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 ORIGINAL RESEARCH PAPER
MEDICOLEGAL SIGNIFICANCE OF POSTMORTEM LIVIDITY IN
DETERMINATION OF TIME SINCE DEATH
Anand P Rayamane1, M P Kumar2, S D Nanandkar3, G S Chavan4, S S Bhise5, Dayananda R5
ABSTRACT
In present study it was found that postmortem lividity
usually appears 1 to 2 hours after death in punctate and
small patchy form, 2 to 4 hours after death in big patchy
form and 4 to 6 hours in homogenous form. Fixation of
postmortem lividity occured during the period of 7 to 9
hours after death. Lividity is well appreciated in persons
with fair complexion and in adequate light (Preferably in
day light). Site of lividity helps to determine cause of death
in hanging to a certain extent in cases of hanging and
drowning by tanking other factors into consideration.
Anemia significantly affects the process of appearance,
extent and grade of lividity but does not affect fixation of
postmortem lividity. In non ambulatory cases lividity
appeared early & was well marked after death. It was
moderate to well developed and fixed earlier by 2 to 3
hours than in ambulatory cases.
Keywords: Postmortem lividity, Time since death, Autopsy.
INTRODUCTION AND REVIEW OF LITERATURE
“Man is the most cunning of all animals.
Chameleon changes its color during lifetime but
The man changes his color even after his death”.
The time of death is sometimes extremely important. It
is a question almost invariably asked by investigating
officers, sometimes with a touching faith in the accuracy of
the estimate. Determining the time of death is extremely
difficult, and accuracy is impossible”.
A recurring problem in forensic medicine is the need to
fix the time of death within the limits of probability. It is self-
1. Asst Prof
2. Assoc Prof, ## Asst Prof, Dept of Forensic Medicine,
MMCRI Mysore
3. Prof and HOD
4. Assoc Prof, #Asst Prof Dept of FMT, GMC& Sir JJH
Mumbai
Corresponding Address
Dr Anand P Rayamane, MD (FM) PGDMLE, PGDHR
Assistant Prof, Deparment of Forensic Medicine
Mysore Medical College and Research Institute
Mysore-570001
Cell- 07259114490Email: anandprayamane@gmail.com
evident that the longer the interval of time between death
and the examination of the body, the wider will be the limits
of probability.
Various methods have been tried to find out the time of
death. These include study of physical, chemical,
biochemical, histological and enzymatic changes which
occur progressively in a dead body. Postmortem lividity is
one of the physical changes useful for estimating time of
death to a certain degree of accuracy.
Post-mortem lividity however, recently has received little
serious attention reflected by the relative paucity of
publications in this area. Much of what is known and written
about the subject is in relation to gross observations on an
anecdotal basis, with very few papers generated from
properly designed studies1.
Post- mortem lividity is one of the important signs of
death; it is also called the “darkening of death” because
shortly after death, in from 20 minutes to 2 hours usually
purple red blotches begin to appear in the skin. Within first
3-4 hours after death these livid blotches may be blanched
out by pressure of the finger against the skin only to return
when the finger is removed. After a vague, undefined length
of time, when the blood hemolyses and stains the
surrounding tissues by diffusion this maneuver cannot be
repeated. The forensic significance of this change in the
stability of the lividity is that if the position of the dead
body has been changed after death but before lividity is
fixed the findings of two different areas of distribution of
lividity, such as in front and behind may serve as mute
evidence that the body has been moved since death.2
Thus post-mortem lividity is very important in
calculating time since death where other advanced
techniques to determine time since death are not available.
Therefore the present study is carried to know mechanism
of formation and effect of factors affecting development of
postmortem lividity in relation to determination of time since
death, as it may be observed on all bodies, irrespective of
cause of death and is seen although with difficulty even in
deaths from hemorrhage.
Postmortem lividity is a bluish or reddish-purple
discoloration due to capillo-venous distension with blood,
at the undersurface of the skin of the dependant parts of
the body, due to settling of blood in those areas due to pull
of the gravity, when circulation to keep the blood in motion
ceases.3
 Journal of Forensic Medicine & Toxicology Vol. 31 No. 1 & 2, January - June 2014
In hypostasis, gravitational pooling of blood into the
capillaries occurs within the dermis (consisting of the
papillary and reticular layer) in the dependant parts of the
body.
