SlideShare una empresa de Scribd logo
1 de 87
Descargar para leer sin conexión
Pregnancy ,Delivery
Dr SM Arman Hossain
1
Pregnancy
Definition of pregnancy :
Pregnancy is the state of female which is produced due to
the implantation of fertilized ovum in the uterine
endometrium and ultimately give rise to a fetus.
Pregnancy is a condition of having a developing embryo
or fetus in the female, when an ovum is fertilized by a
spermatozoon.
2
Duration
• Average: 280 days
• Maximum: 354 days
• Min:180 days
• Zygot : Fertilized ovum
• Embryo : After implantation to 8th weak
• Fetus :After 8th week
3
Viable age/ Viability
• It is the erliest age at which, if the child is born alive, is
physically capable to lead a seperate life outside the
body of the mother, depends on many biological &
physiological factors as also on the extrinsic factors.
• It means capability of a foetus to lead life after birth
independently.
• Avarage viable age: 210 days or 7 months
• Earliest viable age: 180 days or 6 moths
4
Signs & symptoms of pregnancy
A. Presumptive signs
B. Probable signs
C. Certain signs/Positive signs
5
Presumptive signs
1. Amenorrhoea
2. Morning sickness
3. Changes in the breast
4. Changes in the vagina -Jackquemier’s sign:After 4thwk.
5. Pigmentation of skin
6. Sympathetic disturbances
7. Frequency of micturition
8. Constipation
9. Appearance of linea nigra & striae graviderum
10. Altered food choice
11. Quickening – Multi :16-18th, Primi:18-20th wk.
6
Probable signs
1.Progressive enlargement of abdomen
2. Height of the uterus
3.Softening of cervix of uterus (Hegar’s sign) :7-10th wk.
4.Intermittent uterine contraction (Palmer’s sign) : 4-8th wk.
5. Cervix: Goodell`s sign is positive at about 4 months.
It is the extreme softening of the cervix & there is also
bluish discoloration of the cervix.
4.Uterine souffle : It is a soft blowing murmur, which is
synchronous with mother’s pulse. Present at the End of 4th
month.
5.Ballotment test
6.Pregnancy test
7
Certain signs/ Positive sign
1.Foetal movement : After 20th wk
2.Auscultation of foetal heart sound :
18-20th wk, 120-160 b/m
3. Palpation of foetal parts
2.Imaging -USG –6th wk,
-Radiology –after 3rd month,
-MRI, etc
8
Hegar’s sign & Linea nigra
9
Jacquemier’s sign/ Chadwick’s sign
Color of the vaginal mucosa is changes from pink to
violet, depending to blue as a result of venous obstruction
is called Jacquemier’s sign/ Chadwick’s sign
Braxton Hick’s sign: It is characterized by intermitten
painless uterine contraction of the fetus. Each contraction
lasts about one minute, followed by relaxation for about
2-3 minutes. It is a probable sign of pregnancy.
10
Tests for pregnancy /Pregnancy tests
1.Biological tests -Aschheim-Zondek test
Frank test
Friedman test,
Hogben test/Xenopus test,
Galli- Mainini/male frog test.
2.Immunological/serological tests –
Agglutination-inhibition test,
Haemoagglutination-inhibition test,
RIA & ELISA
3.Imaging - USG,Radiology, MRI etc.
11
Medico legal importance of pregnancy
criminal cases :
1.Execution of death sentence
2.Court procedure - suspended in advanced pregnancy
3.Pregnancy claimed to be the result of rape
4.Pregnancy in an un-married girl of 16 years or less and
in married girl of 15 years or less pointed towards
commission of the offence of rape
5. Suit for breach of promise of marriage
12
Medico legal importance of pregnancy
6. False blame by a girl against a man & blackmailing
7.Charge of adultery against the man, who is responsible
for the woman’s pregnancy
8. Pregnancy may ascertain the motive behind suicide or
homicide of an unmarried woman or widow
9. In case of alleged concealment of pregnancy, birth and
infanticide.
10. Alleged criminal abortion
13
Medico legal importance of pregnancy
Civil cases :
1.Nullity of marriage
2.Pregnancy and divorce
3.Inheritance of property
4.To get more alimony a woman may claim to be pregnant
incase of divorce
5.Compensation cases - In accidental death of husband –
damage suit for pregnant wife
6.Illegitimacy & posthumous baby
7.Leave facility for pregnant woman.
14
Unusual pregnancies
1. Twin/Multiple pregnancy
2. Superfoetation
3. Superfecundation
4. Foetus papyraseous or compressus
5. Pregnancy without knowledge of the pregnant woman
6. Pregnancy without real sexual intercourse
15
Pseudocyesis/Spurious pregnancy/False
pregnancy/Phantom Pregnancy
It is a condition where a woman shows most of the signs &
symptoms of pregnancy such as enlargement of abdomen,
weight gain , nausea , morning sickness but she is not
pregnant.
Commonly subjects suffer from some kind of psychic &
