Assessment of neonaticide in the setting of concealed and denied pregnancies

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.