DR.

ROMAN AL MAMUN

Lecturer and Autopsy Surgeon

Forensic Science and Toxicology

Determination of gestational age is important in civil and criminal cases.

Determination of gestational age is important in civil and criminal cases.

Fetal age is usually estimated by measuring physical parameters:

Crown-heel length & weight of fetus and by noting morphological features, organ development and
appearance of ossification centers.

Other method for evaluation of age includes:

Fetal biometric measurements by ultrasound.

The parameter includes fetal crown-rump length, biparietal diameter, head circumference, abdominal
circumference,femoral length, foot length and appearance of fetal heel ossification centers.

Estimating gestational age when a fetus dies is a specialized task in forensic medicine .

Techniques for determining the gestational age of fetal or perinatal (around the time of birth) remains
are mainly aimed at calculating the time since conception, and at determining if a specific disease could
be the cause of fetal loss.

The World Health Organization has set the viability threshold at 20 weeks gestation.

Fetal death is defined as the death of a product of conception (fetus) before complete expulsion or
extraction from its mother, regardless of the duration of pregnancy.

Fetal death is divided into three categories:

1.Early 2.Intermediate and 3. Late.
Early fetal death occurs at less than 20 completed weeks of gestation; intermediate fetal death occurs
from week 20 through week 27 of gestation; and late fetal death occurs at 28 or more completed weeks
of gestation.

Proper classification of the fetal age into the correct classification has important ethical, legal, and also
clinical implications.

Depending on the general condition of fetal remains, forensic specialists might face difficulties with age
estimation.

The whole skeletal length was probably the first marker used for fetal assessment and is considered
valuable for diagnosing various syndromes and skeletal dysplasias (abnormal development) as well as
for assessing fetal development.

However, even if still considered a marker of developmental age, the whole skeletal length may be
affected in post mortem (after death) assessment by the putrefactive (decomposition ) process.

In particular, body length increases slightly with maceration (tissue softening in liquid), whereas body
weight and head circumference seem to be unaffected.

For this reason, long bone length is considered a more stable and reliable marker than full-body
measurements.

Several investigators have produced linear regression formulas based on crown-heel length, crown-
rump length, or body diameters to determine gestational age.

The advent of ultrasonography allowed a more accurate determination of fetal gestational age (crown-
rump length or biparietal diameter and/or femur length).

This technology is useful in forensic measurement of bones from standardized post-mortem radiographs
in cases of questionable gestational age and can be compared with previous ultrasonographic
measurements.

One relatively accurate radiographic (x ray or other radiographic image) protocol for estimating fetal
gestational age at death is based on femur (the long bone in the leg) diaphyseal (shaft) length, and
compares images of fetal femur measurements with measurements of the same bones at autopsy .

As several organs show major changes in developmental patterns throughout fetal development,
maturation of fetal tissues and organs has been also proposed for gestational age estimation.

Histological maturation of several soft tissues (skin, thymus, lungs, thyroid gland, kidneys, adrenal
glands, and central nervous system) between 12–40 weeks gestation, and compared the estimated
gestational age with that obtained by long bone measurement.
 Skin, lung, and kidney tissue (each with unique but distinguishable stages of development) were found
to be useful for a more accurate assessment of gestational age when integrated with long bones
measurements.

The growth of fetal long bones is affected by several conditions that might lead to growth retardation of
the fetus in the womb.

Macroscopic examination (with the eye)or radiographic (x ray) examination are the most common
methods used to estimate fetal age.

Examination of the tissues and organs is also important for a better definition of fetal age.

Term DEVELOPING OVUM is used for 1st 7-10 days after conception i.e. until implantation occurs.

Term EMBRYO is used from 1 week to end of 2nd month.

After 2nd month, it is called FETUS.

The age of fetus can be determined by taking into account appearance of different characters at
different time.

At the end of 1st month

Length-1 cm, weight-2.5g

Eyes are seen as two dark spots.

Umbilical vessels present.

Mouth is seen as cleft.