Taylor gives the following list of synonyms for
postmortem lividity: ‘postmortem hypostases,
subcutaneous hypostases, cadaveric lividities,
suggilations, vibices, postmortem stains’. Of these names
postmortem hypostasis or simply hypostasis is, the best,
founded as it is on the accepted theory as to the method by
which it is produced.4
Post-mortem lividity appears when the blood ceased to
circulate; it tends to pool in the large venous reservoirs of
the trunk, the venae cavae and their major tributaries. The
blood then drains into the veins and venules of the
dependent parts by the action of gravity producing
discolouration in the areas of skin not subjected to pressure.
Post-mortem lividity begins in the form of mottled
patches after death on the dependent parts of the body.
Gradually these patches increase coalesce and lividity is
fully developed and fixed as the time since death increases.
Different authors had given different time intervals for
the appearance and fixation of post-mortem lividity.
Post-mortem lividity can slightly appear before death
in those who die from a prolonged illness in which a terminal
circulatory failure permits some ante-mortem pooling of
blood at the back of the body. On the other hand post-
mortem lividity can unduly delayed in anaemia and in deaths
associated with considerable loss of blood; in these
circumstances it may not develop at all.
The intensity of colour of hypostasis depends upon
the amount of reduced hemoglobin in the blood. Large
amount of reduced hemoglobin produces deep purplish
blue colour of the stain. The colour of hypostasis is purplish
blue due to the following reasons: (i) In recently dead or
dying tissue oxygen dissociation takes place and this
continues until equilibrium is reached between oxygen
tension in capillaries and surrounding tissue (ii) Reflux of
venous blood from the venular and of the capillaries, which
adds to the blueness.5
The colour of lividity depends on the colour of blood
and mode of death. Normally it is reddish purple or bluish
purple. In deaths from anemia and hemorrhage the colour
is very faint. In deaths from asphyxia, the blood being
chiefly venous in colour, the lividity is intensely developed
and purple in colour. Certain poisons impart a distinct colour
to lividity, e.g. carbon monoxide-cherry pink, potassium
cyanide— bright red, potassium chlorate-chocolate brown,
phosphorous—dark brown, nitrites-red brown, aniline
dye—deep blue, hydrogen sulphide-bluish green and
opium almost black.6
The most significant coloring seen in carbon monoxide
poisoning where the carboxyhemoglbin concentration of
13
the blood rises above 30 percent. Cyanide poisoning can
also causes a pinkish hypostasis through the formation of
cyanomethaemoglobin. Much rarer is the blue, dark purple
or chocolate colored lividity in certain poisoning due to
the formation of methaemoglobin. 7
The site of distribution and pattern of lividity depends
upon the position after death. Frequently the body has
been on the back, the hypostasis is found on the back. In
hanging, lividity is observed over the dependent lower
limbs, the external genitalia, the lower parts of forearms and
hands. In drowning, lividity is observed over the face and
upper parts of the body as body usually floats face
downwards. If the body has been lying face downwards,
the hypostasis is found on the front of the body, possibly
only one side of the face if the head was turned. Postmortem
staining at different of the body indicates the different
position of the body after death.4
Lividity will not develop in that region which is in actual
contact with the surface on which the body is lying due to
occlusion of the toneless capillaries by the pressure of the
body. These areas are known as contact pallor. Similarly it
is not seen on those parts, which have been compressed
by tight clothing or tight rapping of a sheet, but occurs as
a strip of bands called vibices.3
The extent and time of appearance of hypostasis
depends upon: (a) Volume of blood in circulation at the
time of death, and (b) fluidity of blood. In persons dying
from condition with slow circulatory failure such as cholera,
typhus, tuberculosis or uremia, hypostasis may appear
shortly before death and is markedly developed shortly
after death.4
The extent of lividity depends upon the amount and
fluidity of blood as there is no fixed time limit at which the
blood begins to coagulate after death. The post-mortem
fluidity of blood depends upon the rate of intravascular
coagulation and amount of available fibrinolysin. When
fibrinolysin is active, coagulation rate is slow and fluid
blood gravitates in the dependent parts of the body after
death.
After complete formation of the post-mortem lividity, if
the blood is left undisturbed for a period of 5-6 hours, then
the lividity over the areas gets fixed. If the position of the
body is disturbed or altered after the fixation of the lividity,
then the lividity will not be disturbed though the colour
may slightly fade in intensity.
