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Definition of live birth or stillbirth - medical news. Signs of a live birth

The criterion for live birth is the occurrence of extrauterine pulmonary respiration in a viable fetus. A stillbirth is the birth of a fetus that does not breathe spontaneously after delivery. To determine the live birth, the so-called vital tests (pulmonary and gastrointestinal) and histological examination of the lung tissue are used. The presence of air in the lungs and gastrointestinal tract before autopsy can be established by radiography of the corpse.

Pulmonary vital test is based on the change in the density of breathing lungs compared to non-breathing ones. The lungs of a non-breathing newborn are airless and dense (Fig. 102), their surface is smooth and uniform. They are small in volume, lie deep in the pleural cavities and are covered in front by the heart and thymus gland. The relative density of non-breathing lungs is greater than 1 (1.05-1.056), so they sink in water. On the cut, their tissue is uniformly reddish, anaemic.


With the first breath. a child's lungs begin to expand and fill with air, their volume increases, the relative density becomes less than 1, so they float in water. From the surface and on the cut, their tissue is motley, marble-like, light red areas alternate with darker ones, with pressure, not only blood, but also bloody foam is released from the cut surface.

The technique for conducting a lung test is as follows: before opening the chest cavity, the trachea is separated and bandaged together with the esophagus. After that, they open the chest cavity, remove the lungs, heart and thymus gland in a single complex and lower them into a spacious vessel with water. If the complex sinks, then the heart is separated from it, then the thymus gland.

If even some lungs sink, then separate lobes are cut off from them and placed in water; if they sink, then pieces are separated from them, similar to straightened ones, and lowered into the same place. Separate pieces are squeezed under water and observe whether air bubbles are released from them.

Expert evaluation of the results of this test is sometimes difficult. A positive result (lungs floating in water) is observed when the newborn was breathing. Also, rotten breathing and non-breathing lungs do not sink, so the lung test is unreliable with putrefactive changes in the corpse.

Partially floating lungs of a stillborn who was mechanically ventilated, as well as frozen and incompletely thawed lungs of both live and stillborn. A negative result (when the lungs sink) occurs in stillborns, as well as in secondary atelectasis, when the lungs of a breathing baby collapse, but did not live long.

Usually secondary atelectasis develops in preterm infants. Histochemical examination of the lung tissue in such cases often shows the absence or a sharp underdevelopment of the anti-atelectatic substance - surfactant.

It is believed that the surfactant, located on the surface of the alveoli, lowers the surface tension and prevents them from falling.

Gastrointestinal test . Simultaneous with the onset of spontaneous breathing (and sometimes even earlier), the infant develops swallowing movements, during which air enters the gastrointestinal tract. At the same time, the stomach and intestines acquire the ability to swim in water, and the gastrointestinal test is based on this. To perform it, before removing the organs of the chest and abdomen, the stomach is tied up at the entrance and exit with two ligatures. Ligatures are also applied to the loops of the small and large intestines. The extracted complex, as well as the lungs, is tested for buoyancy. Swimming of the entire complex or only one stomach indicates a live birth. However, air can also enter the stomach during mechanical ventilation. In decayed corpses, this test is also not conclusive due to the formation of putrefactive gases in the intestines.

Usually the results of pulmonary and gastrointestinal tests are the same. However, other combinations of the results of these tests are also possible: the lungs float, the stomach and intestines sink - the newborn lived and breathed for a short time, during which the air did not have time to penetrate into the gastrointestinal tract. If the lungs sink and the stomach floats, this may be an indication of secondary atelectasis. True, the latter option is very rare.

Histological examination of the lungs is mandatory when establishing live and stillbirth. The alveoli and bronchioles of the stillborn lungs are collapsed, of various shapes and sizes, the alveolar epithelium is cubic, elastic fibers are arranged in the form of bundles and spirals. In the breathing lungs, the alveoli are straightened, their walls are thin, the alveolar epithelium is flattened, the capillaries are full-blooded, the elastic fibers follow the contours of the straightened alveoli. In some forms of congenital pulmonary insufficiency, especially in preterm infants, hyaline membranes are found in the alveoli and alveolar ducts. They do not occur in stillborns, so hyaline membranes can be considered a sign of live birth.

