Morte fetal e suspeita de morte neonatal na abordagem médico-legal integrada: limites das docimásias, contribuição da imagem pós-morte e protocolo pericial

Abstract

Background: distinguishing fetal death from death after live birth may be critical in medicolegal investigations, but no isolated finding proves extrauterine life or establishes infanticide. Objective: to critically review maceration findings, classic docimasias, histology, postmortem imaging, and placental examination, and to propose an integrated approach to fetal death and suspected neonatal death. Methods: narrative review with a structured search of PubMed/MEDLINE, SciELO, and LILACS, supplemented by institutional guidelines and citation tracking. Studies published from January 2010 to September 2026 were prioritized; earlier studies were included when essential to validation of docimasias or maceration chronology. Results: maceration supports intrauterine death, although timing remains approximate. The hydrostatic lung test may support aeration but is affected by ventilation, decomposition, prematurity, and pulmonary disease. Histology, extrapulmonary tests, and postmortem CT or MRI are also adjunctive and are not stand-alone gold standards. Placental and umbilical cord examination is essential for investigating fetal death mechanisms but does not automatically exclude neonatal death or external action. Conclusion: opinions should integrate history, scene, autopsy, histology, placenta, laboratory tests, and imaging, while allowing an indeterminate conclusion when evidence is conflicting or degraded. Criminal classification requires evidence beyond the autopsy.