Assessment of neonaticide in the setting of concealed and denied pregnancies

  • Sophie Stenton
  • Marta C. CohenEmail author
Original Article


It is known that concealed and denied pregnancy are both associated with increased health risks to the mother and infant. Whilst there is literature surrounding management and safeguarding in these instances, we are not aware of a case review of post-mortem findings in infants with a history of concealed or denied pregnancy. We performed a retrospective review of all coronial post-mortems performed between 2003 and 2018 on infants and fetuses with a history of concealment or denial of pregnancy. Maternal demographics, delivery information, post-mortem findings and results of ancillary investigations were analyzed. Twenty cases (1.8% of total coronial workload in the period of the study) were included. Four women admitted to concealing their pregnancy, eleven denied their pregnancy and in the remaining five cases the bodies of the infants had been abandoned and the mother was not traceable. The bodies of these infants were found in waste disposal sites, wooded areas and in a drainpipe. Only six infants in total were judged to have survived delivery, all others were stillborn or unascertained. Perinatal hypoxia, large subdural hemorrhage and congenital pneumonia were the reported causes of death in those infants that were liveborn. In one case there was suspicion of neonaticide. Concealment and denial of pregnancy occur in a wider demographic than perhaps anticipated and is not limited to teenage primigravids. Mothers with concealed and denied pregnancy hid the body of their deceased infant out of fear of prosecution. In many circumstances, viability at birth cannot be ascertained.


Autopsy Concealed pregnancy Denied pregnancy Neonaticide 



  1. 1.
    National Collaborating Centre for Women's and Children's Health (UK). Antenatal care: routine care for the healthy pregnant woman. London: RCOG Press; 2008. (NICE Clinical Guidelines, No. 62.) Accessed 12 Nov 2019Google Scholar
  2. 2.
    Rodie VA, Thompson AJ, Normal JE. Accidental out of hospital deliveries: obstetric and neonatal case control study. Acta Obstet Ginecol Scand. 2002;81:50–4.CrossRefGoogle Scholar
  3. 3.
    Brezinka C, Huter O, Biebl W, Kinzl J. Denial of pregnancy: obstetrical aspects. J Psychosom Obstet Gynecol. 1994;15:1–8.CrossRefGoogle Scholar
  4. 4.
    Haddrill R, Jones G, Mitchell C, Anumba DOC. Understanding delayed access to antenatal care: a qualitative interview study. BMC Preg Childbirth. 2014;14:207.CrossRefGoogle Scholar
  5. 5.
    Finlay F, Marcer H, Baverstock A. G293 management of a concealed pregnancy. ADC. 2016;101:164–5.Google Scholar
  6. 6.
    Jenkins A, Millar S, Robins J. Denial of pregnancy: a literature review and discussion of ethical and legal issues. JRSM. 2011;104:286–91.CrossRefGoogle Scholar
  7. 7.
    Spinelli MG. A systematic investigation of 16 cases of neonaticide. Am J Psychiatry. 2001;158:811–3.CrossRefGoogle Scholar
  8. 8.
    Ophoven JJ. Pediatric forensic pathology. In: Gilbert-Barness, editor. Potter’s pathology of the fetus, infant and child. Philadelphia: Mosby; 2007. pp. 741–840.Google Scholar
  9. 9.
    Beier M, Reinhard KW, Wessel J. Denial of pregnancy as a reproductive dysfunction: a proposal for international classification systems. J Psychosom Res. 2006;61:723–30.CrossRefGoogle Scholar
  10. 10.
    Office for National Statistics London. Accessed 12 Nov 2019.
  11. 11.
    Thynne C, Gaffney G, O'Neill M, Tonge M, Sherlock C. Concealed pregnancy: prevalence, perinatal measures and socio-demographics. Ir Med J. 2012;105:263–5.PubMedGoogle Scholar
  12. 12.
    Wessel J, Buscher U. Denial of pregnancy: population based study. BMJ. 2002;324:7335.CrossRefGoogle Scholar
  13. 13.
    Wessel J, Gauruder-Burmester A, Gerlinger C. Denial of pregnancy – characteristics of women at risk. Acta Obstet Gynecol Scand. 2007;86:542–6.CrossRefGoogle Scholar
  14. 14.
    Friedman SH, Heneghan A, Rosenthal M. Characteristics of women who deny or conceal pregnancy. Psychosomatics. 2007;48:117–22.CrossRefGoogle Scholar
  15. 15.
    Gheorghe A, Banner J, Hansen S, Stolborg U, Lynnerup N. Abandonment of newborn infants: a Danish forensic medical survey 1997-2008. Forensic Sci Med Pathol. 2011;7:317–21.CrossRefGoogle Scholar
  16. 16.
    Mitchell EK, Davis JH. Spontaneous births into toilets. J Forensic Sci. 1984;29:591–6.PubMedGoogle Scholar
  17. 17.
    Lee ACW, Li CH, Kwong NS, So KT. Neonaticide, newborn abandonment, and denial of pregnancy – newborn victimisation associated with unwanted motherhood. Hong Kong Med J. 2006;12:61–4.PubMedGoogle Scholar
  18. 18.
    Zambaldi C, Cantilino A, Farias JA, Moraes GP, Sougey EB. Dissociative experience during childbirth. JSOG. 2011;32:204–9.Google Scholar
  19. 19.
    Cohen M, Scheimberg I. Forensic aspects of perinatal deaths. Acad Forensic Pathol. 2018;8:452–91.CrossRefGoogle Scholar
  20. 20.
    Gilbert-Barnes E, Debich-Spicer DE. Handbook of pediatric autopsy pathology. Totowa: Humana Press; 2005. p. 471–98.CrossRefGoogle Scholar
  21. 21.
    Siebert JR. Potter’s pathology of the fetus, infant and child. 2nd ed. Philadelphia: Elsevier; 2007.Google Scholar
  22. 22.
    Sieswerda-Hoogendoorn T, Soerdjbalie-Maikoe V, Maes A, van Rij RR. The value of post-mortem CT in neonaticide in case of severe decomposition: description of 12 cases. Forensic Sci Int. 2013;23:298–303.CrossRefGoogle Scholar
  23. 23.
    Barber JL, Sebire NJ, Chitty LS, Taylor AM, Arthurs OJ. Lung aeration on post-mortem magnetic resonance imaging is a useful marker of live birth versus stillbirth. Int J Legal Med. 2015;129:531.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Histopathology Department, Sheffield Children’s Hospital NHS FTSheffieldUK
  2. 2.Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK

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