hormonal disorder. The woman believes that she is pregnant.
May false labour pain at full term.
It is mostly found in –childless women,
women nearing the menopause
Pathological conditions –pelvic/abdominal tumours,
fatty abdomen.
16
Superfoetation
Fertilization of a second ovum in a woman who is already
pregnant is called superfoetation
This is a type of twin pregnancy where, during the
continuation of pregnancy an ovum is liberated in a
subsequent cycle which gets fertilized followed by
progressive development of both the fertilized ova
17
Superfecundation
Fertilization of two ova discharged from the ovary at the
same menstrual period by two seperate act of coitus
commited at short intervals
Two ova are discharge at a time in one ovulation period
the two ova may be fertilized by sperms of two different
act of coitus, occuring within a short period.
18
Difference betweeen Superfecundation & Superfoetation
Trails Superfecundation Superfoetation
1. Time of fertilization Fertilization of the two
or more ova from the
same menstrual cycle by
sperm from seperate
sexual acts
It can occur where there
are two uteri, or where
the menstrual cycle
continues through
pregnancy.
2. Age of the fetus May be same/ difference
between two fetal age is
small
Must not same & there is
atleast 1 menstrual cycle
difference between the
two fetus
3. Occurence More possibility than
superfoetation
Extremely rare in human
19
Fetus Papyraseous/ Compressus
In twin pregnancy one fetus may grow & develop more at
the cost of another. The latter may eventually die & get
compressed & flattened gradually. Such a fetus is termed
as Fetus Papyraseous/ Compressus.
20
Delivery
Delivery : It means parturition or expulsion of the product
of conception from the uterus after full term of pregnancy.
It is the spontaneous expulsion of the product of
conception from the uterus of a pregnant woman at full
term in normal way.
It is the expultion or extraction of the child at birth
21
Signs of recent delivery
o In living :
1.General indisposition: Woman is pale, exhausted & ill
looking
2.Breasts: Breasts are full, enlarged and tender with a
knotty feeling and colostrums or milk may be present.
Areola is dark, nipple is enlarged.
3.Abdomen: Pendulous, wrinkled & show striae
graviderum
4.Uterus: Contracted & retracted body of the uterus feels
like hard muscular tumour
22
Signs of recent delivery
5.Vagina: Smooth walled, relaxed, capacious & may show
recent tears which is usually heals by the seventh day.
The rugae begin to reappeare about the third week.
6.Labia: Tender, swollen & bruised or lacerated.
7.Cervix of uterus: Soft & dilated. Internal os begins to
close in the first 24 hours.
8.Lochial discharge –Lochia rubra:4-5 days, Lochia
serosa:4-5 days, Lochia alba :upto 2-3wks
9. Perinium: Sometimes lacerated.
10. .Intermitten uterine contraction
23
Signs of recent delivery
o In dead body: All local signs present in recent delivery
of living may be present. Some other changes after
death are...
1. Uterus is flabby for up to 2 days and then gradually
shrinks and resumes its firmness with its cavity
obliterated.
2. The ovaries and fallopian tubes are usually congested.
3. The bladder shows edema and hyperemia and
frequently submucous extravasation of blood.
24
Signs of remote delivery
Signs of remote delivery (Includes some permanent sings
of pregnancy & permanent signs of delivery) In living –
1. Abdomen : Abdominal walls tend to show multiple
white scars on lateral aspects.
2. Breasts: They are lax, soft and pendulous. Nipples are
enlarged with areola darkened.
3. Vulva: Vagina is partially open as labia do not
completely close the orifice.
4. Cervix: Cervix is Irregular and show scars. External os
is also irregular and fissured
25
Signs of remote delivery
Signs of remote delivery in dead body –
1. Uterus: Uterus is larger, thicker and heavier.The Walls
are concave from inside forming a wider and rounded
cavity.The body of uterus is twice the length of the
cervix.
2. Cervix: Cervix is irregular in form & shortened. Its
edges show cicatrices. The external os is not well
defined.
26
Medico legal importance of delivery
The legal issues linked with delivery are –
1. Abortion
2.Infanticide
3.Concealment of birth
4.Suppositious child (False delivery)
5.Blackmailing
6.Contested legitimacy
7.Nullity of marriage
8.Divorce
9.Chastity
10.Defamation
27
ML importance of delivery
11.Inheritence
12.Execution of death sentence
13.Trial
14.Delivery after being pregnant as a result of rape
15.Delivery before 16 is evidence of rape
16.Homicide & suicide
17.Leave after delivery
28
Difference between parous & nulliparous uterus
