Pregnancy, Delivery & Abortion PDF

VERGINITY DEFINITION A virgin(virgo intacta) is a female who has not experienced sexual intercourse. Defloration means loss of virginity HYMEN The hymen is a fold of mucous membrane about 1mm thick, situated at the vaginal outlet. Structurally the hymen varies considerably. It maybe thin...

VERGINITY DEFINITION A virgin(virgo intacta) is a female who has not experienced sexual intercourse. Defloration means loss of virginity HYMEN The hymen is a fold of mucous membrane about 1mm thick, situated at the vaginal outlet. Structurally the hymen varies considerably. It maybe thin membrane or maybe tough & fleshy Sometimes it may consist of elastic tissue and be easily distensible. Hymen has no innervation  TYPES OF HYMEN 1. Annular – with round/oval opening (common) 2. Semi-lunar/ Crescentic 3. Infantile – with a small linear opening in middle 4. Cribriform – multiple small opening 5. Verticle 6. Septate – with 2 lateral openings 7. Fimbriate – margine is wavy/ undulated/ marked irregular. Should not be mistaken for rupture. Causes For Rupture Of Hymen o Accidents o Masturbation by introducing foreign body o Surgical operation o Tampons o Scratching o Ulceration due to diptheria, fungus or other diseases. The presence of unrupture hymen is a presumption, but is not an absolute proof of virginity. Medico – legal Aspects ❖ Nullity of marriage ❖ Divorce ❖ Defamation ❖ Rape NULLITY OF MARRIAGE : The marriage never existed between 2 people and marriage was not valid. 1. When either party was under the age of marriage contract 2. When either party was of unsound mind/ mental defective at the time of marriage 3. When one party was already validly married. 4. Where the marriage has not been consummated due to impotence / wilful refusal 5. Where woman was pregnant by another man at the time of marriage. PREGNANCY Pregnancy Is A Condition Of Having A Developing Embryo Or Foetus In The Female ( uterus), When An Ovum Is Fertilized By Spermatozoon.  MEDICO-LEGAL IMPORTANCE 1) Trial in the court – pregnancy may be pleaded to avoid appearance in the court. 2) Capital punishment – high court has power to postpone the execution of death sentence until 6 months after delivery or to commute it. ( sec 416 Cr.P.C) 3) Feigning – pregnancy & deliverry after the death of her husband to claim the property. 4) Defamation – alligation of defamation can be made by an abandoned pregnant woman 5) Suicide /homicide – pregnancy maybe alleged as a motive for suicide or murder of an unmarried woman / widow 6) Divorce – woman may allege pregnancy to get more alimony 7) Criminal abortion – whether she was quick with the child or not to determine the punishment (sec 312 I.P.C) 8) Infanticide – in concealment of birth / pregnancy and infanticide cases 9) Negligence - a medical officer may terminate pregnancy thinking that it maybe tumour 10)Maternity leave 11)Pregnancy in minor PSEUDOCYESIS : spurious / phantom pregnancy woman feign pregnancy or firmly believes to be pregnant and shows all the subjective symptoms of pregnancy. Woman nearing menopause/ hysterical/ an immense desire to be pregnant Thorough examination reveal the truth. SUPERFECUNDATION It means the fertilization of the two ova which have been discharged from the ovary at the same period by two separate acts of coitus committed at short intervals Fertilization maybe sometimes from different men Medico-legal aspects- doubt of adultery and infidelity. SUPERFOETATION Fertilization of a second ovum in a women who is already pregnant. Fraternal twins – identical twins- dizygotic Identical twins- monozygotic Vanishing twin syndrome- twin embolism syndrome / foetal resorption LEGITIMACY AND DISPUTED PATERNITY Legitimacy is the legal state of a person born in lawful marriage or within 280 days of dissolution of marriage by death of husband or divorce as per sec 112 IEA.  ILLEGITIMACY The child becomes illegitimate or bastard if it can be proved that the husband could not possibly be the father of child by producing evidence Under the age of puberty Physically incapable to beget children bcoz of illness / congenital / acquired deformity. Did not have access to his wife during the time that the child was begotton Blood group of child and alleged father are not compatable  MEDICO-LEGAL SIGNIFICANCE 1. INHERITANCE : a legitimate child can only inherit the property of his father. 2. SUPPOSITITIOUS CHILDREN : it means fictitious children for claiming money or property 3. PATERNITY : a. Parental alikeness b. Atavism c. Developmental defects d. Paternity test e. DNA fingerprinting  DELIVERY Delivery means expulsion or extraction of the foetus from the uterus at birth. ML- significance : ▪ Infanticide ▪ Concealment of birth ▪ Feigned delivery ▪ Abortion ▪ Legitimacy ▪ Nullity of marriage ▪ Divorce ▪ Blackmail SIGNS OF DELIVERY  ABORTION Legally , abortion (miscarriage) means the premature expulsion of the foetus from the mothers womb at any time of pregnancy, before full term of pregnancy is completed.  CLASSIFICATION NATURAL ARTIFICIAL SPONTANEOUS THEREPEUTIC ACCIDENTAL CRIMINAL CRIMINAL ABORTION : A criminal abortion is the induced destruction and expulsion of the foetus from womb of the mother unlawfully i.e when there is no indication for the operation. Punishment for inducing criminal abortion- sec 312 to 316 IPC Sec. 312 IPC: Whoever voluntarily causes criminal abortion with the consent of the patient is liable for imprisonment upto 3 years and/or fine, and if the woman is quick with child, imprisonment may extend upto 7 years.  Sec. 313 IPC: If miscarriage is caused without the consent, imprisonment upto 10 years and fine. Sec. 314 IPC: If pregnant woman dies from this act, imprisonment upto 10 years and fine. Sec. 315 IPC: Any act done with intent to prevent the child being born alive or cause its death before birth is punished with imprisonment upto 10 years and/or fine. Sec. 316 IPC: Any act which cause death of quick unborn child amounts to culpable homicide and imprisonment upto 10 years and fine. METHODS OF CRIMINAL ABORTIONS METHODS ABORTIFACIANT GENERAL LOCAL DRUGS VOILENCE VIOLENCE ECBOLICS VIOLENT CUPPING EMMENAGOGUES EXERCISE, HUGGINSON’S GENITO-URINARY CYCLING, SYRINGE TRACT IRRITANT JUMPING, RUPTURE OF GIT IRRITANTS JOLTING ETC MEMBRANES DRUGS HAVING ABORTION STICK POISONOUS SYRINGE EFFECTS ASPIRATION UTUS PASTE  COMPLICATIONS OF CRIMINAL ABORTION IMMEDIATE COMPLICATIONS : Vasovagal shock Perforation of vaginal wall and haemorrhage Laceration of cervix and haemorrhage Perforation of uterus and bowel Haemorrhage from placenta Air / fat embolism Amniotic fluid embolism DELAYED COMPLICATIONS: Cervical Necrosis Infected laceration LATE COMPLICATION Septic mertritis Salpingitis Pulmonary thrombo – Oophroritis phlebitis, embolism Peritonitis Hepatic failure and jaundice Septicemia Renal failure Pneumonia Tetanus  Duties of a Doctor in Suspected Criminal Abortion i. He must ask the patient to make a statement about the induction of criminal abortion. If she refuses, he should not pursue the matter, but inform the police. ii. Doctor should keep all the information obtained by him as professional secret. iii. He must consult a professional colleague. iv. If the woman's condition is serious, he must arrange to record the dying declaration. v. If the woman dies, he should not issue a death certificate, but should inform the police for post- mortem examination.