in overstretching of the neck up to the point of decapitation.10 In a previously reported case of a new born it was suggested that excessive traction on the head can result in overstretching of the neck
Figure 1 Showing irregularly severed trunk with waxy material smeared all over.
Peer review under responsibility of Forensic Medicine Authority.
Production and hosting by Elsevier
Figure 2 Ante-mortem features can be well appreciated as the injuries are produced over the scalp with retrieval of the head using a forceps at a gap of 3–4 h after decapitation.
2090-536X ª 2013 Production and hosting by Elsevier B.V. on behalf of Forensic Medicine Authority. http://dx.doi.org/10.1016/j.ejfs.2013.09.003
Please cite this article in press as: Inamadar P.I. et al. Accidental decapitation during delivery, Egypt J Forensic Sci (2014), http:// dx.doi.org/10.1016/j.ejfs.2013.09.003
2 to the point of decapitation.1 In addition there were twisting movements due to seizures resulting in the decapitation. In medical institutions complete transparency is advocated by the medical profession, however despite the existence of regulations regarding full disclosure medical practitioners are reluctant to divulge the details of adverse events.10 References 1. Hejna P, Bohnert M. Decapitation in suicidal hanging–vital reaction patterns. J Forens Sci 2013;58(Suppl. 1):S270–277. 2. Hejna P, Safr M, Zatopkova L. Suicidal decapitation by guillotine: case report and review of the literature. J Forens Sci 2012;57:1643–5. 3. Hejna P, Havel R. Vehicle-assisted decapitation: a case report. Am J Forens Med Pathol 2012;33:73–5. 4. Ausania F, Cittadini F, Cascini F, Polacco M, Pascali VL, Oliva A. Decapitation due to car accident. Am J Forens Med Pathol 2011;32:308–9. 5. Morild I, Lilleng PK. Different mechanisms of decapitation: three classic and one unique case history. J Forens Sci 2012;57:1659–64. 6. Zoja R, Gentile G, Giovanetti GF, Palazzo E. Death by complete decapitation of motorcyclist wearing full face helmet: case report. Forens Sci Int 2011;207:e48–50. 7. Spitz DJ, Prator PC, Stratton JE, et al. Neck injuries caused by automatic two-point seat belts: an analysis of four cases. J Forens Sci 2005;50:159–63. 8. Saldeen T. Fatal neck injuries caused by use of diagonal safety belts. J Trauma 1967;7:856–62. 9. Buschmann C, Solarino B, Puschel K, Czubaiko F, Heinze S, Tsokos M. Post-mortem decapitation by domestic dogs: three case reports and review of the literature. Forens Sci Med Pathol 2011;7:344–9. 10. Hiss J, Kahana T, Burshtein I. Accidental fetal decapitation: a case of medical and ethical mishap. Am J Forens Med Pathol 2011;32:245–7. 11. Hirsch M. Intrapartum seizure in a patient undergoing cesarean delivery: differential diagnosis and causative factors. AANA J 2011;79:403–7. 12. Curran CA. Intrapartum emergencies. J Obstetr Gynecol Neonat Nursing 2003;32:802–13.
P.I. Inamadar et al. 13. Zhu B, Quan L, Ishida K, et al. Decapitation in suicidal hanging – a case report with a review of the literature. Leg Med (Tokyo, Japan) 2000;2:159–62.
Praveenkumar I. Inamadar * Department of Forensic Medicine, Hassan Institute of Medical Sciences, Hassan 573201, Karnataka, India *Tel.: +91 9480056787. E-mail address: [email protected]
Amit Agrawal Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
Shashidhar Mestri Department of Forensic Medicine, KarpagaVinayaga Medical College, GST Road, Chinnakolambakkam, Kanchipuram, Tamilnadu, India
Prabhawati P. Inamadar Department of Paedodontics, Al-Ameen Dental College, Bijapur, Karnataka, India
Received 5 July 2013; received 29 August 2013; accepted 27 September 2013
Please cite this article in press as: Inamadar P.I. et al. Accidental decapitation during delivery, Egypt J Forensic Sci (2014), http:// dx.doi.org/10.1016/j.ejfs.2013.09.003
Contents lists available at ScienceDirect
Egyptian Journal of Forensic Sciences journal homepage: www.ejfs.org
LETTER TO THE EDITOR
Accidental decapitation during delivery Dear Sir, Complete or incomplete decapitation is a rare consequence of suicidal hanging,1,2 vehicle-assisted suicide,3 road traffic accidents4–8 and post-mortem decapitation by domestic animals.9 Blunt trauma to the head and neck of a newborn during delivery leading to decapitation is a rare and unfortunate event.10 32 year old female from a low socio-economic family suffering from epilepsy for the last 9 years was on irregular treatment. She had previously three healthy children (2 male and 1 female). She was having amenorrhea for 8 months and 12 days. In the early morning she experienced lower abdominal pain and had an urge to pass stool. The pain continued to increase and she noticed a watery discharge from the vagina. Spontaneous labor was precipitated with severe lower abdominal pain. The baby started coming out of the uterus legs first, however when it was delivered till the chest the mother got exhausted. There was no immediate availability of medical support. At the same time she had an episode of generalized tonic-clonic seizures. During the event somehow she got hold of the legs of the fetus and dragged her violently resulting in an ante-mortem decapitation of the fetus. Following that she was in altered sensorium probably due to postictal confusion. Her son cried for help and the neighbors came to the rescue. She was taken to the hospital and forceps delivery was carried out to deliver the head and evacuation of the placenta. The mother was well nourished (height-164 cm, weight 59 kg). Postmortem examination of the neonate was performed after around 6 h of the event (Figs. 1 and 2). Intrapartum seizures are challenging emergencies that increase the risk of adverse outcomes for the mother as well as for the fetus.11,12 Also an episode of seizures can result in fetal hypoxemia and cause the fetal stress that can initiate labor.12 Decapitation injuries occur due to overstretching of the neck structures10,13 and associated head movements.13 The factors responsible for the decapitation in the present case were similar to the circumstances described for decapitation in the literature1,5–7 i.e. opposing forces at a fixed point (in the present case
the head was inside the uterus and the torso was lying outside the uterus and a constriction ring was formed at the level of cervix during the seizure episode) resulting in overstretching of the neck up to the point of decapitation.10 In a previously reported case of a new born it was suggested that excessive traction on the head can result in overstretching of the neck
Figure 1 Showing irregularly severed trunk with waxy material smeared all over.