Limbs appear as bud like processes.

At the end of 2nd month

Length-4 cm, wt-10 g

Mouth & nose separated.

Hands & feet are webbed.

 Umbilical vessels disappeared.

Placenta begins to form.

Anus is seen as dark spot.

1st ossification centre in a fetus appears in clavicle(4-5 wk), followed by maxilla(6 wk).

At the end of 3rd month

Length-9 cm, wt-30g

Eyes closed & pupillary membrane appears.

Nails appear in the form of thin membrane on fingers & toes.

Sex is not yet differentiated.

Placenta formed & differentiated.

At the end of 4th month

Length-16 cm, wt-120g

Sex can be recognized.

Lanugo hair is seen on the body.

Convolution begin to develop in the brain.

Meconium is found in the duodenum.

( meconium is a mixture of bile, mucus & shed off mucosa.)

At the end of 5th month

Length-25 cm, wt-225-450g

Midpoint at xipoid.

Nails distinct & soft.

Light hair appears on head.

 Eyelids closed, eyebrow & eyelash absent.

Skin is wrinkled & covered with VERNIX CASEOSA.

( vernix caseosa protects fetal skin from amniotic fluid)

Umbilicus recedes upwards.

Testes present on psoas.

Centre for calcaneum present.

At the end of 6th month

length-30 cm, wt-450-900g

Hair appear on head.

Eyebrows & eyelashes are beginning to form.

Eyelids are adherent & pupillary membrane is still present.

Cerebral hemisphere cover cerebellum.

Skin is red, vernix caseosa present.

Nails are distinct.

Testicles lie close to kidneys & scrotum is empty.

Meconium is seen in upper part of large intestine.

Centre for manubrium & 1st segment of mesosternum present.

At the end of 7th month

Length-35 cm, wt-1350-1800g

Skin is dusky red, thick & fibrous.

Subcutaneous fat begins to be deposited.

Nails are thick but do not extend to the tips of fingers & toes.

Eyebrow & eyelash distinct & eyelids are open.

 Scalp hair is 0.75 cm.

Gall bladder contains bile & caecum is seen in right iliac fossa.

Pupillary membrane has almost disappered.

Testicle may be found in external inguinal ring.

Meconium is seen in whole of small intestine.

Centre of ossification of talus appeared.

At the end of 8th month

Length-40 cm, wt-1.5 kg

Placenta weighs 500g.

Scalp hair thicker.

Skin is red but not wrinkled & covered with soft hair.

Lanugo has disappeared from face.

Nails nearly reach the end of fingers & toes.

At the end of 9th month

Length-45 cm, wt-2250-3250g

Scalp is covered with dark hair of 4 cm length.

Lanugo is seen only on shoulders.

Vernix caseosa is present over the flexures of joints & neck folds.

Placenta weighs 500g.

Nails have grown over the tips of fingers & toes.

Both the testicles have descended to the scrotum.

Meconium is seen at the end of large intestine.

 Ossification centre appears at the lower end of femur.

At the end of full term fetus

Appearance of full term mature child:

Length-45-50cm, wt-3-3.5kg

Head is about 28 cm in circumference & well covered with hair which is 3.5 cm long & dark.

Head of male weighs 100g more than female.

Head is 1/4th of whole body length.

Lanugo is seen only on shoulders.

Skin is covered with vernix caseosa which is readily seen in the flexure of joints & neck folds.

Vernix caseosa is white cheesy substance made up of sebaceous secretion & epithelial cells.

Being sticky, it can not be easily removed. It protects fetal skin against maceration while in liquor amnii.

Pupillary membrane is absent.

Nails project beyond finger tips & to the end of toes.

Umbilicus is situated midway between pubis & ensiform cartilage.

Umbilical cord is fleshy with a normal spiral twist & a glistening surface of about 45-50 cm in length.

Cartilage of nose & ear present.

Both testicles have descended into scrotum.

Vulva is closed & labia minora is covered by fully developed labia majora.