points Nullirous uterus parous uterus
1.Size
2.Weight
3.Ratio between body &
cervix
4.Upper surface of fundus
5.Uterine cavity
6.Scar for placental
attachment
7.External os
8.Internal os
1.Smaller (7x5x2cm)
2.40 gm
3.Length of body & cervix
almost equal .
4.Less convex & is in the
same line of broad ligament
5.The inner walls are
convex & that makes a
triangular cavity with less
space
6.Absent
7.Small roundish dimple
like depressed opening
8.Circular, well defined
1.Larger (10x6x2.5cm)
2.80-100 gm
3.Length of body is almost
twice the length of cervix .
4.More convex & is at a
higher level than line of
broad ligament.
5.The inner walls are concave
& that makes a
comparatively large &
spacious cavity.
6.Present
7.Tranverse slit like opening.
8.Ill defined , margin
wrinckled
29
Suppositious child
Suppositious child : A suppositious child is one belonging
to another person produced by a women claiming her
own.
Motives/ ML importance:
1. Inheritance of property
2. Blackmailing a male
3. When a widow claims higher compensation from
husband’s emplyer.
30
Posthumous child
It is a child born after the death of its father, the mother
being conceived by the said father.
Medico legal importance:
• Legitimacy,
• paternity,
• inheritance of property
• increased compensation from father’s emplyer
• Compensation cases against slanders against the
mother.
31
Post maturity/Post mature baby
It means birth of a baby after 15 days of average duration
of gestation. (After 280+15=295 days)
Features of Post mature baby –
1.Over size (more than 20’’)
2.Increased length of hair ( more than 7”)
3.Over weight
4.Nails –prominence beyond fingers
5.Radiology –Ossification centers in upper end of tibia &
cuboid bone of the fetus
32
Prematurity/ Pre mature baby
It means birth of a baby before 15 days of average
duration of gestation. (After 280-15=265 days)
Features of Pre mature baby –
1.Smaller size – less birth length
2.Less birth weight (<2.5kg)
3.Undescended testis
4.Eyes are more closed
5.Less developed nails
33
Abortion
• Definition
• Types
• Criminal abortion
• Indication of MTP
• Abortion procedure
• Complications of criminal abortion
• Medico legal importance
• Doctor & abortion
34
Abortion
Definition: Legally abortion means termination of
pregnancy by premature expulsion of the fetus, from the
uterus , at any time of pregnancy.
Abortion means the premature expultion of the fetus from
the mother’s womb at any time of pregnancy, before full
term of pregnancy is completed.
Interruption of the conception of pregnancy before 20th
wks with or without expultion of the fetus either
spontaneously or induced is called abortion.
35
Types of abortion
A. Spontaneous
1.Natural
2.Accidental
B. Induced
1.Legal or justifiable
2.Criminal
36
Causes of spontaneous(natural/accidental) abortion
(mostly during 2nd-3rd month, 15-20%)
1.Defect in the ova, including chromosomal defect
2.Developmental defect of fetus
3.Low implantation of zygote
4.Diseased condition of decidua or placenta
5.Rh incompatibility
6.Retroverted uterus
7.Submucus uterine fibroid
8.Malformed uterus
9.Uterine hypoplasia
10.Hyperpyrexia of mother
37
Causes of spontaneous abortion
11.HTN
12.DM
13.Hormonal deficiency
14.Fatigue & general ill health
15.Sudden shock, emotional disturbance
16.Syphilis
17.Nephritis
18.Arsenic/lead toxicity etc.
19.Drug toxicity
20.Some vegetable poisoning
21.Trauma
38
Legal or justifiable(Therapeutic abortion)MTP Indications
Maternal conditions
A. Medical conditions –
1.Respiratory conditions – Active PT
2.Renal conditions –chronic nephritis, NS, PCKD
3.Cardiovascular conditions –CCF, Malignant HTN, Rh
heart disease
4.Endocrine & metabolic conditions –Sever thyroid
disorders with cardiac problems, Uncontrolled DM
5.Gastrointestinal conditions –U.colitis
6.Neurological conditions –chorea, multiple sclerosis
39
Cause of MTP(Medical Termonation of pg)
B.Surgical conditions
1.Malignancy– Ca-breast/cervix/Ovary
2.Chronic pyloric stenosis
C.Obstetric conditions
1.Toxemia of pregnancy
2.Threatened abortion with persistent or severe
haemorrhage
3.Repeated C/S
4.Uterine fibroids
5.Ireducible prolapse of the gravid uterus
D.Psychiatric conditions–Schizophrenia, severe
depression
40
Cause of MTP(Medical Termonation of pg)
E. Conditions relating to ovum or foetus –Ectopic
pregnancy, dead fetus, hydatidiform mole, placental
detachment or disease, acute hydramnios, gross
malformation.
F. Humanitarian conditions: Pregnancy as result of rape.
G.Social conditions : Widow, contraceptive failure
41
Common methods of Therapeutic Abortion
