Forensic Medicine Related to Pregnancy and Trauma

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Questions and Answers

Which sign indicates possible recent violence related to cervical trauma?

Cervical dilation without laceration

Bloody discharge and recent laceration (correct)

Presence of metallic foreign bodies

Laceration without discharge

What test can be utilized to confirm the presence of fetal tissue in abortion investigations?

Precipitin test for products of conception (correct)

Ultrasound imaging for fetal heartbeat

Blood analysis for hormone levels

MRI scan for uterine abnormalities

In a post-mortem examination, which finding is consistent with peritonitis?

Gritty texture of the cervix

Inflammation of the endometrium

Peritoneum showing signs of irritation (correct)

Congestion and bruising of the vagina

Which of the following findings might indicate air embolism during an autopsy?

Air bubbles in the pulmonary veins Signup and view all the answers

What necessity arises if air embolism is suspected during the autopsy process?

Post-mortem radiology before the autopsy Signup and view all the answers

Which condition is NOT a civil circumstance that affects the medicolegal importance of pregnancy?

Allegations of rape Signup and view all the answers

What is a presumptive sign of pregnancy that is acknowledged, but not sufficient for a legal diagnosis?

Nausea and Vomiting Signup and view all the answers

At which month does the uterus first become an abdominal organ?

Third month Signup and view all the answers

What legal strategy might a female condemned to death employ regarding her pregnancy?

Allege pregnancy to delay execution Signup and view all the answers

Which symptom is NOT considered presumptive for diagnosing pregnancy medically?

Spotting between periods Signup and view all the answers

Which physiological change occurs as a result of increased blood supply in the breasts during early pregnancy?

More prominent veins Signup and view all the answers

What happens to the position of the fundus of the uterus by the end of the sixth month of pregnancy?

It is at the level of the umbilicus Signup and view all the answers

In what circumstance might the estimation of the duration of pregnancy be crucial for a woman?

In legal accusations of infidelity Signup and view all the answers

What is the primary anatomical difference in the cavity shape between a nulliparous and parous uterus?

Globular Signup and view all the answers

Which method of abortion involves the use of irritant poisons?

Vaginal plugging Signup and view all the answers

What is the correct relationship between the uterine wall thickness in parous and nulliparous uteri?

Parous walls are thinner Signup and view all the answers

In the context of medicolegal conditions, which scenario is NOT typically associated with examination for abortion?

Suspected natural miscarriage Signup and view all the answers

Which of the following is a potential complication of inducing abortion through local violence?

Air embolism Signup and view all the answers

What defines criminal abortion?

Induction of abortion for personal reasons Signup and view all the answers

Which of these is NOT a method used by non-professionals to induce abortion?

Administration of abortifacient drugs Signup and view all the answers

What best describes the external cervical os in a parous uterus?

Transverse slit with scar Signup and view all the answers

At what point in pregnancy can fetal heart sounds typically first be auscultated using a fetal stethoscope?

22 weeks Signup and view all the answers

What is the significance of Hegar’s sign during pregnancy?

It signifies the softening of the cervix. Signup and view all the answers

What factor could prevent the fetal heart sounds from being heard during pregnancy?

Presence of a fatty abdominal wall Signup and view all the answers

When can a pregnancy test based on urine HCG typically provide a positive result?

2 weeks after the first missed period Signup and view all the answers

What change occurs in the vaginal mucosa during pregnancy?

Becomes violet due to increased vascularity Signup and view all the answers

Which of the following describes the changes in the uterus during pregnancy?

It enlarges and becomes soft and globular Signup and view all the answers

What is the earliest stage at which the gestational sac can be identified through ultrasound scanning?

5 weeks after conception Signup and view all the answers

What is a disadvantage of urinary immunological tests for detecting HCG?

They may lead to false positive results in certain conditions Signup and view all the answers

What is the normal duration of pregnancy calculated from the first day of the last menstrual period?

280 days Signup and view all the answers

Which method is used to determine the age of the fetus in a living condition?

Ultrasonography Signup and view all the answers

What characterizes Artificial Insemination Donor (A.I.D.) compared to Artificial Insemination Homologous (A.I.H.)?

A.I.D. uses donor semen Signup and view all the answers

Which sign of recent delivery can be observed within six weeks in a living female?

Enlarged breasts with colostrum Signup and view all the answers

In cases of disputed maternity, what must be verified to establish maternity claims?

Date of labor must coincide with the age of the fetus Signup and view all the answers

What is the primary purpose of Invitro Fertilization (IVF)?

To induce fertilization outside the body Signup and view all the answers

What condition leads to examination for signs of delivery in cases of infanticide?

Suspicion of killing a newborn infant Signup and view all the answers

How many weeks is the normal duration of pregnancy stated, including the variability allowance?

