Coffin birth, also known as postmortem fetal extrusion, [1] [2] is the expulsion of a nonviable fetus through the vaginal opening of the decomposing body of a deceased pregnant woman due to increasing pressure from intra-abdominal gases. This kind of postmortem delivery occurs very rarely during the decomposition of a body. The practice of chemical preservation, whereby chemical preservatives and disinfectant solutions are pumped into a body to replace natural body fluids (and the bacteria that reside therein), have made the occurrence of "coffin birth" so rare that the topic is rarely mentioned in international medical discourse.
Typically during the decomposition of a human body, naturally occurring bacteria in the organs of the abdominal cavity (such as the stomach and intestines) generate gases as by-products of metabolism, which causes the body to swell. In some cases, the confined pressure of the gases can squeeze the uterus (the womb), even forcing it downward, and it may turn inside-out and be forced out of the body through the vaginal opening (a process called prolapse ). If a fetus is contained within the uterus, it could therefore be expelled from the mother's body through the vaginal opening when the uterus turns inside-out, in a process that, to outward appearances, mimics childbirth. The main differences lie in the state of the mother and fetus and the mechanism of delivery: in the event of natural, live childbirth, the mother's contractions thin and widen the cervix to expel the infant from the womb; in a case of coffin birth, built-up gas pressure within the putrefied body of a pregnant woman pushes the dead fetus from the body of the mother.
Cases have been recorded by medical authorities since the 16th century, though some archaeological cases provide evidence for its occurrence in many periods of human history. While cases of postmortem fetal expulsion have always been rare, the phenomenon has been recorded under disparate circumstances and is occasionally seen in a modern forensic context when the body of a pregnant woman lies undisturbed and undiscovered for some time following death. There are also cases whereby a fetus may become separated from the body of the pregnant woman about the time of death or during decomposition, though because those cases are not consistent with the processes described here, they are not considered true cases of postmortem fetal extrusion.
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The cause of postmortem fetal extrusion is not completely understood, as the event is neither predictable nor replicable under experimental conditions. Evidence has accumulated opportunistically and direct observation is serendipitous. [2] While it is possible that more than one cause can produce the same result, there is an accepted hypothesis, [2] [3] based on established research in the fields of biochemistry and forensic taphonomy, Note a [4] and further supported by observational research, that accounts for the taphonomic mechanisms that would result in the most often encountered cases of postmortem extrusion of a non-viable fetus.
Typically, as a dead body decomposes, body tissues become depleted of oxygen and the body begins to putrefy; anaerobic bacteria in the gastrointestinal tract proliferate and as a result of increased metabolic activity, release gases such as carbon dioxide, methane, and hydrogen sulfide. [5] [6] These bacteria secrete exoenzymes to break down body cells and proteins for ingestion which thus weakens organ tissues. Increasing pressure forces the diffusion of excessive gases into the weakened tissues where they enter the circulatory system and spread to other parts of the body, causing both torso and limbs to become bloated. These decompositional processes weaken the structural integrity of organs by separating necrotizing tissue layers. [6] Bloating usually begins from two to five days after death, depending on external temperature, humidity, and other environmental conditions. [7] As the volume of gas increases, the pressure begins to force various body fluids to exude from all natural orifices. [8] It is at this point during the decomposition of a pregnant body that amniotic membranes become stretched and separated, and intra-abdominal gas pressure may force the eversion and prolapse of the uterus, Note b which would result in the expulsion of the fetus through the vaginal canal. [9] It has been observed that the bodies of multiparous women Note c are more likely to spontaneously expel the fetus during decomposition than those who died during their first pregnancy, because of the more elastic nature of the cervix. [10]
Numerous documented cases of postmortem fetal extrusion were described in the medical compendium Anomalies and Curiosities of Medicine, first published in 1896. [3] The earliest presented case occurred in 1551 when a pregnant woman was tried and hanged by the courts of the Spanish Inquisition. Four hours after her death, and while the body still hung by the neck, two dead infants were seen to fall free of the body. This is unusual for the short amount of time elapsed between death and the postmortem delivery. As no information is given regarding other ambient circumstances, it is unclear whether the onset of putrefaction was accelerated, or if other causal factors were at work. [4] In the city of Brussels, in 1633, a woman died in convulsions and three days later a fetus was spontaneously expelled. In Weissenfels, in 1861, postmortem fetal extrusion was observed sixty hours after the death of a pregnant woman. Other cases are described, though only a few describe the unexpected discovery of fetal remains following exhumation. Most cases occurred before burial; in some of these, the body was in the casket while in other cases the body was still on its deathbed or on a bier. [3]