1.Dilatation & curettage (D&C) – suitable for early
pregnancy under GA.
2.Dilatation & oxytocin infusion
3.Low rupture of membrane
4.Use of utus paste (containing mercury)
5.Vacuum aspiration
6.Amniotic replacement by hypertonic glucose or saline
solution.
7.Some prostaglandin preparations are used –
locally/orally/IV to induce abortion.
8.Laparotomy
42
Common procedure of criminal abortion in practice
A. Abortifacient drugs
1.Ecbolics –directly contract pregnant uterus –ergots,
quinine, strychnine
2.Emmenagogues – initiate menstrual flow–
oestrogen,borax
3.Purgatives –julap, castor oil, senna.
4.Irritants –cantharides, oil of turpentine
B.Use of general violence
1.Application of severe pressure or force on the wall of
abdomen –blows, kicks, tight pressure
2.Heavy exercise –jumping, jolting, riding
43
Common procedure of criminal abortion in practice
3.Cupping
4.Apptication of very hot/very cold hip bath
5.Combined mechanical violence & drug administration.
C. Use of local violence
1.Application of hot or cold douches in vagina
2.Administration of objects into uterine cavity with out
dilatation
3.Insertion of FB into the uterus
4.Syringe aspiration
5. Introduction of utus paste in uterus
44
Complications of criminal abortion
A. Local injuries : excoriation, lacerations/perforations in
upper vagina/cervix/uterine wall
B. Immediate effects
1.Shock & hemorrhage
2.Air embolism
3.Reflex vagal inhibition
C. Delayed effects
1.Sepsis/ septicaemia/ pyaemia
2.Toxaemia
45
Complications of criminal abortion
3.Peritonitis
4.Tetanus
D. Remote effects
1.Jaundice , renal suppression, renal failure
2.Bacterial endocarditis, pneumonia, empyema,
meningitis
3.Leg vein thrombosis –pulmonary embolism
4.DIC
E. Poisonous effects of drugs
46
Medicolegal importance of abortion
1.Abortion may be induced without proper indication or
in acontravention to other provision of MTP Act , when it
amounts to a crime.
2.When a doctor violets the provision of MTP Act, he is
liable to be punished.
3.A pregnant or even non pregnant woman may malinger
abortion, due to assault, to bring a false charge against a
person.
4.Abortion may be feigned to bring a charge of rape by a
man , for blackmailing the man.
47
Medicolegal importance of abortion
5. Abortion may be feigned to claim compensation by a
working woman, linking the said abortion with her
hazardous duty.
6.A woman may be falsely charged for inducing criminal
abortion.
7.A woman who has aborted, may be falsely charged for
infanticide.
8. A woman who has aborted, may bring a charge of
negligence against her doctor.
48
Doctor & abortion
1.The doctor should consult a professional colleague.
2.He should render proper treatment to the patient.
3.Law demand that the police authority should be
informed about the crime. The doctor should other wise
maintain professional secrecy.
4.Dying declaration
5. If woman dies, then the doctor should inform the police
for arranging for PM examination & other
investigations.
49
Findings related to abortion in living
Those depend upon the stage of pregnancy, abortion
method & time elapsed since abortion at the time of
examination. Signs of recent delivery may be present.
1.Relevent history.
2.Breasts may be found enlarged
3.Bruises may be found in abdominal wall & other parts
of body, striae
4.Some sorts of injury in the external genitalia including
fourchette
5.Vaginal canal may show excoriation, laceration or
wounds of the mucus membrane
50
Findings related to abortion in living
6.External os may show tears or lacerations & marks of
forcep or other instruments.
7.Signs of any disease if present predisposing to natural
abortion.
8.In first trimester abortion specific local signs include –
hemorrhage (relatively small amount), softening of
external os & maternal passage, slight increased size of
uterus –normalized within few days.
9.In late abortion specific local signs include –
hemorrhage (more), genital parts are markedly soft,
internal os may admit one finger, uterus is enlarged.
10.Signs of violence & complication may be found.
51
PM findings related to abortion
A. External
1.Markes of general violence.
2.Marked cyanosis
3.Enlarged breasts
4.Striae on abdomen
5.External genitalia may show evidence of irritants &
local injuries, bleeding, fetal remains.
52
PM findings related to abortion
B. Internal
1.The pelvic floor & organs may show lacerations,
contusions, ruptures, inflammation, infection,
hemorrhage, marks of instrumentation.
2.Cervix & os may be injured (laceration, tear, bruise),
soft, evidence of dilatation, evidence of instrumentation
& application of abortifacient.