To establish live birth, it is also proposed to use a histological examination of the umbilical cord, umbilical ring and birth tumor, as well as the study of protein fractions of blood serum using the electrophoretic method and inorganic elements of organs and tissues of newborn corpses by the method of emission spectral analysis.

Registration N 23490

In accordance with Article 53 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

1. Approve:

medical birth criteria in accordance with Appendix No. 1;

the form of the birth document "Medical Birth Certificate" in accordance with Appendix No. 2;

the procedure for issuing a birth document "Medical Birth Certificate" in accordance with Appendix No. 3.

2. Recognize as invalid Appendix N 1 to the order of the Ministry of Health and Social Development of the Russian Federation of December 26, 2008 N 782n "On the approval and procedure for maintaining medical records certifying cases of birth and death" (registered by the Ministry of Justice of the Russian Federation on December 30, 2008 No. 13055).

Minister T. Golikova

Appendix No. 1

Medical birth criteria

1. The moment of birth of a child is the moment of separation of the fetus from the mother's body through childbirth.

2. The medical criteria for birth are:

1) the gestation period is 22 weeks or more;

2) the body weight of the child at birth is 500 grams or more (or less than 500 grams in case of multiple births);

3) the length of the child's body at birth is 25 cm or more (if the body weight of the child at birth is unknown).

3. A live birth is the moment of separation of the fetus from the mother's body through childbirth at a gestational age of 22 weeks or more with a newborn weighing 500 grams or more (or less than 500 grams for multiple births) or if the baby's body weight at birth is unknown, with a length the body of the newborn is 25 cm or more if the newborn has signs of a live birth (breathing, heartbeat, pulsation of the umbilical cord or arbitrary muscle movements, regardless of whether the umbilical cord has been cut and whether the placenta has separated).

4. The weight of a child's body at birth is the result of weighing a newborn, produced during the first hour of his life. Measurement of the length of the body of a newborn is carried out with its elongated position on a horizontal stadiometer from the top of the crown to the heels.

Newborns born weighing up to 2500 grams are considered low birth weight newborns, up to 1500 grams - very low birth weight, up to 1000 grams - extremely low birth weight.

5. Stillbirth is the moment of separation of the fetus from the mother's body through childbirth at a gestational age of 22 weeks or more with a newborn body weight of 500 grams or more (or less than 500 grams for multiple births) or if the baby's body weight at birth is unknown, with a length the body of the newborn is 25 cm or more in the absence of signs of a live birth in the newborn.

6. Medical organizations and individual entrepreneurs engaged in medical activities are recommended to make records of all newborns, born alive and dead, in the history of childbirth, the history of the development of newborns and in other medical documentation issued for newborns.

Appendix No. 2

Appendix No. 3

The procedure for issuing a birth document "Medical Birth Certificate"

1. This Procedure regulates the rules for storing, filling out and issuing a birth document "Medical Birth Certificate" (hereinafter referred to as the Medical Birth Certificate).

2. A medical birth certificate is issued:

1) the medical organization in which the birth took place;

2) during childbirth outside a medical organization:

a medical organization whose doctor provided medical care during childbirth;

the medical organization to which the mother applied after childbirth;

3) an individual entrepreneur engaged in medical activities (hereinafter referred to as an individual entrepreneur).

3. A medical birth certificate is issued for newborns born alive at a gestational age of 22 weeks or more with a newborn weighing 500 grams or more (or less than 500 grams for multiple births), or if the birth weight of a child is unknown, when the length of the body of the newborn is 25 cm or more if the newborn has signs of a live birth (breathing, heartbeat, pulsation of the umbilical cord or arbitrary muscle movements, regardless of whether the umbilical cord has been cut and whether the placenta has separated).

4. In case of multiple births, a medical birth certificate is issued for each child.

5. A medical birth certificate is issued to parents (one of the parents), and if the parents are not able to personally obtain a medical birth certificate - to a relative of one of the parents or another person authorized by the parents (one of the parents), or an official of a medical organization or an official to a person of another organization in which the mother was during childbirth or the child is, upon presentation of documents proving the identity of the parents (one of the parents) or the identity of the applicant and confirming his authority, against a receipt for state registration of birth, carried out in accordance with Federal Law dated 15 November 1997 N 143-FZ "On acts of civil status" *.

