Scholarly article on topic 'Accidental decapitation during delivery'

Accidental decapitation during delivery Academic research paper on "Clinical medicine"

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Academic research paper on topic "Accidental decapitation during delivery"


Egyptian Journal of Forensic Sciences (2014) xxx, xxx-xxx

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Egyptian Journal of Forensic Sciences

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Egyptian Journal of Forensic sciences


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 post-ictal 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). Intra-partum 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 litera-ture1'5-7 i.e. opposing forces at a fixed point (in the present case

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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.

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.

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Please cite this article in press as: Inamadar P.I. et al. Accidental decapitation during delivery, Egypt J Forensic Sci (2014), http://


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


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Praveenkumar I. Inamadar * Department of Forensic Medicine, Hassan Institute of Medical Sciences, Hassan 573201, Karnataka, India

*Tel.: +91 9480056787. E-mail address:

Amit Agrawal Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh,

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://