Meconium is present in rectum. It is generally expelled in a day or two after delivery.

Centre of ossification is present in femur, cuboid & upper end of tibia.

Placenta is about 22 cm in diameter & about 700g in weight.

Six frontanelles are present. Anterior frontanelle is 4x2.5cm.

Radiographically, the mineralization of deciduous incisors starts at the 16th week of intrauterine life.
Before the mineralization of tooth germs starts, the tooth germs may be visible as radiolucent areas on
the radiograph; the subsequent radiographs of the mandible will depict the deciduous teeth in various
stages of mineralization as per the pre-natal age of the fetus.
One of the methods employed is:

Stages by Kraus and Jordan (1965)5

They studied the early mineralization in various deciduous teeth as well as the permanent first molar.
The development is described in 10 stages, denoted by Roman numerals from I to X; the IXth stage
includes three stages and the Xth stage includes five stages.

The radiological age determination is based on assessment of various features as follows:

• Jaw bones prenatally

• Appearance of tooth germs

• Earliest detectable trace of mineralization or beginning of mineralization

• Early mineralization in various deciduous teeth during intrauterine life

• Degree of crown completion

• Eruption of the crown into the oral cavity

• Degree of root completion of erupted or unerupted teeth.

• Degree of resorption of deciduous teeth

• Measurement of open apices in teeth

• Volume of pulp chamber and root canals/formation of physiological secondary dentine

• Tooth-to-pulp ratio

• Third molar development and topography

1. Biparietal diameter :
The fetal head was imaged in an axial section with the fetus in a direct occiput transverse position.

The instrument was set at medium gain so that parietal bones measure approximately 3 mm in
thickness.

The BPD was measured from the outer surface of the skull table to the inner margin of the opposite

skull table.

2. Head circumference :

The fetal HC was traced along the outer perimeter of the calvarium using the electronic digitizer at the
same level as for the BPD.

3. Abdominal circumference:

It was measured on the transverse image of the fetus at the level of liver.

A major landmark was the umbilical portion of left portal vein deep in the liver; fetal stomach
represented the second landmark.

The measurements were made from the outer edge of one side to the outer edge of other side.

4. Femur length :

It is usually easy to see fetal long bones from 13 weeks onward.

The measurement was obtained with a linear array transducer.

It was measured along the long axis of diaphysis using a straight line from the tip of greater trochanter
to lateral epicondyle.

Assessment of Age in Fetus

Introduction

Assessment of of age if Fetus is important in Cases of (Medico-legal Aspect) Criminal Abortion,

Infanticide, Still-Born or Dead Born Baby, Fabricated Abortion, Marriage, Divorce, Adoption,
Inheritance etc.

The Stages of development of Fetus are given below:

Ovum: First 7-10 Days after conception.

Embryo: 1st week to 2 months after conception.

Fetus: 2 months till completely born.

Neonate: 1st month after birth.

Infant : When completely born up to one year of age.

Rule of Haase:
During the first five months of pregnancy the square root of the length gives the approx. age of the
fetus in months.

During last five months the length in centimeters is divided by five gives the age in months.

Flowchart of proceed for age determination of fetus :

Specimen

Approx. Length of Fetus

Apply Haase Rule

Approx. Age

 Can comment on internal organs and on level of muconeum whether it is in Duodenum/ Large
intestine.

 State of Skin whether wrinkled or smooth

Specific Features of a particular age :

At the end of First Month (Embryo)