6. Medical organizations and individual entrepreneurs keep records of forms of medical birth certificates.

7. Forms of medical birth certificates, bound in books, are sealed with a signature and seal indicating the full name of the medical organization or the surname, name and patronymic of the individual entrepreneur. Forms of medical birth certificates are kept by the head of a medical organization or by an individual entrepreneur in the same way as the stubs of issued medical birth certificates, the entries in which must completely match the entries made in the relevant paragraphs of the medical birth certificate.

8. The series and number of the form of the medical certificate of birth is affixed by the manufacturer of the forms. Duplication of the series and numbers on such forms is not allowed.

9. Incorrectly completed forms of medical birth certificates and their stubs are crossed out, the entry "spoiled" is made and they remain in the book of forms of medical birth certificates.

10. In case of loss of a medical birth certificate, upon a written application of the person who received it, a medical birth certificate is issued with a note in the upper right corner "duplicate", filled in on the basis of the back of the medical birth certificate stored in a medical organization or with an individual entrepreneur.

11. Information about the issuance of a medical birth certificate (date of issue, number and series) must be indicated in the register of medical birth certificates.

12. The medical birth certificate is filled in with ink or a ballpoint pen without abbreviations. It is allowed to fill out a medical birth certificate using computer technology.

13. The corrected or crossed out text is confirmed by the entry "corrected to believe", the signature of the person filling out the medical birth certificate, and the seal of the medical organization or individual entrepreneur. Making more than two corrections to the medical birth certificate is not allowed.

14. Filling in the medical birth certificate is carried out by entering the necessary information and underlining the relevant designations.

15. All items of the medical birth certificate are subject to completion. If it is impossible to fill in one or another item of the medical birth certificate due to the lack of relevant information, an entry "unknown", "not established" or a dash is made.

16. When filling out a medical birth certificate, the full name of the medical organization, the number and date of issue of the license to carry out medical activities, the address of the medical organization and the code according to the All-Russian Classifier of Enterprises and Organizations (OKPO) are indicated.

17. In the case of filling out a medical birth certificate by an individual entrepreneur, his last name, first name, patronymic, address, number and date of issue of a license to carry out medical activities are entered in the appropriate lines.

18. When filling out a medical birth certificate, the All-Russian classifier of management documentation (OKUD) is indicated in the corresponding line.

19. When completing a medical birth certificate:

1) in paragraph 1 "The child was born", the date of birth (day, month, year), as well as the time (hours, minutes) are indicated. Information is taken from the history of childbirth, the history of the development of the newborn and other documents;

2) paragraph 2 "Last name, first name and patronymic" is filled in completely according to the identity document of the mother, and the surname, first name, patronymic (if any) of a minor mother who has not reached the age of fourteen years - on the basis of her birth certificate. In the absence of such information, the entry "unknown" is made;

3) in paragraph 3 "Date of birth" the day, month, year of birth are entered - on the basis of the data contained in the mother's identity document (for a minor mother who has not reached the age of fourteen years - in the birth certificate);

If the date of birth of the mother is unknown, dashes are put in all cells of paragraph 3. If only the year of birth is known (determined by a forensic expert), it is indicated in the corresponding cells, dashes are put in the remaining cells. When using computer technology to process the database, it is acceptable to use the letters "XX" instead of unknown information;

4) in paragraph 4 "Place of permanent residence (registration)" information is entered in accordance with the mark on registration at the place of residence made in the mother's identity document. In the absence of a mother's identity document, the entry "unknown" is made;

5) paragraph 5 "Locality" indicates whether the settlement, which is the place of residence (registration) of the mother, belongs to an urban or rural area;

6) paragraph 6 "Marital status" indicates whether a woman is or is not in a registered marriage. In the absence of a mother's identity document, the entry "unknown" is made;

7) in paragraph 7 "Education", filled in according to the mother, a note is made on education:

a) in the "professional" position:

"higher" is marked by those who graduated from a higher educational institution;

"incomplete higher" is marked by those who have completed at least two courses of a higher educational institution and received a diploma of incomplete higher education, as well as by those who have completed half or more of the study period in a higher educational institution;

"average" is marked by those who graduated from a secondary specialized educational institution;

"primary" is marked by those who graduated from an institution of primary vocational education;

b) in the "general" position:

"secondary (complete)" is marked by those who have graduated from a secondary general education institution and received a certificate of secondary (complete) general education;

"basic" is noted by those who graduated from the 9th grade of a secondary general education institution, an incomplete secondary school, as well as by students of grades 10-11 of a secondary general education institution;

"primary" is marked by those who graduated from an elementary educational institution, as well as by students of grades 4-9 of a secondary educational institution;

8) item 8 "Employment" is filled in according to the mother:

a) in the position "was employed in the economy":

"heads and specialists of the highest qualification level" include heads (representatives) of government and administration at all levels, including heads of institutions, organizations and enterprises, specialists in the field of natural and technical sciences, biological, agricultural sciences, health care, education;

"other specialists" include specialists of an average level of qualification in physical and engineering areas of activity, health care, education, financial, economic, administrative and social activities;

"skilled workers" include workers engaged in the preparation of information, paperwork, accounting and maintenance, workers in the service sector, housing and communal services, trade, agriculture, forestry, hunting, fish farming and fishing, including those producing products for personal consumption, small industrial enterprises, art crafts, construction, transport, communications, geology and exploration of subsoil, operators, apparatchiks, plant and machine operators;

"unskilled workers" include unskilled workers in all sectors of the economy;

"employed in military service" include persons whose positions, professions and occupations are related to the Armed Forces of the Russian Federation;

b) in the position "was not employed in the economy":

"pensioners" include non-working persons receiving a labor (old age, disability, loss of a breadwinner) or social pension;

"students and pupils" include students in institutions of primary, secondary and higher vocational education, students in general education institutions;

“working on a personal subsidiary farm” includes persons who were engaged in agricultural work and (or) raising livestock on their subsidiary plot, mainly for consumption on their farm;

the "unemployed" include persons seeking work and registered with the employment service as unemployed;

"other" includes persons (not employed in the economy) who are employed in the household, and persons without a fixed place of residence;

9) paragraph 9 "Term for the first visit to the doctor (paramedic, midwife)" is filled out on the basis of information from the individual card of the pregnant woman and the puerperal (discharge summary), the term for the first visit to the doctor (paramedic, midwife) is indicated in weeks;

10) item 10 "To whom, according to the account, the child was born to the mother" is filled in taking into account the dead and excluding stillborn children during previous births;

11) in paragraph 11 "Surname of the child", filled in at the request of the parents, the surname of the child is indicated only if the parents have the same surname;

12) point 12 "Place of birth" indicates the republic (territory, region), district, city (village) where the child was born. In the absence of such information, the entry "unknown" is made;

13) paragraph 13 "Locality" indicates whether the settlement belongs to an urban or rural area;

14) in paragraph 14 "Birth took place", a note is made on where the birth took place: in a hospital, at home, in another place or unknown;

15) in paragraph 15 "Gender" a note is made about the gender of the child (boy or girl). If it is impossible to visually determine the sex of the child, it is recorded at the request of the mother;

16) paragraph 16 "Child's body weight at birth" indicates the child's body weight in grams, established as a result of the first weighing carried out during the first hour of his life;

17) in paragraph 17 "Length of the child's body at birth" shall indicate the length of the child's body from the top of the crown to the heels, measured in centimeters;

18) in paragraph 18 "The child was born" the positions are noted:

a) "during singleton birth", if the birth is singleton (dashes are put in other positions);

b) "with multiple births", if the births are multiple (a dash is put in the position "with singleton births"):

in "which in a row" indicates the order of birth of a child in multiple births;

"number of births" indicates the number of births in multiple births;

19) in paragraph 19 "Person who took birth" indicates the person who took birth: a doctor, paramedic (midwife) or other person;

20) in paragraph 20, information about the person who filled out the medical birth certificate is indicated: last name, first name, patronymic of the doctor (paramedic, midwife), his position, his signature is put.