3.Uterus –enlarged, placental attachment , injury, FB,
remains of fetus, placenta, membrane.
4.Microscopic/ histopathological examination
5.Chemical examination –viscera & uterus
53
Difference between natural & criminal abortion
Points Natural abortion Criminal abortion
1.Cause
2.Infection
3.Marks of violence on
abdomen
4.Injuries in genital organs
5.Toxic effects of drugs
6.Foreign bodies in genital
tract
7.Foetus
1. Natural
2.Rare
3.Not present
4.Absent
5.Absent
6.Absent
7.Wounds are absent.
1.Induced
2.Frequent
3.May be present
4.Present
5.Present in vagina,
cervix, GIT, UT
6.May be present
7.Wounds may be present.
54
Feticide
Feticide: Feticide means destruction of the fetus at any
time before its birth by unlawful means.
Related 3 important terms :
• Still born
• Live born
• Dead born
55
Still born
When fetus of more than 28 weeks of gestational age
(after viable age) did not breath or show any sign of life
at any time after complete birth is called still born child.
Death occurs during labour process.
Causes of still birth –
1. Complicated labour
2.Flooding of the lungs with liquor amnii
3.Desquamation of bronchial epithelium
MLI of still birth –
• Question feticide, abortion & infanticide
56
Live born & Dead born
Live born: A child is regarded as live born when it takes
breath or shows any signs of life after birth.
Dead born : A dead born child is one which has died in
the uterus before birth. It may show signs of rigor mortis,
maceration or mummification just after birth.
57
Signs of live birth
During life- Hearing of cry, seeing of movement of body or
limb, muscle contraction, heart sound.
During autopsy –
1.Degree of maturity
2.Shape of the chest
3.Diaphragm level
4.Lungs
5.Changes in the stomach & intestine
6.Middle ear changes
7.Changes in the skin
8.Changes in caput succedaneum
9.Changes in the umbilical cord
10.Changes in the circulation
58
Difference between Live born & Still born
Points Live born Still born
1.Chest
2.Diaphragm
3.Lungs
i.Position
ii.Volume
iii.Edges
iv.Colour
v.Appearance
1.Arched or dram shaped, its
circumference is greater
than that of abdomen ,
intercostal spaces are wider.
2.At the level 6th or 7th rib.
3.Lungs –
i.Fill the thoracic cavity,
overlapping the heart & the
thymus gland with covering
pleura.
ii.Voluminous
iii.Rounded
iv.Mottled pink
v.Marbled due to expanded
1.Flat, its circumference is
less than that of abdomen ,
intercostal spaces are
narrow.
2.At the level of 4th or 5thrib.
3.Lungs –
i.Lying at the back of the
thoracic cavity behind the
heart & the thymus gland
with covering pleura
wrinkled & loose.
ii.Small.
iii.Sharp
iv.Uniform, dark blue-red.
v.Smooth, not marbled
59
Difference between Live born & Still born
Points Live born Still born
vi.Consistency
vii.Air vesicles
viii.Squeezing under water
ix.On cutting
x.Hydrostatic test
xi.Static test
4.Stomach-bowel test
vi.Spongy, elastic, crepitant
vii.Visible, sometimes
individually
viii.Bubbles produced are
small & uniform in size.
ix.Exudate frothy blood
though not decomposed.
x.Positive
xi.Ration of weight of lung
to body is 1:35
4.Positive
vi.Dense, firm, liver like &
non-crepitant.
vii.Expanded air vesicles
not seen on surface.
viii.Not preoduced, if any
are large & unequal in size
due decomposition.
ix.Exude little blood but no
froth unless decomposed.
x.Negative
xi. Ration of weight of lung
to body is 1:70
4.Negative.
60
Difference between still birth & Dead birth
Trait Still birth Dead birth
1. Intra uterine age After 28th week of
gestation
No specific mention of its
intra uterine age
2. Time of death Fetus was alive in the
utero, but dies during the
process of delivery
Dead in utero
3. Causes Anoxia, prematurity, birth
trauma or toxemia
Congenital anomaly,
ABO & Rh
incompatibility
4. Predominance Seen mostly among
illegitimate & immature
male children
No such predominance
5. Sign of prolong labour May present Not seen
6. Sign of intrauterine
death
May/ may not be present Must be present
Infanticide
Infanticide: Killing of a newly born baby within 15 days of its birth
is infanticide.
Causes of infant death :
A. Natural causes
1.Prematurity
2.Asphyxia
3.Congenital malformation
5.Haemolytic disease including Rh-incompatibility
6.Neonatal infection
7.Early separation of placenta
8.Pre-eclamptia/ eclamptia in mother
9.Haemorrhage from birth trauma
10.SIDS
62
Cause of Infanticide
B. Unnatural causes
1.Accidental causes
a)During birth:
i.Prolonged labour
ii.Pressure on or prolapsed cord
iii.Knot of the cord or twisting round the neck
iv. Injuries
v.Death of the mother
b)After birth:
i.Suffocation
ii.Precipited labour