 Length is about 1 cm

 Weight is about 2.5 gm

  The Eyes are seen as dark spots

 The Mouth seen as a cleft

At the end of Second Month

 Length is about 4 cms

 Weight is about 10 gm

 The hands and feet are webbed

 The Placenta begins to form

 The Anus is seen as a dark spot

At the end of Third Month

 Length is about 9 cms

 Weight is about 30 gm

 Eyes Closed and Pupillary Membrane appears

 Nails starts appearing

 Neck is formed

At the end of Fourth Month

 Length is about 16 cms

 Weight is about 120 gm

 Sex can be recognized

 Lanugo hair is seen over the body

 Convolution begins to develop in brain

 Meconeum is found in the duodenum

At the end of Fifth Month

  Length is about 25 cm

 Weight is about 400 gm

 Nails are distinct and soft

 light hair appears on head

 Skin is covered with Vernix Caseosa

 Meconeum is seen at the beginning of large intestine

At the end of Sixth Month

 Length is about 30 cm

 Weight is about 700 gm

 Eyebrows and eyelashes appear

 Skin is red and wrinkled. Subcutaneous fats begins to be deposited.

 The testes are seen close to the Kidney

At the end of Seventh Month

 Length is about 35 cm

 Weight is about 900-1200 gm

 Crown-rump length is about 23 cms

 Foot length is about 8 cms

 Nails are thick

 Eyelids open and pupillary membrane disappears

 Skin is dusky red, thick and fibrous

 Muconeum is found in the entire large intestine

 Testes are found at the external inguinal canal

 Gallbladder contains bile

  Caecum is seen in Right iliac fossa

 Ossification centre is present in the Talus

At the end of Eight Month

 Length is about 40 cm

 Weight is about 1 Kg to 2.5 Kg

 Nails reach to the tip of finger

 Scalp hair is thicker

 Left testis is present in the scrotum

 Placenta weight is around 500 gm

At the end of Ninth Month

 Length is about 45 cm

 Weight is about 2.5 Kg to 3 Kg

 Scalp hair is dark and 4cms long

 Meconeum is seen at the end of large intestine

 Ossification center are usually present in the lower end of femur, in Cuboid and Capitate bone.

Newer methods Assessment of Gestational Age from Hand and Foot Length:

Obstetricians have been using the fetal foot length to estimate gestational age.

Fetal hand and foot lengths have been found to highly correlate with gestational age and therefore
these parameters could be utilized to estimate gestational age.

The utilization of fetal hand length and foot measurements will serve as a useful adjunct data for
estimation of age in reliable manner.

Fetal foot length was measured in the plantar and longitudinal plane from the posterior heel to the tip
of longest toe and hand length was taken on palmar surface in longitudinal plane from wrist crease to
the tip of the middle finger.

All the measurements were done three times and the mean value was used in analysis.
The data was analysed using SPSS software by regression analysis.

Graphs were also plotted to determine pattern of growth and their correlation with crown rump length
if any.

Streeter first evaluated the fetal foot for gestational age assessment in 1920.

Hern’s then elaborated a strong relationship between fetal foot and gestational age.

The period of gestation estimated by measurement of fetal foot length appears to be in aggrement with
other ultrasound parameters.

The human fetal age was estimated from the direct measurements of femur and incisor teeth, and
strong correlations were found between fetal age, femoral, and teeth measurements.

Forensic medical experts, obstetricians, and pediatricians generally use head circumference (HC)
measurement as an age estimation parameter.

During the fetus period teeth are also indicators of age, which develops within the sockets of the
alveolar bones in the upper and lower jaws.

The crown and root size of the teeth develop linearly to a certain time, starting from the initiation of the
mineralization phase until the completion of the hard tissues due to the incremental deposition process
of dentinal, enamel, and cementum matrices with certain rates.

Teeth are major factors in age estimation of fetuses which starts growth during the prenatal embryonic
period and have several advantages over skeletal aging since they exhibit less variability than bones and
are more durable against external influences because of its hardness.

The hardness of teeth is approximately 5, whereas the bone hardness is 2–3, according to Mohs
hardness scale, which is the hardest tissue in the body.

HC was determined by the circular measurement passing over the glabella and the external occipital
protuberance with a nonelastic metric tape in centimeters and the tooth dimensions; labiolingual (LL),
mesiodistal (MD), crown height (CH), and root height (RH) were taken in millimeters as follows:

LL width, which is measured on the maximum dimension between the labial and lingual surfaces and on
the midsagittal location of the cementoenamel junction ; MD width,which is the maximum dimension
between the mesial and distal surfaces ; CH, which is the maximum measurement from incisal edge to
cervical on the midsagittal line; and RH between the cervical line and the edge of the developing root on
the midsagittal line of the labial root surface.

