|HOW TO DO IT
|Year : 2020 | Volume
| Issue : 2 | Page : 138-141
Fetal and infant embalming- A cost effective approach
Pooja Bhadoria, Mathew Joseph, Amarjyoti Chaturvedi, Brijendra Singh
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
|Date of Submission||08-Sep-2020|
|Date of Decision||18-Sep-2020|
|Date of Acceptance||05-Oct-2020|
|Date of Web Publication||15-Dec-2020|
Dr. Pooja Bhadoria
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhadoria P, Joseph M, Chaturvedi A, Singh B. Fetal and infant embalming- A cost effective approach. J Med Evid 2020;1:138-41
| Introduction|| |
Embalming the body of an adult or an infant is a multistep procedure which preserves the body, delay autolysis and putrefaction for a certain period, following which the body can be used for exhibition, academic and research purposes. During embalming, the bodily fluids are removed and are replaced with formaldehyde-based chemical solutions to maintain as far as possible, life-like state.
Age is one of the important factors to be considered while performing an embalming procedure. Age not only influence embalming techniques but also infusion sites, volume and strength of embalming solution, infusion pressure and rate of flow. Other factors that influence embalming include size and weight of the body, cause of death and postmortem changes.
Embalming requirement of an infant is not the same as that of an adult. Certain important facts should be considered before embalming the infants and children. Infant skin is very delicate and can easily distend and wrinkle after arterial injection. The vessels in the infant are extremely small and delicate. Concerning the use of embalming solutions, regular arterial fluids of strength similar to adult or a slightly reduced strength can be used.
Commonly used vessels for embalming are common carotid artery, femoral artery, external iliac artery, ascending aorta and abdominal aorta. The common carotid artery is an easily accessible, big calibre vessel accompanied by the internal jugular vein which affords excellent drainage. The external iliac artery which continues as the femoral artery is also easily accessible, one among the larger vessels with accompanying veins for drainage. The abdominal aorta is the largest artery and is accompanied by the inferior vena cava that could be used for drainage. However, the vessel is deep seated and requires 2–3” long incision in the left of the midline in the middle of the abdomen to expose.
The use of the embalming solution containing the normal adult dilution is advised in infants too but requires a smaller volume of fluid than adults as it depends on the size and weight of the body.
In traditional foetal embalming, a foetus is immersed in 10% formalin after cavity embalming and spot injections. However, this method does not ensure adequate fixation for bigger foetuses. The foetuses fixed and stored in traditional ways are not always suitable for developmental and microanatomical studies, which is a matter of great concern. Hence, the present study was carried out to ensure better fixation and preservation.
Majority of the anatomists would have done many adult embalming during their residency training period or in their professional life. Several books and research articles on adult embalming are available in the literature, and a lot of researches are going on at present. However, despite a lot of searches, only very few materials were available on infant embalming in the medical literature.
| Methodology|| |
The foetuses are procured from the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, after obtaining ethical clearance and written informed consent of the parents. The gestation ages of the procured foetuses are determined using the following parameters [Figure 4]a, [Figure 4]b, [Figure 4]c, [Figure 4]d:
|Figure 1: Photograph of foetus of 34 weeks of gestation showing: (a) Body of foetus along with materials required for embalming. (b) Femoral artery in femoral triangle after giving a 2–3 cm incision. (c) Insertion of intravenous cannula (26 G) into femoral artery|
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|Figure 2: Photograph of foetus of 34 weeks of gestation showing: (a) Intravenous cannula in femoral artery, which is connected to syringe on another end for manual injection of embalming fluid with 100 ml syringe. (b) Embalmed body wrapped in formalin wet cotton|
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|Figure 3: Photograph of foetus of 34 weeks of gestation showing: (a) Embalmed body wrapped in formalin wet cotton. (b) Body of foetus after 2 years of embalming|
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|Figure 4: Photograph showing landmarks for measuring various parameters to calculate gestational age: (a) Crown–rump length. (b) Biparietal diameter. (c) Interpupillary distance. (d) Crown–heel length|
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- Crown–heel length
- Crown–rump length
- Biparietal diameter
- Foot length
Fetal and Infant embalming is generally performed by either of two methods. The first is traditional cavity embalming followed by surface treatment and the second is a new method in which arterial embalming is done. In cavity treatment, method of embalming, aspiration and cavity filling is done by an infant trocar. The infant trocar is about 12” in length with an inside diameter of ¼” . The right or left inguinal region of the abdominal cavity is used as an entry point for trocar.