20. If the mother does not have a document proving her identity (for a minor - a birth certificate), to ensure state registration of birth, paragraphs 2-4 and 6 of the medical birth certificate and 2-4 stubs of the medical birth certificate are filled in according to the mother, which should be marked "according to the mother" in the upper right corner, certified by the signature of the head and the seal of the medical organization.

21. A medical birth certificate is signed by the head of a medical organization (or an authorized person) or an individual entrepreneur indicating the last name, first name, patronymic and certified by a round seal.

22. In paragraphs 1-7 of the spine of the medical birth certificate (hereinafter referred to as the spine), entries are made that fully correspond to the records made in the relevant paragraphs of the medical birth certificate.

23. In paragraph 8 of the spine, the surname, name, patronymic, position of the doctor (paramedic, midwife) who filled out the medical birth certificate is indicated, his signature is put.

24. In paragraph 9 of the spine, an entry is made about the surname, name, patronymic of the recipient of the medical birth certificate (from among the persons specified in paragraph 5 of this Procedure) and his relationship to the child, as well as data on the identity documents of the recipient of the medical certificate of birth (series, number, issued by whom) and his authority, date of receipt and signed by the recipient of the medical birth certificate.

* Collection of Legislation of the Russian Federation, 1997, N 47, art. 5340; 2001, N 44, Art. 4149; 2002, N 18, Art. 1724; 2003, N 17, Art. 1553; No. 28, Art. 2889; No. 50, Art. 4855; 2004, N 35, art. 3607; 2005, N 1, art. 25; 2006, N 1, art. 10; N 31, art. 3420; 2008, N 30, Art. 3616; 2009, N 29, Art. 3606; No. 51, Art. 6154; No. 52, Art. 6441; 2010, N 15, art. 1748; N 31, art. 4210; 2011, N 27, art. 3880; No. 49, art. 7056.

Ministry of Health of the Russian Federation and the State Statistics Committee of the Russian Federation

Instruction
on the definition of criteria for live birth, stillbirth, perinatal period

For the purposes of international comparability of domestic statistics in the field of perinatology and in connection with the transition to the criteria for live birth and stillbirth adopted by the World Health Organization, health authorities and institutions should adhere to the following definitions and concepts of live birth, stillbirth, perinatal period and parameters of the physical development of the newborn (fetus).

1. Live birth

Live birth is the complete expulsion or removal of the product of conception from the mother's body, regardless of the duration of pregnancy, and the fetus after such separation breathes or shows other signs of life, such as heartbeat, pulsation of the umbilical cord or voluntary movements of the muscles, regardless of whether the umbilical cord has been cut and separated placenta. Each product of such a birth is regarded as a live birth.

2. Stillbirth

Stillbirth is the death of the product of conception before its complete expulsion or removal from the mother's body, regardless of the duration of pregnancy. Death is indicated by the absence of breathing in the fetus after such separation or any other signs of life, such as heartbeat, umbilical cord pulsation, or voluntary muscle movements.

3. Weight at birth

Birth weight is the result of the first weighing of the fetus or newborn, recorded after birth. This weight should preferably be established within the first hour of life before significant postnatal weight loss occurs. Measurement of the length of a newborn (fetus) must be made with its extended position on a horizontal stadiometer.

Newborns (fetuses) born weighing less than 2500 g are considered low birth weight fetuses; before 1500 - very low; up to 1000 - with extremely low.

4. Perinatal period

The perinatal period begins at 28 weeks of gestation, includes the period of childbirth, and ends after 7 complete days of a newborn's life.

5. Health care institutions register in medical records all those born alive and dead, having a body weight at birth of 500 g or more, regardless of the presence of signs of life, in the manner established by order of the Ministry of Health of the USSR 12.06.86 N 848 p.p.1, ( appendix 2 and 3).

6. The following are subject to registration in the registry office:

Born alive or dead with a body weight of 1000 g or more (or, if the birth weight is unknown, the body length is 35 cm or more or the gestation period is 28 weeks or more), including newborns weighing less than 1000 g - with multiple births;

All newborns born with a body weight from 500 to 999 g are also subject to registration with the registry office in cases where they have lived more than 168 hours after birth (7 days).

