Postmortem Changes of Female External Genitalia and Their Importance in Suspected Sexual Abuse.

Examination of the female external genitalia to assess for sexual abuse is performed in living individuals, and the interpretation of the findings is based on evidence-based studies. However, in the deceased, no such studies are available, and postmortem changes could present as suspicious findings that can be mistaken for trauma. Patches of discoloration in the hymen were reported previously in one case as hypostasis (i.e., livor and lividity), and based on this finding, it was listed as a finding that is not associated with trauma. This was a retrospective study that was conducted in the Center of Forensic and Legal Medicine in Dammam, Saudi Arabia over a 4-year period. The study included 30 deceased women in whom photographic documentation of their external genitalia was assessed for postmortem changes. The postmortem interval ranged from less than 24 h to more than 100 days, and the ages of these deceased women were in the 20-40 year-old age group. In cases where the hymen, vagina, and/or fossa navicularis were clearly visible, none of these areas showed any hypostatic discoloration. A comparison between antemortem and postmortem appearance of the hymen in one case clearly showed the absence of hypostatic changes in the hymen. In conclusion, any discoloration of the external genitalia that is detected in a female decedent requires serious consideration.

Child Fatalities in Dammam: A Call for Child Fatality Reviews in Arab Countries.

Identifying children's risk exposure is the first step toward mortality prevention. This retrospective study determined the causes of child fatalities in Dammam, Saudi Arabia. Death reports of children and adolescents from 1999 to 2015 (N = 157) were analyzed. Boys represented most cases (69%) and there were two age peaks (1-5 years and 16-18 years). Accidents (typically immersion) defined the main death circumstance (51%) followed by homicide (25%). Only 33% of cases underwent autopsy, and the most common cause of death was head injury (27%) followed by firearm injury. Only one immersion death underwent autopsy. This study revealed important data about the risk exposure of children in Dammam and emphasizes deficient investigative procedures. Child fatality reviews comprise systematic data collection by multidisciplinary teams to determine the true risks toward children in a community. Such teams do not exist in Arab countries; therefore, strategies should be implemented to initiate them.