MERTVOROZHDYONNOST (synonym still birth) — the birth or extraction from an organism of mother of a fruit at duration of gestation of 28 weeks and more, i.e. a fruit of 35 cm in height and more, weighing 1000 g and more which after separation from a body of mother did not make any breath. The statistics of M. are estimated as follows:
([number of the children who were born the dead] / [the number of the children who were born all (live and dead)]) x
at the same time mortinatus is considered 1000 a fruit, at to-rogo there is no independent extra uterine lung respiration at the birth and at unsuccessfulness of revival in the artificial way irrespective of existence of heartbeat or other signs of life.
Indicators of frequency of still births of the full-term and premature children are similarly estimated (to number of all full-term or premature). According to G. F. Tserkovny (1976), the fruits which antenatalno died make about 40% of all mortinatus; premature children 7 — 8 times more often are born the dead in comparison with full-term. According to V. I. Grishchenko and A. F. Yakovtsov (1978), the level of an indicator of M. over the certain countries fluctuates from 5 to 20 per milles, including in the developed countries M.'s indicators the lowest.
Depending on the term of approach of death in relation to sorts M. divide on antenatal and intranatal. M. in cases when death of a fruit came of 28 weeks and before childbirth in time is considered antenatal; antenatal death of a fruit is established on the basis a wedge, (the termination of heartbeat and stir of a fruit prior to the beginning of a childbed) and rentgenol, signs. M. in cases when death came during a childbed is considered intranatal; intranatalno it is necessary to carry to the dead also the newborns who were born with heartbeat, but did not begin to breathe after the resuscitation actions.
The reasons of a still birth
the Reasons of a still birth are various and studied not completely: processes in an organism of mother, the fruit and in so-called fetal egg matter patol. Pathology of a fruit and change in an afterbirth in many respects depend on the previous and associated diseases of mother, complications of pregnancy and childbirth. The reasons anti-and intranatal) still births can be divided into the main and direct. Are the main reasons for M.: complications of pregnancy (late toxicoses, bleedings, etc.), anomalies of patrimonial activity, the provision of a fruit and placental presentation, pathology of an umbilical cord and placenta, diseases of mother which are not connected with pregnancy: heart diseases, hypertension, nephropathy, diabetes, acute and hron. inf. diseases, acute poisonings, immunol, incompatibility of mother and fruit, etc. Asphyxia, a hemolitic disease, a pre-natal infection, inborn malformations and genetic diseases can be proximate causes of antenatal death of a fruit. Intranatalno a fruit can die at patol, the course of childbirth (an intracranial birth trauma, asphyxia of a fruit, an eclampsia of mother, placental presentation, etc.).
The pathoanatomical research pursues the aim to find out a cause of death of a fruit: asphyxia of a fruit, a birth trauma and also whether there was a fruit viable or were available malformations incompatible with life or a pre-natal disease. In each case of asphyxia or a birth trauma of a fruit it is necessary to establish whether these states were the main reason for death or a complication of the previous pre-natal disease of a fruit — Fetopathies (see). Macroscopic signs of the mortinatus fruit which died antenatalno are, as a rule, the expressed maceration of an integument, an autolysis of internals, lack of air in a stomach and full primary atelectasis of lungs. As a result of maceration epidermis of a fruit disappears layers in the form of grayish-white films, the wet bluish-red derma is bared; internals are flabby, on a section creep away, in perigastriums bigger or smaller amount of transparent bloody liquid. The autolysis of internals complicates microscopic examination. Longer than other bodies lungs remain, to-rye it is always necessary to subject to microscopic examination. Maceration of an integument and an autolysis of internals are expressed to those more considerably, than longer the fruit was found dead vnutriutrobno; if the fruit was taken quickly, maceration and an autolysis can not be.
The placenta owing to the termination fetal and preservations of maternal blood circulation is anemic as a result of a prelum of vessels of fibers.
The stomach at mortinatus does not contain air, fallen down; lungs are drawn in to a root, do not fill a chest cavity, fleshy, bluish-red, on a cut surface during the pressing dark liquid blood appears. Hydrostatic vital tests (see) negative. Surely it is necessary to consider existence of air sites in the lungs arising owing to an artificial respiration at resuscitation; microscopically artificial and air sites differ from a natural raspravleniye of lungs in existence of large air-vessels with ruptures of alveolar partitions (fig. 1) alternating with sites atelectasis (see).