For each case of death in the perinatal period, a "Certificate of Perinatal Death" is filled out. Fetuses born with a body weight of 500 grams or more are subject to pathological examination.

Registration in the registry offices of stillborns and cases of death of newborns in the perinatal period is carried out by those institutions that issue a certificate of perinatal death in the manner established by order of the Ministry of Health of the USSR N 1300 of November 19, 1984.

7. For the purpose of international comparability of domestic statistics, when calculating the perinatal mortality rate, the number of fetuses and newborns with a body weight of 1000 g or more (or, if birth weight is unknown, a body length of 35 cm or more or a gestational age of 28 weeks or more) is used.

Sectoral perinatal mortality statistics, in accordance with WHO recommendations, include all births of fetuses and newborns weighing 500 g or more (or, if birth weight is unknown, body length of 25 cm or more or gestational age of 22 weeks or more). ).

live birth- this is the complete expulsion or extraction of the product of conception from the mother's body, regardless of the duration of pregnancy, which, after such separation, breathes or shows other signs of life, such as heartbeat, muscle contraction, pulsation of the umbilical cord, regardless of whether it is cut or not, the placenta has detached. Each product of such a birth is considered a live birth.

Fetal death (stillborn fetus) is the death of the product of conception before its complete expulsion or removal from the mother's body, regardless of the duration of pregnancy. Death is indicated by the fact that after such a separation, the fetus does not breathe or show any other signs of life, such as a heartbeat, pulsation of the umbilical cord, or certain muscle movements.

Full-term newborn- a child born at a gestational age of 37 weeks to 42 weeks with average body weight. In a full-term newborn, the head makes up 1/4 of the body. It is important to determine the shape of the head and the circumference of the skull at birth . During the first 2-3 days of life, the configuration of the skull is preserved in the child., which is due to the passage of the head through the birth canal of the mother. Variants of the norm include such forms of the skull as dolichocephalic, brachycephalic, tower-shaped skulls. The circumference of the head in full-term babies is 33-36 cm, it can exceed the circumference of the chest by 1-2 cm. The large crown is open, its dimensions normally do not exceed 2.5-3 cm. The small crown is no more than 0.5 cm - can be open in 25-30% of full-term newborns.

Premature newborn- a child born between 24 and 37 completed weeks of gestation.

Postterm newborn- a child born at 42 completed weeks of gestation or more.

When comparing the indicators of the physical development of the child and the gestational age(gestational age) distinguish the following groups of children:

1. Newborns with a large body weight.

2. Newborns with normal physical development for a certain gestational age.

3. Newborns with low body weight for gestational age or newborns with intrauterine growth retardation.

4. Newborns with intrauterine (congenital) malnutrition.

Material from the Forensic Medical Encyclopedia

Definitions and criteria for live births and stillbirths are contained in Order No. 318 of the Ministry of Health of the Russian Federation and Resolution No. 190 of December 04, 1992 of the State Committee of the Russian Federation on Statistics “On the transition to the criteria for live births and stillbirths recommended by the World Health Organization”.

Criteria for live birth and stillbirth

Live birth criteria

A live birth is considered to be the complete expulsion or removal of the product of conception from the mother's body, regardless of the duration of pregnancy, regardless of whether the umbilical cord has been cut and whether the placenta has separated, and the fetus after such separation:

  • breathing, or
  • has a heartbeat, or
  • pulsation of the umbilical cord, or
  • voluntary muscle movements.

To establish a live birth, the presence of one sign is sufficient.

Criteria for stillbirth

Stillbirth is recognized as “the death of the product of conception before its complete expulsion or removal from the mother’s body, regardless of the duration of pregnancy”, while death is indicated by the absence of the fetus after such separation:

  • breath,
  • heartbeat,
  • cord pulsations,
  • voluntary muscle movements.

Forensic definition of live birth and stillbirth

In forensic medicine, it is believed that the morphological manifestations of the fetal heartbeat, umbilical cord pulsation and voluntary muscle movements have not yet been established, and therefore, in practice, the solution to this issue is still limited to determining the presence or absence of traces of extrauterine respiration of the newborn.