Peer review under responsibility of Forensic Medicine Authority.
Production and hosting by Elsevier
Figure 2 Ante-mortem features can be well appreciated as the injuries are produced over the scalp with retrieval of the head using a forceps at a gap of 3–4 h after decapitation.
2090-536X ª 2013 Production and hosting by Elsevier B.V. on behalf of Forensic Medicine Authority. http://dx.doi.org/10.1016/j.ejfs.2013.09.003
Please cite this article in press as: Inamadar P.I. et al. Accidental decapitation during delivery, Egypt J Forensic Sci (2014), http:// dx.doi.org/10.1016/j.ejfs.2013.09.003
2 to the point of decapitation.1 In addition there were twisting movements due to seizures resulting in the decapitation. In medical institutions complete transparency is advocated by the medical profession, however despite the existence of regulations regarding full disclosure medical practitioners are reluctant to divulge the details of adverse events.10 References 1. Hejna P, Bohnert M. Decapitation in suicidal hanging–vital reaction patterns. J Forens Sci 2013;58(Suppl. 1):S270–277. 2. Hejna P, Safr M, Zatopkova L. Suicidal decapitation by guillotine: case report and review of the literature. J Forens Sci 2012;57:1643–5. 3. Hejna P, Havel R. Vehicle-assisted decapitation: a case report. Am J Forens Med Pathol 2012;33:73–5. 4. Ausania F, Cittadini F, Cascini F, Polacco M, Pascali VL, Oliva A. Decapitation due to car accident. Am J Forens Med Pathol 2011;32:308–9. 5. Morild I, Lilleng PK. Different mechanisms of decapitation: three classic and one unique case history. J Forens Sci 2012;57:1659–64. 6. Zoja R, Gentile G, Giovanetti GF, Palazzo E. Death by complete decapitation of motorcyclist wearing full face helmet: case report. Forens Sci Int 2011;207:e48–50. 7. Spitz DJ, Prator PC, Stratton JE, et al. Neck injuries caused by automatic two-point seat belts: an analysis of four cases. J Forens Sci 2005;50:159–63. 8. Saldeen T. Fatal neck injuries caused by use of diagonal safety belts. J Trauma 1967;7:856–62. 9. Buschmann C, Solarino B, Puschel K, Czubaiko F, Heinze S, Tsokos M. Post-mortem decapitation by domestic dogs: three case reports and review of the literature. Forens Sci Med Pathol 2011;7:344–9. 10. Hiss J, Kahana T, Burshtein I. Accidental fetal decapitation: a case of medical and ethical mishap. Am J Forens Med Pathol 2011;32:245–7. 11. Hirsch M. Intrapartum seizure in a patient undergoing cesarean delivery: differential diagnosis and causative factors. AANA J 2011;79:403–7. 12. Curran CA. Intrapartum emergencies. J Obstetr Gynecol Neonat Nursing 2003;32:802–13.
P.I. Inamadar et al. 13. Zhu B, Quan L, Ishida K, et al. Decapitation in suicidal hanging – a case report with a review of the literature. Leg Med (Tokyo, Japan) 2000;2:159–62.
Praveenkumar I. Inamadar * Department of Forensic Medicine, Hassan Institute of Medical Sciences, Hassan 573201, Karnataka, India *Tel.: +91 9480056787. E-mail address: [email protected]
Amit Agrawal Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
Shashidhar Mestri Department of Forensic Medicine, KarpagaVinayaga Medical College, GST Road, Chinnakolambakkam, Kanchipuram, Tamilnadu, India
Prabhawati P. Inamadar Department of Paedodontics, Al-Ameen Dental College, Bijapur, Karnataka, India
Received 5 July 2013; received 29 August 2013; accepted 27 September 2013
Please cite this article in press as: Inamadar P.I. et al. Accidental decapitation during delivery, Egypt J Forensic Sci (2014), http:// dx.doi.org/10.1016/j.ejfs.2013.09.003