At absence or insignificant expressiveness of maceration and an autolysis it is possible to reveal symptoms of a disease of a fruit in bodies, characteristic of fetopathies of any etiology. The increase or reduction of lump of a fruit which is not corresponding to its age, existence of dystrophic and focal necrotic changes in parenchymatous bodies, gepato-and a splenomegaly with existence of the large centers of a miyeloeritropoez which are not corresponding (by the size) to age of a fruit, intersticial infiltrates preferential from eosinophilic myelocytes in a liver, a pancreas and a thymus, aktsidentalny involution with a degrowth of a thymus, existence of immaturity and malformations of fabrics, napr, a cystous dysplasia of kidneys (fig. 2) concern to them. Except these general signs, the changes characteristic, e.g., of an isoimmune hemolitic disease of a fruit, inborn listeriosis, syphilis, a toxoplasmosis, a cytomegaly, mycoplasmosis, a rubella, chicken pox, serumal hepatitis, diabetes, a thyrotoxicosis, nek-ry inborn diseases are observed.
Because many diseases of a mortinatus fruit macroscopically are not distinguished, it is necessary to apply in a complex microscopic, bacterial., cytogenetic, immunofluorescent and biochemical methods of a research of bodies and afterbirth.
Need for radiodiagnosis can arise before pathoanatomical and court. - medical necropsy of a fruit, and also in a case a wedge, signs of pre-natal death of a fruit. Occasion for rentgenol, researches can appear nek-ry difficulties of differentiation of live birth and is dead the births at a section research, need of comparison of results of hydrostatic vital tests to results rentgenol, researches, and also cases of the expressed cadaveric decomposition.
So-called test of Dillon, edge consists in detection on the roentgenogram of signs of gas in a digestive tract of a corpse (according to the scientist, it testifies to a zhivorozhdennost), cannot be considered as a reliable indicator. According to many researchers, it rentgenol, the research loses diagnostic value later 48 hours after death owing to development of putrefactive processes in went. - kish. a path and in cases of use of an artificial respiration.
At rentgenol. a research the image of all corpse, and if necessary and separate bodies shall be received. Roentgenograms make in direct and side, and sometimes and in additional purposeful projections.
The main rentgenol, signs of a still birth: 1) total absence of gas in lungs, a stomach and intestines (fig. 3, a); 2) lack of gas in lungs, however is possible availability of gas in a digestive tract, but not further a duodenum (fig. 3, b); 3) perhaps small expansion of lungs at total absence of gas in a stomach and intestines; 4) availability of gas in cardial cavities and large vessels (fig. 3, b). The specified signs exclude live birth of the child.
Nek-roye looking alike listed above rentgenol, can be observed by signs at expansion of lungs, live-born in case of absence, in combination with availability of gas in intestines; however gas at the same time occupies a small bowel on a big extent — outside a duodenum that indicates undoubted live birth of the child even at a full bezvozdushnost of lungs. The possibility of life of the newborn within several hours at full not expansion of lungs is explained by the fact that from gas went. - kish. a path diffuses a nek-swarm amount of oxygen. As showed researches A. Ilyin, even 5% of normal amount of oxygen, necessary for life, can support temporarily life of the newborn at rest.
Despite relative diagnostic value rentgenol, researches, it in combination with other methods has undoubted value for court. - medical examinations.
The still birth in the medicolegal relation
Establishment of the fact of a still birth matters at investigation of the criminal cases connected with infanticide (see) at childbirth out of medical institutions.
At a research of a corpse pay attention to existence of external signs of lung respiration: the shape of a thorax at mortinatus less convex, than at live-born, the level of standing of a dome of a diaphragm at mortinatus corresponds to IV, at live-born — to the VI edge (however the specified signs are changeable and unreliable). Diagnostic value has the volume and color of lungs: lungs of mortinatus are not straightened, fallen down, as a rule, they are in back departments of a chest cavity; color their red-brown or brownish-red, to the touch lungs dense, elastic. For definition of a still birth. or live births conducting two vital hydrostatic (swimming) tests — pulmonary and gastrointestinal, based on definition of availability of air in lungs is obligatory and went. - kish. a path (see. Vital tests ).