In the latter, we use intravenous infusion set and syringes used for paediatric age groups, gravity technique and manual positive pressure without using an embalming machine. The composition of embalming fluid, and the materials required for the technique are given in [Table 1] and [Table 2], respectively [Figure 1]a.
Before the process of embalming, the body is disinfected with a topical disinfectant (unigram) solution followed by soap and water wash. Special care is taken to clean oral and nasal regions. Eye caps or cotton pads may be inserted under the lids to effect eye closure. The mouth is closed before embalming, either by the use of an adhesive or by suturing. After embalming, the mouth can again be cleaned and reglued
Following disinfection, a 2–3 cm incision is given in the anterosuperior thigh. Skin, subcutaneous fascia, deep fascia and muscles are retracted step by step to expose the femoral artery and vein [Figure 1]b;[Figure 5]a and [Figure 5]b. An intravenous cannula (26 G) is inserted into the femoral artery which is followed by fluid infusion [Figure 1]c; [Figure 6]a and [Figure 6]b.
|Figure 5: Photograph of foetus of 29 weeks of gestation showing dissection in femoral triangle to expose various structures after giving a 2–3 cm incision (a) Removal of skin and superficial fascia (b) Removal of deep fascia|
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|Figure 6: Photograph of foetus of 29 weeks of gestation showing: (a) Femoral artery exposed in femoral triangle after fine dissection. (b) Insertion of intravenous cannula into femoral artery|
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Rate of flow and pressure of embalming fluid should be sufficient to overcome the resistance of the body and to distribute the arterial solution without causing tissue distension. It must be remembered that the sufficient force is necessary to establish good distribution, especially in distal parts such as hands and feet. Embalming fluid is injected manually using 100 ml syringe [Figure 2]a. The procedure is continued until the required amount of fluid (0.167 L fluid is required per 1 kg body weight) is injected into the body.
Following arterial embalming, about 4 times of brain volume 20% strength embalming solution is introduced into the cranial cavity through the anterior fontanelle to ensure brain fixation. Cannula is removed and vessel is ligated, following which the incision is sutured. Eyelids are retracted, and an incision over the cornea with blade (no. 11) is given to preserve ocular structures. The embalmed body is then wrapped in formalin wet cotton for about 10 days [Figure 2]b and [Figure 3]a, following which the body is stored in a special container along with adult cadavers. The fetus was well preserved even after one year [Figure 3]b.
| Results|| |
Thirty foetal and infant embalming were done in the Department of Anatomy, AIIMS, Rishikesh, from August 2018 and May 2020, of which ten were done by the above-mentioned method and the rest were preserved by cavity and surface embalming, since many of them were malformed due to congenital anomalies such as anencephaly, spina bifida, rachischisis, meningomyelocele and other neural tube defects. It was noticed that the bodies which were preserved with arterial embalming by the above-mentioned method appeared in a well-preserved state even after 2 years of embalming [Figure 3]b. Traditional infant embalming requires many puncture sites, and the present method requires only one puncture site with better preservation and adequate fixation.
| Conclusion|| |
According to the observations, the current method of embalming appears to be more efficient than traditional embalming methods. Even if this method consumes a higher time for completion, it is suitable for embalming infants to ensure adequate fixation and better preservation. It can be used for preserving foetal specimens for museum, developmental researches and microanatomical studies.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]