2.Criminal causes –infanticide
63
Motives of infanticide
1. Illegitimate child given birth by –widows, unmarried
girls, married women during prolonged absence of her
husband
2.Inheritance
3.Poverty
4.Familial problems/disharmony
5.Dowry system
6.Family pride
7.Custom
64
Modes of infanticide
A. Act of commission
1.Mechanical violence –suffocation, strangulation,
throttling, drowning, fracture of head by blunt injuries.
penetrating wounds, twisting neck, other injuries
2.Poisoning
B. Act of omission –It is improper assistance during
labour or neglect on the part of mother in regard to
child care – failure to ligate cord, failure to provide
nutrition to the baby, failure to protect from extremes of
weather, failure of proper nursing.
65
Autopsy of newborn
Objectives
1.To determine whether DB/SB/LB.
2.To determine cause of death
3.To determine manner of death
4.To determine the intrauterine age & thereby the question of
viability.
Special consideration in autopsy of a newborn
1.External – Development, skin, maceration, caput, cord,
placenta, lividity, FB in mouth or upper respiratory passage,
natural orifices, injuries
2.Internal –Lungs, stomach, intestinal content, ossification
centers.
66
Hydrostatic test
• It is based on the lowering of the specific gravity of the
lungs due to expansion of their alveoli by inspiration during
the act of breathing.
• In the fetal condition & before distension with air , the
lungs are heavier than water & after distension with air the
become lighter than water. Hence if the undistended lung or
its portion be thrown into water, it sinks, while after
distension it floats, thereby indicating that respiration had
taken place.
• If the test is positive , it is a proof of respiration after birth.
• Fallacies- emphysema by putrefactive gases, artificial
respiration; consolidation, edema, congenital tumor,
asphyxia neonatorum; partial breathing, still birth.
67
Precipitate labour
Precipitate labour may be defined as the sudden & rapid
deliver of a fetus specially in case of multipara women
with roomy pelvis without the knowledge of the mother.
Types-
1.True precipitate labour
2.Pseudo or false precipitated labour
68
Medico legal importance
1.Infanticide
2.Injury to foetus
Complications
1.Suffocation –by falling into lavatory pan
2.Head injury & fracture of the skull –by falling on a hard
object.
3.haemorrhage –by torn end of cord.
4.Drowning
69
Viable age
• Viable age –It means capability of a fetus to lead life after
birth independently.
• Avarage viable age: 210 days or 7 months
• Earliest viable age: 180 days or 6 moths
Features of viable age (7th month) –
1.Length :13-16 inches
2.Weight:2-4 lbs
3.Skin:Raw-looking & is covered with a thicker layer of
vernix caseosa .
4.Eyelids:Non adherent, eyelash present, membrana pupilaries
is avascular & undergoing atrophy.
70
Viable age
5.Nails:Well developed but do not extend to the tip of
fingers & toes
6.Caecum:Lies in right iliac fossa.
7.Meconium:Present through the large bowel
8.Testes:May be at internal inguinal ring
9.Convolution over cerebral hemispheres are in the stage
of formation.
10.Centers of ossification: In talus, 2nd & 3rd segment of
sternum.
71
SIDS/cot death /Crib death
Sudden infant death syndrome (SIDS): Sudden death of an
infant which is unexpected by history & in whom a
thorough autopsy fails to reveal an adequate cause of death.
Features -
1.Age range –2wks-2 yrs. 1-7th month, 2-3rd month.
2.Sex –slight male preponderance
3.Twins
4.Season –more in colder/winter
5.Socieo-economic conditions –low, single, poor
6.Suspected factors –hypersensitivity to cows milk, infection.
7. Prematurity: Increased the risk
72
Battered baby syndrome/caffy syndrome
• Battered baby: A battered baby is one who presents
with signs of multiple injuries in its body which are not
accidental in nature rather inflicted by its parents of
foster parents.
• Battered baby syndrome: Battered baby syndrome
refers to injuries sustained by a child as a result of
physical abuse, usually inflicted by foster parent or
guardian.
73
Features of battered baby
1.Age –1 yr
2Sex- male preponderance
3.Position in family- eldest or youngest, unwanted, illegitimate
4.Socio economic factor – Younger parents, isolated, lower
education, lower class, family disharmony, emotional problems,
criminal record, unemployed, unstable
5.History -Discrepancies
6.Precipitating factors –Crying, refusal to be quiet, soiling of
napkins etc.
7.Injuries –Direct manual violence, soft tissue injuries, abrasion-
bruise-lacerations of different ages. Injury to head, neck ,face.
8. Treatment –delay in seeking medial attention.