40 weeks ± 2 weeks Signup and view all the answers

Which of the following complications can arise from cervical shock during an abortion procedure?

Cervical dilation leading to cardiac arrest Signup and view all the answers

Which abortifacient drug is classified as an ecbolic and has a specific effect on the uterus by inducing contractions?

Oxytocin Signup and view all the answers

What is the primary risk associated with the use of potassium permanganate during abortion?

Local necrosis of the vagina Signup and view all the answers

Which of the following is classified as a general protoplasmic poison that can lead to the expulsion of the ovum?

Mercury Signup and view all the answers

What kind of shock can occur due to severe pain from a perforation of the uterus during an abortion?

Neurogenic shock Signup and view all the answers

What effect does the strong irritation of the gastrointestinal tract have as a method of inducing abortion?

Lead to reflex uterine contraction Signup and view all the answers

Which potential post-abortion complication is linked to sepsis and typically occurs after the first three days following an instrumental abortion?

Septicemia Signup and view all the answers

Which abortifacient drug requires a high dose to be effective, resulting in potential complications such as methemoglobinemia and blindness?

Quinine Signup and view all the answers

Study Notes

Medicolegal Importance of Pregnancy, Delivery & Abortion

Civil Circumstances:
- Inheritance: A widow may claim pregnancy shortly after her husband's death to inherit his estate.
- Divorce: A woman might claim pregnancy to receive greater alimony for her child.
- Disputed Paternity: Accurate pregnancy duration estimation is crucial when a woman is accused of being pregnant while her husband is away, challenging paternity.

Criminal Circumstances

Rape: A pregnancy arising from rape strengthens the accusation, and the victim may seek compensation.
Capital Punishment: A pregnant female condemned to death penalty may use pregnancy to delay the execution.
Suicide Attempts: Pregnancy might be a factor in cases of attempted suicide.

