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FM2.{16,25},FM14.6 | Conducting & Reporting the Medico-legal Autopsy — SDL Guide (Part 2)

Post-mortem Artefacts: Recognition and Distinction from Injuries

Post-mortem artefacts are changes in the body that occur after death — due to resuscitation attempts, handling, transport, insect activity, or decomposition — that can mimic or obscure ante-mortem injuries. Failure to recognise artefacts is one of the most consequential errors in forensic pathology: misattributing a CPR fracture to a homicidal assault, or failing to recognise insect pseudo-wounds as post-mortem, can change the manner-of-death determination and alter the course of criminal proceedings.

Resuscitation artefacts are the most practically important category for practising clinicians because they are created by healthcare providers:
- Anterior rib fractures (typically ribs 3–7 bilaterally, near the costochondral junction) from external cardiac compression during CPR — these are stereo-typically anterior and bilateral, unlike assault rib fractures which are often unilateral and posterior
- Sternal fractures from CPR — typically transverse, mid-sternum
- Laryngeal and tracheal contusions and mucosal lacerations from endotracheal intubation
- Needle marks and subcutaneous bruising from IV access, arterial lines, or emergency injections
- Defibrillation burns — small, well-defined, oval marks on the chest corresponding to electrode pad positions
- Gastric distension and aspiration from bag-mask ventilation

The key to differentiating resuscitation artefacts from ante-mortem injuries is the clinical history and the pattern: bilateral anterior rib fractures in a known resuscitation case are almost certainly artefactual; isolated posterior rib fractures in a person who was never resuscitated require injury explanation.

Insect activity artefacts occur primarily at natural orifices — mouth, nose, eyes, anus, genitalia — where blowfly larvae (maggots) create tissue defects that can resemble lacerations or excoriations. In advanced decomposition, these may be extensive. The forensic physician must distinguish the irregular, shallow, progressive defects of insect activity from the directed, patterned defects of ante-mortem injury.

Handling and transport artefacts include: skin pressure marks from body bags or transport surfaces (mimicking ligature marks); postural lividity changes if the body was moved before livor fixation; and abrasions from body movement across surfaces.

Decomposition artefacts include: blebs and blistering (mimicking burns or ante-mortem contusions); skin slippage (making precise injury measurement impossible); green discolouration masking bruises; and bloating that distorts facial and body landmarks.

The documentation strategy: when artefacts are present, record them specifically, explain their probable cause, and distinguish them explicitly from the findings attributed to ante-mortem events in your opinion section.

Post-Mortem Artefacts vs Ante-Mortem Injuries: Recognition and Differentiation

Applied Practice: Writing the PM Report and Opinion

The post-mortem report is the primary output of the medico-legal autopsy and the document on which criminal and civil proceedings depend. Competency FM14.6 requires you to prepare PM reports for at least 15 cases of varied aetiology in supervised or simulated practice. Understanding the structure of the report and the standards for the opinion section is therefore a core competency, not an adjunct.

The standard government PM report form in India has the following structure:

Part 1 — Identification details: case number, date, time, authority (CRPC provision and form number), identity of deceased, referring officer details.

Part 2 — External examination findings: post-mortem changes (state and time estimate), build, identifying features, clothing, injuries (each numbered, described with location/size/type/direction/age).

Part 3 — Internal examination findings: each body cavity in sequence; organ descriptions; fluid collections; specific pathological findings.

Part 4 — Specimens preserved and dispatched: complete list of all specimens, preservatives, containers, FSL forwarding number.

Part 5 — Opinion: the forensic physician's professional conclusions, structured as:
- (a) Cause of death — in ICD three-part format: immediate cause, antecedent cause, underlying cause
- (b) Manner of death — natural/accidental/homicidal/suicidal/undetermined, with referenced findings
- (c) Mechanism of death — the physiological pathway
- (d) Other conclusions — PMI estimate, presence of ante-mortem injuries, identity of wounds
- (e) Provisional vs final opinion — where FSL results are awaited, the opinion must be clearly marked 'provisional pending toxicology'

The opinion section demands absolute discipline. Two rules must never be broken: (1) every conclusion in the opinion must be referenced to specific numbered findings in the observations section — 'homicide based on findings 3, 7, and 12'; (2) the physician must distinguish between what is directly observed ('incised wound measuring 4 cm × 2 cm over the left temporal region') and what is inferred ('consistent with a sharp-edged weapon'). The word 'consistent with' is the appropriate hedge — not 'caused by' (which implies certainty the examination cannot provide) and not 'probably from' (which is imprecise).

For FM14.6's simulated environment, practice writing reports for: drowning, hanging, firearm injuries, blunt force trauma, sharp force trauma, and poisoning cases — the core repertoire of medico-legal autopsy aetiologies.

Structure of the Standard Indian Government Post-Mortem Report Form (Five Parts)