Munchausen syndrome by proxy :
74
Munchausen’s syndrome by proxy
Munchausen by proxy syndrome (MBPS) is a relatively rare
form of child abuse that involves the exaggeration or fabrication of
illnesses or symptoms by a primary caretaker.
It is a peculiar & dangerous form of child abuse usually involving
the mother, in which children are brought to doctors for induced
sign & symptoms of illness with a fictitious history
Age factor: it is frequent in children of few weeks of age to 21
years.
75
Munchausen’s syndrome by proxy
Diagnosis:
• Illness is produced of alleged, or both by a parent
• Repeated request for medical care of a child, leading to
multiple medical procedure
• Parental denial of knowledge of the cause of the
symptoms
• Regression of symptoms when the child is separated
from parents
76
Munchausen’s syndrome by proxy
Method of production of illness:
• Mother pries her finger and add blood to the urine of
the child & take the sample to the doctor
• The child’s nose is closed with two finger and the lower
jaw is pushed up with the palm to block the airways
• A pillow or towel is put over the face of the child & the
face is pushed down into bed clothing
• The mother gives insulin to the child & takes to the
hospital with hypoglycemia
• Vomiting
• Diarrhea: laxatives, salt poisoning etc.
77
Munchausen’s syndrome by proxy
Usually, the cause of MBPS is a need for attention and Sympathy
from doctors, nurses, and other professionals. Some experts
believe that it isn't just the attention that's gained from the "illness“
of the child that drives this behavior, but also the satisfaction
in deceiving individuals whom they consider to be more important
and powerful than themselves.
Because the parent or caregiver appears to be so caring and
attentive, often no one suspects any wrongdoing. Diagnosis is
made extremely difficult due to the the ability of the parent or
caregiver to manipulate doctors and induce symptoms in the child
78
Marriage
Definition of marriage:
Marriage is legally a contract between man & woman
which implies physical union by coitus.
Marriageable age (In Bangladesh) :
• Male :21 yrs,
• Female :18 yrs.
79
Nullity of marriage
It means marriage is declared never to have existed in law.
Marriage becomes null & void due to some reasons.
1.When either party was under the marriageable age
during marriage.
2.When either party was already validly married without
knowledge of opposite party.
3.When one party was of unsound mind or a mentally
defective at the time of marriage.
4.Where the marriage has not been consummated due to
impotence or willful refusal.
80
Divorce
Divorce means legal dissolution of previously valid
marriage.
A woman can demand divorce from her husband in the
following conditions –
1.Adultery
2.Rape, sodomy, bestiality
3.In case of incurable insanity, leprosy, AIDS.
81
Legitimacy
Legitimacy : It is condition of a person being born in
wedlock.
Legitimate child :
Legitimate child is one who is born during the
continuation of a valid marriage of its parents or within
280 days after dissolution of their marriage when mother
remaining unmarried, unless it can be proved that the
parties to the marriage had no sexual access to each other
at any time when he could have been begotten.
82
Illegitimate or Bastered child
A child is considered illegitimate or bastered in the
following situations –
1.It is born out of lawful wedlock between parents.
2.It is born within wedlock, but without the husband
having the power of procreation.
3.The husband did not have the access to his wife during
the time that the child was procreated.
4.It is not born with in a competent period after
dissolution of marriage .
5.The blood groups of the child & the alleged father are
not compatible.
83
Medico legal importance of legitimacy
Question of legitimacy arises in–
1.Inheritance
2.Affiliation case
3.Suppositious children
4.Disputed paternity
5.Impotence
84
Investigations for legitimacy
1.Confirmation of impotence or sterility
2.Average period of gestation
3.Maximum period of gestation
4.Minimum period of gestation
5.Superfoecandation
6.Superfoetation
7.Paternity & maternity
8.Ever delivered a viable child.
9.Marriage & divorce
85
Paternity
Paternity : paternity means establishment of parenthood
by different investigation.
Contested or disputed paternity : When the paternity of a
child is in question.
Determination of paternity :
1.Complexion
2.Hereditary diseases
3.Atavism
4. Paternity tests
i)Blood grouping –ABO, Rh & Mn system –50-60%
ii. HLA test –99%
iii)DNA profiling –about 100%
86
Thanks To All
87