Signs of Pregnancy

Presumptive Signs: These are not definitive medical proof, as they can occur in other non-pregnancy conditions.
- Amenorrhea
- Nausea and Vomiting (Morning Sickness)
- Frequent Urination
Breast Changes (2nd-3rd Months):
- Increased firmness and tenderness
- More prominent and visible veins
- Darkening of the areola
- Enlargement of Montgomery glands
- Presence of colostrum
Abdominal Wall Signs:
- Abdomen enlargement evident in the 2nd trimester;
- Linea nigra in the middle
- Stria gravidarum (stretch marks) visible on the sides
Uterine Enlargement:
- 3rd month: uterus palpable just above the symphysis pubis
- 4th month: fundus at the junction of lower 1/3 and upper 2/3 of line connecting symphysis pubis to the umbilicus
- 5th month: fundus at the junction of lower 2/3 and upper 1/3
- 6th month: fundus reaches the umbilicus level
- 7th month: fundus reaches the junction of lower 1/3 and upper 2/3 line connecting the umbilicus to the xiphisternum
- 8th month: fundus reaches the junction of lower 2/3 and upper 1/3
- 9th month: fundus reaches the level of the xiphoid process
Other Genital Changes:
- Dark pigmented vulva
- Vaginal mucosa becomes violet (from originally pink) due to increased vascularity and mucous secretion
- Softening of the cervix (Hegar’s sign), originally firm as cartilage , by the 2nd month
- Uterus enlarged, soft, and globular
Palpable Uterine Contractions: Can be felt after 20 weeks
Sure Signs:
- Palpation of fetal parts, specifically the head and limbs (16 weeks)
- Palpation of fetal movements (20 weeks)
- Auscultation of fetal heart sounds (22 weeks, can also be detected via Doppler at earlier stages, between 12-14 weeks).
- Key points to differentiation include rhythm (120-140 beats per minute), and distinctness from maternal pulse and uterine souffle.
Fetal Heart sounds' Absence: Possible reasons for absence of fetal heart sounds include fatty abdominal wall, excess amniotic fluid, or fetal death.
Pregnancy Tests: Based on the presence of human chorionic gonadotropin (hCG) in urine or blood.
- Urinary Immunological Tests: Antigen-antibody reaction detecting hCG 2 weeks after missed period. Morning urine is optimal.
- Blood Radioimmunoassay: Detects hCG 2 days after implantation, quantifies hCG levels.
Ultrasound Scanning:
- Visualizes the gestational sac and embryo (as early as 5 weeks).
- Aids in pregnancy duration assessment, fetal disease identification, and age determination.
Duration of Pregnancy:
- The typical gestation period is 280 days (40 weeks ± 2 weeks), calculated from the first day of the last menstrual period.
Dead Cases Exam Diagnostic Points:
- Examine the uterus for weight, length, and contents.
- Determine fetal age.
- Perform microscopic examination of chorionic villi in early pregnancy.
Gestational Period Determination:
- Living individuals: Fundal level and ultrasound are used.
- Dead individuals: Uterine weight and length are used to gauge the period of gestation (see chart for specific measurements and correlates)
Artificial Insemination:
- A medical procedure to induce pregnancy by inserting semen into the female genital tract beyond sexual intercourse.
  - Homologous (A.I.H.): Uses semen from the spouse, useful in cases of male infertility or hostile vaginal conditions.
  - Donor (A.I.D.): Utilizes a donor's semen, ethically contentious, with resulting offspring being unlawful.
In Vitro Fertilization (IVF): Fertilizing an ovum outside the body and then placing the embryo in the uterus. Lawful if the sperm and egg are from the parents, and unlawful if sperm and/or egg are from a donor.
Delivery:
- Conditions requiring examination: Inheritance claims by widows, infanticide accusations, disputed maternity cases, kidnapping cases
Signs of Recent Delivery (in the living, within 6 weeks):
- General Signs: Pallor, exhaustion, rapid pulse, enlarged breasts containing colostrum, lax abdomen showing striae gravidarum and linea nigra.
- Local Signs: Congested and swollen vulva, perineal tears or bruising, vaginal discharge ("lochia"; initially bloody, then pinkish, and finally white and turbid, lasting 14 days), a softer cervix), and a uterus that descends to a midpoint between the umbilicus and pubic symphysis within a week.
Signs of Recent Delivery (in the dead):
- Uterus demonstrates involution, showing reduced size and diminished weight, containing blood clots and reduced substance amount in the womb after delivery..
- Laceration or bruising around the site of the placenta
- Enlargment of the corpus luteum organ of the ovary
- Dilated, bruised, and potentially lacerated vagina
- Signs of episiotomy or perineal tears
Signs of Remote Delivery (in the living):
- Breast changes: lax, soft, pendulous breasts; enlarged nipples; dark areola.
- Abdominal changes: lax abdomen; striae gravidarum; linea nigra.
- Vaginal changes: labia do not completely close the vaginal orifice; possible scarring on the perineum.
- Hymen ruptured
- Vaginal mucosa smooth (loss of vaginal rugae or folds)
Signs of Remote Delivery (in the dead): -Endarteritis obliterans evident at the placental site.
Differences between parous and nulliparous uteri: (see chart for detailed comparison)
Criminal Abortion:
- Expulsion of pregnancy contents before full term, due to reasons beyond saving the woman's life.
Conditions Requiring Abortion Examination:
- Injuries resulting in alleged abortion.
- Taking of medication for abortion.
- Concealment of abortion after the accusation.
- Post-abortion death necessitating examination.
Methods of Abortion Induction:
- General Violence: Violent exercises, jumping from a height, lifting heavy objects.
- Local Violence (Non-professional): Instruments (knitting needles, wood), inserting foreign objects, using irritants (arsenic, mercury).
- Local Violence (Professional): Catheter introduction, D&C; injecting hypertonic solutions, removing amniotic fluid and replacing it with a saline/glucose solution.
- Abortifacient Drugs: • Ecbolics: Have specific action on the uterus leading to contraction (Ergometrine, Oxytocin, Prostaglandins PGE2 & F2, or Potassium Permanganate, Quinine or Lead) with varied effects and risks, such as vascular spasms and gangrene • Drastic purgatives (e.g. Colocynth, cantharides, castor oil, croton oil, jalap) • General prototoplasmic poisons (e.g. arsenic, antimony, mercury, lead oleate)
Abortion Dangers (Complications):
- Neurogenic shock (parasympathetic or sympathetic).
- Hemorrhage (primary/secondary to retained products, sepsis)
- Venous air embolism
- Amniotic embolism
- Acute poisoning
- Disseminated Intravascular Coagulation (D.I.C)
- Sepsis
Abortion Diagnosis (Living Patients):
- Consent of the patient
- Patient history
- Signs of pregnancy
- Signs of general and local violence
- Investigations (blood, urine, stools)
- Products of abortion (precipitin test, fetal age determination)

-Abortion Diagnosis (Dead Patients): -Examine Peritoneum, GIT, Vagina, and Cervix, and Uterus as per the mentioned observations

Autopsy Consideration for Air Embolism: Radiological examinations of the chest and abdomen pre-autopsy are required. Detection of air bubbles in the heart and major thoracic veins confirms the diagnosis.

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Description

Test your knowledge on forensic medicine topics related to pregnancy and trauma. This quiz covers key signs, symptoms, and legal implications in medico-legal cases concerning pregnancy and related complications. Perfect for medical and law students, as well as professionals in the field.