Abstract
The present study aimed to determine whether postmortem period, physical constitution, cause of death, and cardiopulmonary resuscitation are associated with positional changes in the postmortem appearance of conjunctival petechiae. We retrospectively investigated serial forensic autopsies from 6 h to 6 days postmortem (n = 442; male, 303; female, 139; median age, 62 years; range, 0–100 years). The causes of death were sharp instrument injury, blunt force trauma, fire, intoxication, asphyxia, drowning, hypothermia, hyperthermia, acute heart failure, and natural causes. Of these, 28 (male, n = 18; female, n = 10) were aged ≤5 years. Palpebral conjunctival petechiae were initially assessed at autopsy in supine bodies, then reassessed in prone bodies after 30 min. Among 414 bodies, 291 (70.2%) and 123 (29.7%) who were aged between 6 and 100 years, and 18 (64.2%) and 10 (35.7%) aged <5 years at the time of death, were discovered in the supine and prone positions, respectively. The amounts of petechiae increased within 1.5 days postmortem, but not in those discovered in the prone position. The rates at which petechiae increased were higher in supine overweight bodies (BMI ≥ 25.0) and in those who were discovered supine and had died of asphyxia or drowning (37.5%). Cardiopulmonary resuscitation for bodies discovered in the supine and prone positions did not statistically affect the occurrence of petechiae. Several postmortem factors can cause hypostatic blood redistribution that manifests as increased amounts of petechiae in the palpebral conjunctivae.
Highlights
Conjunctival petechiae comprise an important forensic indicator of mechanical compression of the jugular veins caused by external force to the neck [1]
Postmortem experiments on stillborn children conducted by Haberda in 1898 revealed the development of position-induced conjunctival petechiae [8]
The present study found a higher frequency of numerous petechiae in bodies that had been discovered in the prone, compared with the supine position (39.8% vs. 24.6%)
Summary
Conjunctival petechiae comprise an important forensic indicator of mechanical compression of the jugular veins caused by external force to the neck [1]. Consensus in the literature suggests that the pathogenesis of conjunctival petechiae is related to the combined effects of increased cephalic venous pressure and hypoxic damage to endothelial cells [2, 3]. The occurrence of petechiae does depend on external force to the neck, and it does change posthumous-. The present study aimed to identify factors that were involved in the occurrence of conjunctival petechiae in 442 forensic autopsies. Factors included postmortem changes in body position, elapsed time after death, body mass index (BMI), cause of death and resuscitation
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