Additionally,CH and the RH were added to find the total tooth height (TH), [TH=CH+RH]

All four dimensions were taken with a digital Vernier compass.

The data were processed by the computerized statistic program SPSS (Statistical Package for the Social
Sciences) software and statistically log-linear regression and correlation analysis were used to find the
relation between the age with the head and tooth measurements.

Ultrasonographical Age Estimation from Fetal Biparietal Diameter:

Measurement of various fetal body parts is known is fetal biometry.

Ultrasonography is done in every ante natal case for measurement of various fetal parts.

gestational age.

During fetal autopsy, all the parameters for identification, may or may not be available particularly when
body is decomposed or mutilated and sometimes only few bones are available.

Then there is no other option except to find out the age from bones.

Measurement of length of bone and diameters at autopsy is very easy, less time consuming and a
cheaper way of finding out the age of the fetus.

In many cases we may not have all the bones.

If skull is present then we can measure biparietal diameter.

No single parameter is sufficient in giving accurate fetal age ultrasonographically.

Few useful measurements in the fetus are femur length, length of kidney, abdominal circumference and
head circumference.

Measurement of kidney length is useful between 24th to 38th weeks.

Femur length and BPD have more value prior to 36 weeks but after 36 weeks head circumference and
femur length has more value.

Length of femur is also better parameter as compared to BPD for determination of age of fetus in the
third trimester.

Bi-parietal diameter measurement is in less common use after 20 weeks of gestation.

Measurements of bi-parietal diameter also help in determination of age of fetus.

The bi-parietal diameter and femur length correlated equally well with gestational age.

Ultrasound measurement of femur length and bi-parietal diameter are comparably accurate estimators
of gestational age when obtained in the first half of pregnancy
Both estimators, however, become less accurate later in pregnancy.

The correlation coefficient of gestational age versus fetal femur length is statistically greater than that of
the gestational age versus fetal biparietal diameter.

Measurement of the fetal femur appears to be a reliable method for assessing gestational age, which

can compensate for the limitations of the BPD method.

Bi-parietal Diameter:
Average bi-parietal diameter of skull at 4th lunar month of pregnancy is 30.63 mm and
maximum at 10th lunar month is 87.43 mm.

Minimum biparietal diameter of skull at 14 weeks of pregnancy is 28.30 mm and maximum at

39 week is 93.08 mm.

Although technically post mortem examinations can be conducted only on legally viable
fetuses, most pathologists would perform perinatal post mortems on fetuses of a gestational
age greater than about 16 weeks or a body weight greater than 400g.

For fetuses between 400 g and 25 g a “mini-post mortem” can be performed and below 25 g a
longitudinal sectioning method can be employed.

Examination of the placenta is also an essential part of the autopsy of a perinatal case.

Most perinatal and neonatal autopsies are hospital cases; however, infant post mortems may
be medico–legal cases if the cause of death is not known.

In medico–legal post mortems, ancillary investigations are permitted only if they are required
to establish the cause of death, and it is the duty of the pathologist to see that such
investigations are completed.

Specific consent is required from the coroner or equivalent, and they are also responsible for
setting a time limit for sample retention, in discussion with the pathologist.

External Examination

A careful external examination should be made to assess any external abnormality.

In perinatal cases, the shape of the head, the facies, the palate,the number of digits, the
external genitalia, the patency of the anus, and the continuity of the spinal column should be
assessed.
A probe should be passed through each nasal orifice to exclude posterior choanal atresia and
into each external ear to ensure patency.

The eyes should be examined for evidence of icterus and conjunctival haemorrhage.

Evidence of external trauma should also be looked for, particularly with reference to the
obstetric and neonatal history.