During the late 19th century, modern embalming techniques were developed, whereby preservative and disinfectant chemical compounds (such as formaldehyde) are pumped into a body, flushing out the body's natural fluids, and with them the bacteria that flourish during putrefaction and generate the gases that comprise the active force behind the expulsion of the fetus. [11] However, the phenomenon was still recognized by medical science and in 1904, John Whitridge Williams wrote a textbook on obstetric medicine that included a section on "coffin birth". [10] Although the text has remained an important reference in obstetrics, the subject, whether called "coffin birth" or "postmortem fetal extrusion", was excluded by its 13th edition in 1966, [12] and was not mentioned in the edition published in 2009. [13] The subject was discussed in German medical literature during the 20th century, [14] [15] [16] [17] though more detailed case reports in the forensic literature have been published recently. [1] [2]
In 2005, the body of a 34-year-old woman, eight months pregnant, was discovered in her apartment in Hamburg, Germany. [2] The body was bloated and discolored, and upon initial examination, it was found that the head of the fetus had made its appearance in the vaginal opening. At autopsy, medical examiners found that both the head and shoulders of the fetus had emerged, and concluded that it was a case of postmortem fetal extrusion in progress. The woman, who had given birth twice before, had died of a heroin overdose. [2] The case was unusual and serendipitous, as it was the first modern case in which medical practitioners were able to document a case of postmortem fetal extrusion in progress. [2]
In 2008, the body of a 38-year-old woman, seven months pregnant, was discovered in an open field four days after she had disappeared from her residence in Panama. [1] A plastic bag had been left over her head, and she had been gagged; the case was ruled a homicide. The body had suffered from the tropical heat and high humidity, and was bloated and highly discolored. At autopsy, the remains of the fetus were discovered in the woman's undergarments. Although the fetus was in a similar state of decomposition, the umbilical cord was intact and still attached to the placenta inside the uterus. This was the first forensic case in which it could be concluded that coffin birth had occurred based on the position of the bodies and the clear attachment of the umbilical cord to the un-expelled placenta. [1]
In 2019, the autopsy reports in the case of the Watts family homicides in August 2018 revealed that Shanann Watts (who had been 15 weeks pregnant at the time of her murder) had been found in a shallow grave and that the fetus had been expelled from her body, along with the placenta and umbilical cord. [18]
Postmortem fetal extrusion can be very difficult to recognize once a body has undergone complete skeletonization, and bioarchaeologists are often very cautious about asserting the presence of this phenomenon. [19] [20] There are numerous cultural reasons why a mother and an infant might be interred together, so the joint presence of neonatal remains and an adult female is not taken as conclusive evidence of postmortem fetal extrusion; [19] [20] however, there have been excavated burials where the position of a set of fetal remains relative to those of an adult female supported this hypothesis. There are a few general guidelines when an archaeologist is assessing the placement of the fetus and the adult: [19]
In 1975, it was reported that during the excavation of a medieval cemetery in Kings Worthy, England, fetal remains appeared to lie within the birth canal of the skeleton of a young woman, with the fetal cranium external to the pelvic outlet and between the two femora (thigh bones) and the fetal leg bones clearly within the pelvic cavity. [22] Other cases of coffin birth at archaeological sites have been described, such as in 1978 at a Neolithic site in Germany, [24] at a medieval site in Denmark in 1982, [23] and in 2009 at an Early Christian period site at Fingal, Ireland. [21] A coffin birth was also described in a 2011 episode of the BBC show History Cold Case , featuring the Roman era remains of a woman and three neonates discovered near Baldock, Hertfordshire. [25] Another was identified in 2006 in a 14th-century Black Death cemetery in Genoa, Italy. [26]
Because postmortem fetal extrusion is so rare, and occurs under highly idiosyncratic conditions regarding the individual and the ambient environment, [3] [5] [10] [19] this phenomenon has not been studied for possible applications to forensic investigation. Even if the study of postmortem fetal extrusion could lead to improved investigative methods, experimental research would be highly problematic. At present, forensic scientists have at their disposal an array of established techniques and procedures for a death investigation at the stages of decomposition when postmortem fetal extrusion typically occurs. [9]
In archaeology, the study of mortuary context, that is, the interpretation of the postmortem treatment of the dead, whether an individual or as pertains to patterns within a group, has led to the development of hypotheses on social status and/or hierarchy regarding many cultures, ancient and extant. [23] [27] [28] [29] [30] In addition, the determination of whether or not delivery actually occurred before death has a bearing on analyses of the mother's population, as the concentration of trace elements differ markedly between the skeletons of prepartum adult women (before giving birth) and women who are lactating; the identification of coffin birth would lead to more accurate analyses of the number of lactating women in a population or the rate of maternal mortality. [31] It is therefore necessary for investigators to be able to recognize postmortem fetal extrusion when encountered in an excavated burial. [20] [32]
There are also many cases where the remains of the fetus are found separate from the body of the mother, but expulsion was not through the birth canal, and separation of the two bodies may have been influenced by external environmental factors. The process of separation is so unusual that a specific term for the phenomenon may not have been proposed to the scientific community. These cases may have comparable results, but they are not cases of postmortem fetal extrusion.
