**4. External examination**

The body should not be embalmed before the autopsy [3]. A careful external examination should be made to assess any external abnormality. The external features may provide the only information necessary to make the diagnosis of a malformation syndrome. In case of foetal bodies, the measurement of head circumference, chest circumference (at the level of the nipples) and abdominal girth should be measured. The total vertex to heel length has to be noted for an idea regarding maturity and intra-uterine age. The head contour assumes importance in such cases as instrumental delivery may produce trauma mimicking actual violence. Other important procedures include assessing the patency of natural orifices such as the nose, mouth, ears, anus. Evidence of petechial haemorrhages should be looked for in the eyes. For hospital deaths or even in cases found dead after delivery, careful examination of the umbilical cord is paramount; the edges should be checked for sharp cuts, evidence of tearing or gnawing. All puncture marks, needle marks and other injuries should be noted. The skin of the foetus should be examined for staining, discolouration and petechiae. Rodents gnaw away soft tissues of body especially ear, nose, lips etc. They produce shallow craters with irregular border nibbling with leave long grooves and lacks vital reaction [5].

A rough classification exists to help in estimation of maceration (aseptic autolysis) though the changes mentioned are variable depending on temperature and condition of body storage [2].

12 hours – slippage of skin is noted. 24 hours – blebs are formed on the skin. 48 hours – there is sloughing of the skin with blebs rupturing and haemolysis is noted in the viscera. 5 days – the brain liquefies, the cranial sutures overlap (Spalding's sign) and the calvarium collapses. 7 days – the joints get lax and are dislocated.

### **4.1 External measurements**

As already explained above, the following careful measurements should be made with a ruler and a length of string, and compared to tables of normal values to aid assessment of gestational age and allow assessment of growth retardation:


**Figure 1.** *Measuring the length of umbilical cord.*

If any abnormality is suspected, relevant radiological investigations (X-rays) and photography is done [2]. In situ photographs can be very helpful, preserving anatomic relationships and depicting visceral lesions before evisceration and fixation (**Figure 1**).