All bruises, needle punctures, forcep blade marks, surgical incisions, and so forth should be
noted.

Any tubes or catheters should be left in situ for later examination.

It is often easiest to cut these flush with the skin.

This allows later dissection to assess their siting and provides a means of resetting the site (by
placing cut end flush with skin again) if they are inadvertently moved during examination.

The apparent state of nutrition and any evidence of cyanosis, pallor, jaundice, oedema, and
meconium staining should be assessed. A search for

petechial haemorrhages should also be made, both on the skin (particularly of the head and
upper chest) and on the conjunctiva and mucous membranes of the oral cavity.

The shape of the thoracic cavity should also be assessed; a narrow cavity often indicates
pulmonary hypoplasia.

Interstitial emphysema should be sought in cases of neonatal death.

The umbilicus should also be closely inspected.

The initial stages of evisceration are summarised as follows:

• Make an inverted Y incision.

• Dissect skin and musculature from the abdominal wall.

• Check for pneumothorax.

• Open and examine the abdominal cavity.

• Open the umbilical vein.

• Identify and trace umbilical arteries.

• Ligate and transect umbilical vessels.

• Assess the level of the diaphragm.

• Cut sternoclavicular joints.

• Cut ribs at costochondral junctions.

• Expose and examine the thoracic cavity.

Fetal, Perinatal, and Infant Autopsies

• Free the tongue and floor of the mouth.

• Free posterior attachments of the pharynx and neck.

Estimating the Degree of Maceration

In the case of stillbirths, it is important to note whether the body is fresh or macerated, and if
maceration is present, the degree must be assessed to aid estimation of the time interval
between IUD and delivery.

There is a classification system to aid the estimation of the degree of maceration, but the
changes are also affected by the ambient temperature during body storage:

12 hours Skin slippage

24 hours Skin blebs

48 hours Skin sloughing and haemolysis of organs

5 days Liquefied brain, overlapping of sutures, collapse of calvarium

7 days Laxity and dislocation of joints

External Examination

External Measurements

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.

Essential

• Body weight

• Crown–rump length (sitting height)

• Crown–heel length (standing height)

• Foot length

• Head circumference

Helpful

• Abdominal girth (at the level of the umbilicus)

• Chest circumference (at the level of the nipples)

If any abnormality is suspected, whole-body radiography and photography is advisable.

Estimation of Gestational Age and Growth

It is important to make as accurate an estimation of gestational age as possible,and then to use

this estimation to make an assessment of intrauterine growth.

Measurements of crown–rump, crown–heel, and foot lengths,together with whole body

weights and organ weights are the best starting points.

Milestones can also be used to assess gestational age:

Fusion of palatal shelves and fingerprints 10 weeks

Differentiated external genitalia 12 weeks

Head erect and lower limbs well developed 14 weeks

Ears stand out from head 16 weeks

Vernix caseosa present and early toenail development 18 weeks

Head and body (lanugo) hair visible 20 weeks

Skin wrinkled and red 22 weeks

Fingernails present 24 weeks

Partial separation of eyelids, eyelashes present 26 weeks

Eyes open, good head of hair 28 weeks

408 14. Fetal, Perinatal, and Infant Autopsies

Toenails present 30 weeks

Fingernails reach fingertips, skin smooth 32 weeks

Body plump, lanugo absent, toenails reach toetips 36 weeks

Breasts protrude, testes palpable, fingernails beyond 38 weeks fingertips

Other milestones are the radiological time of appearance of various ossification

centres:

Ischium, deciduous teeth rudiments 15–20 weeks

Calcaneus 25–26 weeks

Talus 27–28 weeks

Lower femoral epiphysis 36–37 weeks

Upper tibial epiphysis 38–40 weeks

An assessment of organ maturation can also be useful.The external appearances of the cerebral
hemispheres (gyral formation) is little affected by growth, and various gestational ages.

Further organ assessment is only possible histologically.