In April 2003, the body of Laci Peterson washed up on a shore near San Francisco Bay; she had been pregnant when she disappeared four months earlier, and the fetus she had been carrying was discovered on a separate beach. When questioned by the media, medical authorities initially speculated that a "coffin birth" might have occurred. [33] However, at autopsy the cervix was found to be in a prepartum condition. Medical examiners later concluded that while Peterson's body was in the bay, the skin over the abdominal cavity had ruptured due to natural decompositional processes. Seawater entered the abdominal cavity and washed out most of the internal organs, along with the fetus. [34]
In 2007, a 23-year-old woman in India, over eight months pregnant, hanged herself after contractions had begun. [35] A viable infant was spontaneously delivered unassisted from the woman's body, which was suspended by the neck. The healthy infant was found on the floor, still tethered to the body of the mother by the umbilical cord. The primary cause of the delivery was the otherwise normal contractions, which had begun before death, and was therefore not related to processes of decomposition. [6] [35] While this is not postmortem fetal extrusion, it may be referred to as a case of postmortem delivery, a term which is applied to a broad range of techniques and phenomena with a resultant delivery of a live infant. [36]
In 2008, in Germany, a 23-year-old woman in her third trimester was involved in a motor vehicle accident and died; the non-viable fetus was found between her feet. [37] The vehicle caught fire following initial impact. The woman died of blunt trauma, and her body burned in the car. Investigators came to the conclusion that the extreme heat of the fire burned away epidermal and subcutaneous tissue around the abdominal cavity, after which the anterior aspect of the uterus ruptured, causing the fetus to spill out of the uterine cavity and land on the floor between the woman's feet. The umbilical cord was still intact and connected the fetus to the placenta through the ruptured wall of the uterus. Unlike the woman, who suffered fourth-degree burns over her entire body, the body of the fetus was relatively undamaged. [37] Because the primary cause of separation from the mother's body was thermally induced traumatic rupture of the abdominal and uterine cavities; traumatic separation was not related to normal decompositional processes; and expulsion of the fetus did not involve passage through the birth canal, this is not considered a case of postmortem fetal extrusion. [37]
Whales can be subject to postmortem fetal extrusion. Many species float when dead, due to the gases of putrefaction. Drift whales that wash up on shore, and the carcasses of hunted whales, if not flensed (stripped of blubber) and processed in a timely manner, pose a risk. Tim Flannery wrote that "A rotting whale could fill with gas to bursting, ejecting a fetus the size of a motor vehicle with sufficient force to kill a man." [38]
The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more fertilized eggs until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.
Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or child at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.
Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In developed countries, most deliveries occur in hospitals, while in developing countries most are home births.
In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse". Prolapse means "to fall out of place", from the Latin prolabi meaning "to fall out".
The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic symphysis. In females, the pubic symphysis is attached to the suspensory ligament of the clitoris. In most adults, it can be moved roughly 2 mm and with 1 degree rotation. This increases for women at the time of childbirth.
A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term have a breech baby. Due to their higher than average rate of possible complications for the baby, breech births are generally considered higher risk. Breech births also occur in many other mammals such as dogs and horses, see veterinary obstetrics.
Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a standard part of prenatal care in many countries, as it can provide a variety of information about the health of the mother, the timing and progress of the pregnancy, and the health and development of the embryo or fetus.
Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.
Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present. Disability or death of the mother or baby may result.
Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labour. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.
Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.
Fetal surgery, also known as antenatal surgery or prenatal surgery, is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat congenital abnormalities in fetuses who are still in the pregnant uterus. There are three main types: open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.
A vaginal delivery is the birth of offspring in mammals through the vagina. It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, as it is correlated with lower morbidity and mortality than caesarean sections (C-sections), though it is not clear whether this is causal.
In obstetrics, asynclitic birth, or asynclitism, refers to the malposition of the fetal head in the uterus relative to the birth canal. Many babies enter the pelvis in an asynclitic presentation, but in most cases, the issue is corrected during labor. Asynclitic presentation is not to be confused with a shoulder presentation, where the shoulder leads first.
Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.
Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy.
Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children. Failure to progress can take place during two different phases; the latent phase and active phase of labor. The latent phase of labor can be emotionally tiring and cause fatigue, but it typically does not result in further problems. The active phase of labor, on the other hand, if prolonged, can result in long term complications.
Emergency childbirth is the precipitous birth of an infant in an unexpected setting. In planned childbirth, mothers choose the location and obstetric team ahead of time. Options range from delivering at home, at a hospital, a medical facility or a birthing center. Sometimes, birth can occur on the way to these facilities, without a healthcare team. The rates of unplanned childbirth are low. If the birth is imminent, emergency measures may be needed. Emergency services can be contacted for help in some countries.
The anomaly scan, also sometimes called the anatomy scan, 20-week ultrasound, or level 2 ultrasound, evaluates anatomic structures of the fetus, placenta, and maternal pelvic organs. This scan is an important and common component of routine prenatal care. The function of the ultrasound is to measure the fetus so that growth abnormalities can be recognized quickly later in pregnancy, to assess for congenital malformations and multiple pregnancies, and to plan method of delivery.