Post-mortem lividity undergoes changes when
putrefaction sets in. There is hemolysis of blood and owing
to the pressure of gases developed in blood vessels, the
position of postmortem staining altered. As the process
advances, lividity undergoes a series of changes in colour,
viz. dusky brown and green before finally disappearing
with destruction of blood. In mummification, lividity turns
from brown to black with desiccation of body.6
Journal of Forensic Medicine & Toxicology Vol. 31 No. 1 & 2, January - June 2014
Fixation of post-mortem lividity occurs mainly due to
certain physical factors. Firstly, after the formation of the
post-mortem lividity blood cannot easily pass through the
capillaries. Secondly, by the time there has been total
settling of the blood, rigor mortis is well established all
around the body. This change in the muscle obliterates the
big vessels passing through them. Hence after this period,
the blood cannot pass through these vessels to settle in
the small venules and capillaries in the new areas. Thirdly,
after full establishment of rigor mortis, the venules lie almost
empty and compressed in the rigid muscles at that time and
cannot be easily distended by the resettling blood.3
Non-displacement and non-shifting of lividity is due to
hemoconcentration by loss of fluid which penetrates the
wall of those vessels related to hydrostatic pressure.
Postmortem staining is an intravascular phenomenon
and there is no extravasation of blood in the area. As the
postmortem staining occurs externally on the dependant
parts of the body, it also occurs at the dependant parts of
all the internal organs, the blood of these organs settle at
their dependant parts.
OBJECTIVES
1. To study the mechanism of production of postmortem
lividity.
2. To study the effect of factors affecting development
of postmortem lividity in relation to determination of
time since death.
3. To appreciate role of post mortem lividity in
determination of time since death with reasonable
degree of accuracy.
METHODOLOGY
The study comprises of total 165 cases of which 94
cases studied were hospital death cases which include both
medicolegal and certified deaths where exact time of death
is known, and other 71 cases studied were brought dead
cases where time of death was known approximately but
were certified by the medical officers.
STATISTICAL ANALYSIS
Statistical tests applied in present study are as follows:
a. Fishers Exact test / Pearson’s Chi-square test was
applied to know association between Anemic cases
and Postmortem Lividity, Non Ambulatory cases and
Postmortem Lividity and Postmortem lividity and Time
since Death.
b. One way analysis of variance (ANOVA) test with
Tukey’s post-hoc test was applied to know correlation
between documented time since death, estimated time
since death by postmortem lividity.
14
RESULTS
1. Total 165 cases were studied, out of which 125 (75.8%)
cases were male and 40 (24.2%) cases were female.
2. The age ranged from 1 to 90 years, in present study
maximum deaths were found in the range of 21 to 30
years & 31 to 40 years (23% in each age group) and
remaining of deaths were from the age group 81 to 90
(0.6%) years.
3. Exact time since death was known in 94 (57%) cases
while in 71 (47%) cases approximate time since death
was known.
4. Lividity appeared in the form of punctate patches i.e.
of about 0.5 to 1 cm size then gradually developed into
small patches of 2 to 3 cm, which later joined to form
big patches of size 7 to 8 cm which subsequently
coalesced gradually to form homogenous form of
lividity.
5. Postmortem lividity appeared in 1 to 2 hours after death
in punctate and small patchy form (132 cases i.e. 90%),
in 2 to 4 hours after death developed into big patchy
form in 100 (89%) cases and into homogenous form (83
cases i.e. 76%) in 4 to 6 hours.
6. Fixation of postmortem lividity was occurred in 49 cases
(51%) in duration of 7 to 9 hours after death.
7. Out of total 165 cases maximum cases i.e. 91 (55%)
cases showed moderate grade, 38 (23%) cases showed
mild grade, and 34 (20%) cases showed well developed
grade of postmortem lividity. In 2 (2%) cases
postmortem lividity was absent.
8. In all 165 cases lividity was purple colour.
9. In maximum number of cases i.e. 163 (98.8%) lividity
was at posterior surface and dependant areas.
10. In 1 (0.6%) case found in prone position, lividity was
seen over ventral surface of body.
11. In 1 (0.6%) case of hanging, typical glove and stock
type of lividity was found.
12. Anemia significantly affects process of postmortem
lividity.
13. In non ambulatory cases postmortem lividity appears
& fixes earlier and well developed than ambulatory
cases.
14. In deaths due to acute massive hemorrhage lividity
was either absent or sparsely developed. It was found
to be of mild to moderate grade and fixed in usual time
in these cases.
15. In deaths from circulatory failure in 2 (1.2%) cases
lividity was well marked after death and fixed earlier.
16. Lividity was well appreciated in persons of fair
complexion.
 Journal of Forensic Medicine & Toxicology Vol. 31 No. 1 & 2, January - June 2014
17. Lividity was well appreciated in day light and adequate
light was prerequisite for appreciation of postmortem
lividity.