In the brain, the density of the neuronal cells and the pattern of myelination can be useful.
Purkinje cells in the cerebellum appear at about 28 weeks and the periventricular layer begins
to disappear at about 30 weeks.

In the lung, the extent of alveolar formation, the persistence of small terminal airspaces lined
by cuboidal epithelium and the amount of residual parenchyma are all useful features that aid
the assessment of maturity.

In the kidney, the width of the glomerulogenic zone to the width of the definitive glomerular
zone correlates well with gestation and culminates in the disappearance of the nephrogenic

zone at about 36 weeks of gestation.

The presence and quantity of extramedullary haematopoiesis in the liver and the ratio of
stroma to parenchyma in the pancreas may also be useful.

The thickness of the fetal skin and the development of the subcutaneous fat may also be
helpful, but are obviously greatly affected by growth retardation.
The gall bladder is formed from the caudal part of the hepatic diverticulum in the fourth week
of gestation.

Initially, it is tubular, but it becomes saccular during the 11th week of gestation.

Age from Ossification of Bones

„„ The clavicle is the first bone to ossify in the body from two membranous primary ossification
centers during the 5–6th postovulatory week.

A secondary center forms in the sternal end between 15–17 years and fuses by 20–22 years.

In majority of the bones, primary centers of ossification appear between 7th and 12th weeks of
intrauterine life.

By the age of 11–12th week of IUL, there are 806 centers of ossification.

Stack’s method:

Stack evolved a method to estimate the age from the weight of the erupting teeth of fetus and
infant.

He provided a regression line of weight of growing dental tissues against age (from 5 months in
utero to postnatal age of 7 months).

Age (weeks) Sum of teeth weight (mg)

28 (prenatal) 60

40 (prenatal) 460

2 (postnatal) 530

30 (postnatal) 1840

Boyde’s method:

This method, applicable mainly to estimate age of dead infants, is based on counting the
number of cross striations in the enamel of teeth (incremental lines) from neonatal line
onwards.

Neonatal line is formed soon after birth and can be seen in about 3 weeks, or by electron
microscopy 1–2 days after birth.

Dentition in Determining Age

Age can be determined by using the criteria like eruption and calcification of teeth, Stack’s
method, Miles method, Boyde’s method and Gustafson’s method.

„„ Alveolar cavities which contain teeth are formed around the 3–4th month of intrauterine life
(IUL).

„„ At birth, rudiments of all the temporary teeth and the 1st permanent molars may be found
in jaw.

„„ Each tooth has a crown, neck and a root embedded in jaw bone.

„„ Teeth are composed of dentin covered on the crown by enamel and on the root by
cementum which is attached to the alveolar bone by periodontal membrane.

Tooth enamel is the hardest substance in the body containing primarily hydroxypatite

(crystalline calcium phosphate).

„„ Tooth formation proceeds in an invariable sequence.

The first radiographic evidence is formation of a bony crypt followed by mineralization of crown
tips.

Mineralization proceeds from crown tips down the sides of the tooth.

„„ Root mineralization does not begin until crown formation is complete and root formation
ceases with the reduction of apical foramen.

As the root becomes longer, the crown erupts through the bone.

„„ Mineralization of deciduous dentition begins in utero, early in 2nd trimester, and root
formation of third molar may not be complete until 20 years of age.

„„ During eruption of a permanent tooth, the overlying root of its deciduous predecessor
simultaneously undergoes absorption, until only the crown remains.

The unsupported crown then falls off.

The crown heel length carries importance. According to the Haase Rule (1895), the length
of a foetus up to 5th month (20th week) of gestation represents the square of its age in
months. Thus, a foetus of about 4 months will have a length of 16 cm.

Beyond 5th month, the length of the foetus measured in centimetres divided by 5 gives the age
in months.
Thus, a foetus of 35 cm length will be about 7 th month of age. This is known as Morison
Rule.Difficulties:
Gestational age assessment may be difficult in fetus with anencephaly, hydrocephalus, short limb
dysplasia, post mortem destruction or in mutilated case.