Post-mortem development of conjunctival petechiae following temporary prone position

Abstract

Conjunctival petechiae are an important diagnostic finding in external examination of forensic cases, being a sign of possible mechanical compression of the neck and jugular veins (e.g. choking, strangulation). Nevertheless, it is well known, that strong congestion of the conjunctival blood vessels might lead to the development of petechiae in the perimortal and early post mortem period, e.g. due to a head down position of the body. By now it remains unclear, whether a short term horizontal prone position of a body can lead to the development of conjunctival petechiae in the early post mortem period, a situation that might occur in everyday forensic casework. Therefore, we investigated the occurrence of conjunctival petechiae in 20 deceased at <12h after death following a prone position of 2h. Petechiae developed in 8 cases. Therefore, our results for the first time give evidence that conjunctival petechiae can be observed after a short-term horizontal prone position of a body in the early post mortem period, influencing the assessment of future forensic cases. Furthermore, statistical analysis revealed significant correlations with the examination method used to ectropionise the eyelids (forceps vs. cotton swab) and preceding resuscitation attempts. The latter observations should be considered in future research on the phenomenon.