18. Tight clothing leave pressure pallor over body and
folds of clothing give rise to vibices.
19. Lividity was of homogenous form and moderate to well
developed grade in moderate to well built cases. It was
sparsely developed and was of mild grade in thin and
emaciated cases (due to chronic diseases).
20. Mean Time since Death with Significant Error of Mean
was found to be 7.30 ± 0.22 hours in documented time
since death, 6.37±0.15 hours in Time since Death
established by Postmortem Lividity.
DISCUSSION
Association between Postmortem Lividity and Time
since Death
APPEARANCE OF POSTMORTEM LIVIDITY
In present study postmortem lividity was appeared in
the form of punctate patches i.e. about 0.5 to 1 cm size then
gradually develops into small patches of 2 to 3 cm. These
later on join to form big patches of size 7 to 8 cm which
coalesced gradually to form homogenous form of lividity.
However this process may not be seen in all bodies as
process of lividity was influenced by many factors such as
anemia, non ambulation and cause of death and mode of
death.
Postmortem lividity begins as mottled patches ranging
from 1-2 cm in diameter. These patches gradually increase
in size and coalesce with each other till they become one
uniform area of staining.4.8,9 Our findings are consistent
with these findings.
ASSOCIATION BETWEEN FORM & FIXATION OF
POSTMORTEM LIVIDITY AND TIME SINCE
DEATH
It was found that postmortem lividity was punctate and
of small patchy form in 132 (90%) cases before a period of
2 hours since death and big patchy form was seen after 2
hours since death in 79 (70%) cases which was found to be
statistically significant (P<0.0001). This means that small
patches of postmortem lividity formed within or less than 2
hours of time since death as compared to big patches of
postmortem lividity formed after 2 hours of time since death.
In present study big patchy form of postmortem lividity
was seen in 86 (76%) cases before period of 4 hours since
death and homogenous form of lividity was found in 88
(81%) cases after period of 4 hours since death which was
found to be statistically significant (P<0.0001) which means
that big patches of postmortem lividity appeared in less
than 4 hours of time since death as compared to
15
homogenous form of postmortem lividity appeared at or
after 4 hours of time since death.
Fixation of postmortem lividity was studied in165 cases
of which 96 (58.2%) cases were fixed, 67 (40.6%) cases not
fixed and in 2 (1.2%) cases postmortem lividity was absent.
It was found that 60 (62.5%) cases fixed at or after 7
hours since death and 36 (37.5%) cases fixed before 7 hours
since death which was found to be statistically significant
(P<0.0001) which means that postmortem lividity fixed at or
after 7 hours of time since death.
The results of present study indicated that punctate
and small patchy form appears within 1 to 2 hours. Big
patchy form appears after 2 hours but before 4 hours of
time since death. The homogenous form appears after 4
hours of time since death. Postmortem lividity was fixed at
or after 7 hours of time since death.
Camps (1976)7 states that lividity appears in 0.5 hr and
well marked in 6-10 hour, Vander Over (1976)10 states lividity
appears in 1 hour and reaches maximum intensity in 8 to 12
hours, Polson et. al (1985)11 states lividity appears in patchy
mottled form within 0.5 to 2 hours which enlarge to produce
extensive discoloration in 6-12 hours. Di Maio (2001) 12
states lividity usually evident in 0.5 to 2 hours and
gradually, usually reaches maximum coloration at 8-12 hours
and fixation of postmortem lividity can occur before 8-12
hours. Lividity begins as patchy mottled areas within hour,
well marked in 4-6 hours and lividity becomes well fixed in
6-8 hours after death6,3,13,5,14,9 The findings of present study
are more or less same as discussed above with those of
other authors.
In western studies formation and fixation of lividity was
delayed due to temperate climate.
Present study was compared with various authors as
follows:
ASSOCIATION OF ANEMIA AND POSTMORTEM
LIVIDITY
It was found that maximum cases i.e. 77 (92%) cases were
normal (above 10gm%) and other cases i.e. 17 (18 %) cases
were anemic (below 10gm%).