Great diagnostic value has gistol, a research of lungs of a corpse. Of mortinatus it is characteristic: not straightened alveoluses and bronchial tubes, a cubic form of an epithelium of alveoluses, thick Interalveolar partitions, crimped elastic fibers going as a part of less thick bunches, fine crimped argyrophil fibers. Both other bodies and fabrics of a corpse, napr, an umbilical ring, an umbilical cord are investigated.
For differential diagnosis of a still birth and I. K. Yesipova's live birth, O. Ya. Kauffman (1968) developed a technique of a posthumous rentgenovazografiya in combination with a mikrometriya of arteries of level of respiratory bronchioles, weight ratioes of departments of heart, a condition of umbilical vessels and an arterial (botallov) channel. At mortinatus on roentgenograms the different degree of admission of vessels contrast weight comes to light. The gleam of arteries of level of respiratory bronchioles mortinatus is equal to 0,2±0,54 microns. At live-born intra lobular arteries of lungs form extremely dense network, places merging. The gleam of arteries of level of respiratory bronchioles at live-born by second day of life is equal to 18 — 20 microns. However administration of contrast medium in a pulmonary trunk or in an aorta of a corpse makes impossible conducting swimming tests.
Due to the termination of a blood-groove through funic vessels, and later and through an arterial channel diagnostic value has the beginning of the organization of parcels of blood in umbilical vessels and proliferation of cells in a subendothelial layer of an arterial channel. Development of these processes begins early enough and serves as the proof of live birth.
In expert practice quite often it is necessary to investigate corpses of newborns not only soon after approach of death, but also later various terms when there occur putrefactive changes, drying. In these cases it is necessary to approach assessment of results of the tests described above carefully. At examination of a still birth, especially in cases of putrefactive changes or drying of corpses, the method of an issue spectral analysis of lungs, a liver, blood, a myocardium and a placenta is used (see. Spectral analysis ). At a spectrographic research use sizes coefficient in the relations nek-ry macro - and microelements. It is reasonable to apply a complex a lab. methods that reduces quantity of expert mistakes.
The prevention of a still birth
the Prevention of a still birth includes a complex of recreational actions (gymnastics, walks, good nutrition of the pregnant woman, observance of a work-rest schedule and so forth), especially at the burdened obstetric anamnesis (death of a fruit in the past), at the diseases of the woman able to cause afterwards death of a fruit at pregnancy (a diabetes mellitus, heart diseases, a hypertension, diseases of generative organs, the Toxoplasmosis, etc.), and also at antenatal pathology (see). At an opportunity carry out medicogenetic consultation (see). The pregnant women having this or that pathology for prevention of misbirths or death of a viable fruit are sent to a specialized hospital for control of a condition of the pregnant woman and a fruit and the corresponding treatment (see. Antenatal protection of a fruit ).
See also Pre-natal death .
Bibliography: Drills S. A. and Reznikov of B. D. Rentgenologiya in forensic medicine, page 206, Saratov, 1975; Grishchenko V. I. and Yakovleva A. D. Antenatal death of a fruit, M., 1978, bibliogr.; D and l-l about Ya. G N. Radiological vital test and its justification, Vestn, rentgenol., t. 23, No. 2, page 91, 1939; Potter E. Pathological anatomy of fruits, newborns and children of early age, the lane with English, M., 1971, bibliogr.; Church G. F., F r about l about in and O. G. and To about about-z e in and N. V. O statistical criteria of the perinatal period, Akush, and ginek., Jvft 3, page 24, 1976; Ellenbogen L. S., Bayer H. G o t t 1 i e b M. Roentgen demonstration of gas in the fetal circulatory system, valuable sign of fetal death, Radiology, v. 67, p. 410, 1956; Gruber G. H. Gas in the umbilical vessels as a sign of fetal death, ibid., v. 89, p. 881, 1967; Y 1 p about 6 A. Uber Magenatmung beirn Men-schen, Biochem. Z., Bd 78, S. 273, 1917.
O. G. Frolova; T. E. Ivanovskaya (stalemate. An.), G. A. Pashinyan, P. P. Shirineky (court.), S. A. Sviridov (rents.).