Establishment of signs of extrauterine respiration

One of the first proposed signs of live birth was proposed in 1863 (Elsesser's sign).

Pulmonary swim test

Pulmonary swimming tests (Galen's test, Balthazar's test, Taranukhin's test, Trachtenberg's test) are an addition to the macroscopic examination of the lungs and pleura. In most cases, a microscopic examination of the lungs is also necessary. It should be emphasized that a lung test without a detailed macro- and microscopic examination of the lungs is not sufficient. The pulmonary hydrostatic test is considered positive if the lungs or parts of them float on the surface of the water. A negative test is considered when all parts of the lungs sink when immersed in water. A positive lung test in the absence of putrefactive tissue changes indicates the presence of air in the lungs, that is, it indicates that the child was born alive and breathed after birth ...

In some cases, you need to keep in mind the possibility of straightening the lungs of a stillborn as a result of artificial respiration.

Great difficulties in evaluating the results of the pulmonary swimming test arise when examining lungs with putrefactive changes. In such cases, the accumulation of putrefactive gases in the lung tissue leads to the emergence of airless lungs. When conducting a lung test, a method is recommended, which, however, does not always give a reliable result, is a strong squeezing of pieces of the lungs under water. Sometimes, especially with mild putrefactive changes, using this technique, it is possible to displace putrefactive gases from the lungs. If, after squeezing a piece, it sinks to the bottom, then this indicates that the tissue is airless. The method is based on the fact that the decay of non-breathing lungs begins with the interstitial tissue, from where the gas is easily displaced. In breathing lungs, putrefactive processes begin from the lumen of the respiratory tract, and putrefactive gases, when combined with air, accumulate in the lumens of the pulmonary alveoli, from where it is very difficult to expel them with pressure on the lung tissue.

Bushu-Haberda test

Determining the weight of the volume of water displaced by the lungs

Main article: Daniel method

X-ray examination of the lungs and gastrointestinal tract for the presence of air

Main article: Dillon's test

Gastrointestinal swimming test

In breathing newborns, the stomach and intestines, taken from a corpse and immersed in a vessel of water, float to the surface, since they contain air. Gastrointestinal swim test is positive in a stillborn child who was given artificial respiration. In the case of putrefactive changes, a positive swimming test is explained by the presence of gases in the lumen of the stomach and intestines.

Test for the presence of air in the middle ear cavity

The test is based on the phenomenon of air entering the auditory tube and tympanic cavity during the first respiratory movements.

Method of emission spectral analysis of lung tissue

Establishment of signs of extrauterine pulsation of the umbilical cord

Funicular hematoma

At the same time, it should be noted that an objective morphological confirmation of the umbilical cord pulsation after the birth of the fetus is a hemorrhage into the wall of the umbilical vessels and jelly warts in the area of ​​the umbilical cord division with the formation of a massive intrafunicular hematoma. However, the presence or absence of this sign of live birth directly depends on the time of crossing the umbilical cord, since an intrafunicular hematoma is formed only when the umbilical cord is separated against the background of pulsating umbilical vessels immediately after the birth of a child. In addition, spontaneous or artificial damage or even separation of the umbilical cord is possible until the fetus is completely expelled from the mother's birth canal, for example, during childbirth complicated by prolapse and compression of the umbilical cord. In this case, bleeding from damaged umbilical vessels can be the cause of intranatal fetal death, and the presence of an intrafunicular hematoma can be a reason for erroneously establishing a live birth.

One of the factors that make it difficult to use the presence of a funicular hematoma as a reliable sign of a live birth is the possibility of admission to a forensic medical examination of a newborn corpse without an afterbirth. It is also important that during spontaneous childbirth outside a medical institution in the absence of specialized medical care, the umbilical cord of a live-born fetus is usually cut after the pulsation of the umbilical vessels stops (that is, without the formation of a funicular hematoma) or is not performed at all. Considering the above, one should agree with the opinion of the authors, who consider the presence of signs of extrauterine respiration to be practically the only reliable criterion for a live birth.