It was found that in anemic cases postmortem lividity
was seen in the form of small patchy form in 5 (29 %) cases
after period of 2 hours (P<0.001) and big patches in 5 (29 %)
cases after 5 hours (P<0.0001). Out of 17 anemic cases only
7 (42%) cases were of homogenous form and 10 (58%) cases
Journal of Forensic Medicine & Toxicology Vol. 31 No. 1 & 2, January - June 2014

were small & big patchy form (P<0.0001). This means ambulatory cases, 10 (77%) cases were fixed within 7 hours
appearance of lividity was delayed and homogenous stage of death and 3 (33%) cases fixed after or at 7 hours of death
was not reached in anemic cases. (P<0.0001). This means that in non ambulatory cases
postmortem lividity appears and fixes earlier than ambulatory
Grade of postmortem lividity was studied in 17 anemic
cases. This appearance was also compared with normal
cases, it was found that only 4 (24%) cases were of moderate
cases where in same results seen.
grade and all other 13 (76%) cases belong to mild grade
(P<0.0001). This means in anemic cases lividity was mostly Out of 21 cases of non ambulatory cases, 18 (85%)
of mild grade. cases were of homogenous form, 2 (10%) cases were small
patchy form and 1 (5%) case was of big patchy form of
Out of 17 cases studied 3 (18%) cases postmortem
lividity. In 13 (62%) cases lividity was fixed form and 8
lividity was fixed at or before 9 hours and in 1 (6%) case
(38%) cases not fixed. This means lividity was well marked
after 9 hours (P>0.0909). This means fixation of postmortem
in non ambulatory cases.
lividity in anemic cases occurs in usual time as other cases.
Out of 21 non ambulatory cases maximum i.e. 10 (47%)
This means the condition of anemia as evidenced by
cases showed well developed grade and 9 (43%) cases
low hemoglobin significantly affects the process of
showed moderate grade and other 2 (10%) cases were mild
development of postmortem lividity. This appearance was
grade of postmortem lividity. This means in non ambulatory
also compared with normal cases where in same results
condition lividity was moderate to well developed grade.
seen.
Camps (1976) 7 stated that slight hypostasis can appear
Camps (1976) 7 states post-mortem lividity can be unduly
before death in those who die from a prolonged illness in
delayed in anemia and in deaths associated with
which a terminal circulatory failure permits some
considerable loss of blood; in these circumstances it never
antemortem pooling of blood in the dependant parts of the
develops very well. Guharaj (2003)15 stated that post-
body. Vander Oever (1976) 10 states that onset, the extent
mortem lividity is usually apparent 2-3 hours after death,
and the degree of lividity seems to be variably influenced
but it may take about 4 hours to develop in anemic
by the physical condition of the immediately ante-mortem
individuals. In the opinion of Richard Shepherd (2003) 18
deceased, the cause of death and the environmental
hypostasis is not always seen in a body and it may be
conditions. Di Maio (2001)12 states in individuals, dying of
absent in the young, the old and the clinically anemic or in
terminal cardiac failure, it may actually appear antemortem.
those who have died from severe blood loss. Tsokos (2005)
19 Mathiharan (2006) 8 states that rarely hypostatic congestion
states that in cases with antemortem anemia (e.g., aplastic
resembling postmortem lividity may be seen a few hours
anemia, autoimmune hemolytic anemia, anemia secondary
before death in cases of cholera, plague, uremia, morphine
to malignancy, malnutrition, or infection) livor mortis will
poisoning, typhus and asphyxia. Reddy (2008) 14 states that
be unnoticeable, depending on the hemoglobin count in
hypostatic congestion resembling postmortem staining may
the circulation before death. Karmakar (2007) 16 and Dixit
be seen few hours before death in case of person dying
(2007)5 states that lividity appears shortly after death but
slowly with circulatory failure e.g. tuberculosis, congestive
may not be visible until half to one hour in plethoric
cardiac failure, deep coma and asphyxia. In such cases,
individuals and 1-4 hours in anemic persons. Reddy (2008)14
hypostasis will be marked shortly after death. Finding of
states lividity is intense in asphyxia where blood may not
present study reasonably match with above studies.
readily coagulate, and is less marked in death from
hemorrhage, anemia and wasting diseases due to reduced
CONCLUSION
amount of blood and pigment.
From the present autopsy study it was found that
Findings of present study reasonably match with
postmortem lividity usually appears 1 to 2 hours after death
studies of above mentioned authors.
in punctate and small patchy form, 2 to 4 hours after death
in big patchy form and 4 to 6 hours in homogenous form.
ASSOCIATION OF NON AMBULATION AND
Fixation of postmortem lividity occured during the period
POSTMORTEM LIVIDITY
of 7 to 9 hours after death.
It was found that 73 (88%) cases were ambulatory and
21 (22%) cases were non ambulatory category. REFERENCES
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