Más contenido relacionado

La actualidad más candente

Infant death 1
Infant death 1Infant death 1
Infant death 1FMT
 
Impotence, sterility, artificial insemination
Impotence, sterility, artificial inseminationImpotence, sterility, artificial insemination
Impotence, sterility, artificial inseminationDr Arman Hossain
 
Injury (Forensic science)
Injury (Forensic science)Injury (Forensic science)
Injury (Forensic science)Akshay Deokar
 
Death in Forensic Medicine
Death in Forensic MedicineDeath in Forensic Medicine
Death in Forensic MedicineDr Arman Hossain
 
Strangulation Forensic Medicine
Strangulation Forensic MedicineStrangulation Forensic Medicine
Strangulation Forensic MedicineTittu Joseph
 
Regional injury
Regional injuryRegional injury
Regional injuryFarhan Ali
 
THERMAL INJURIES
THERMAL INJURIESTHERMAL INJURIES
THERMAL INJURIESSuraj Dhara
 
Age & its medicolegal importance
Age & its medicolegal importanceAge & its medicolegal importance
Age & its medicolegal importanceFarhan Ali
 
Medicolegal aspects of Pregnancy, Delivery and Abortion
Medicolegal aspects of Pregnancy, Delivery and AbortionMedicolegal aspects of Pregnancy, Delivery and Abortion
Medicolegal aspects of Pregnancy, Delivery and AbortionShiv Joshi
 
Mechanical injury 3
Mechanical injury 3Mechanical injury 3
Mechanical injury 3Farhan Ali
 
Infant deaths and female feticide
Infant deaths and female feticideInfant deaths and female feticide
Infant deaths and female feticideARIF MASOOD
 
Identification, Forensic Radiology & Odontology
Identification, Forensic Radiology & OdontologyIdentification, Forensic Radiology & Odontology
Identification, Forensic Radiology & OdontologyDr Arman Hossain
 

La actualidad más candente (20)

Death
DeathDeath
Death
 
Virginity, pregnancy and delivery
Virginity, pregnancy and delivery Virginity, pregnancy and delivery
Virginity, pregnancy and delivery
 
Infant death 1
Infant death 1Infant death 1
Infant death 1
 
Impotence, sterility, artificial insemination
Impotence, sterility, artificial inseminationImpotence, sterility, artificial insemination
Impotence, sterility, artificial insemination
 
Injury (Forensic science)
Injury (Forensic science)Injury (Forensic science)
Injury (Forensic science)
 
Identification
IdentificationIdentification
Identification
 
Death in Forensic Medicine
Death in Forensic MedicineDeath in Forensic Medicine
Death in Forensic Medicine
 
Impotence and sterility
Impotence and sterilityImpotence and sterility
Impotence and sterility
 
Strangulation Forensic Medicine
Strangulation Forensic MedicineStrangulation Forensic Medicine
Strangulation Forensic Medicine
 
Sexual offences
Sexual offencesSexual offences
Sexual offences
 
Asphyxia and airway death
Asphyxia and airway deathAsphyxia and airway death
Asphyxia and airway death
 
Regional injury
Regional injuryRegional injury
Regional injury
 
THERMAL INJURIES
THERMAL INJURIESTHERMAL INJURIES
THERMAL INJURIES
 
Age & its medicolegal importance
Age & its medicolegal importanceAge & its medicolegal importance
Age & its medicolegal importance
 
Examination of a victim of rape
Examination of a victim of rapeExamination of a victim of rape
Examination of a victim of rape
 
Medicolegal aspects of Pregnancy, Delivery and Abortion
Medicolegal aspects of Pregnancy, Delivery and AbortionMedicolegal aspects of Pregnancy, Delivery and Abortion
Medicolegal aspects of Pregnancy, Delivery and Abortion
 
Mechanical asphyxia 1
Mechanical asphyxia 1Mechanical asphyxia 1
Mechanical asphyxia 1
 
Mechanical injury 3
Mechanical injury 3Mechanical injury 3
Mechanical injury 3
 
Infant deaths and female feticide
Infant deaths and female feticideInfant deaths and female feticide
Infant deaths and female feticide
 
Identification, Forensic Radiology & Odontology
Identification, Forensic Radiology & OdontologyIdentification, Forensic Radiology & Odontology
Identification, Forensic Radiology & Odontology
 

Similar a Pregnancy, Delivery, Abortion, infant death, marriage, divorce.

DIAGNOSIS OF PREGNANCY
DIAGNOSIS OF PREGNANCYDIAGNOSIS OF PREGNANCY
DIAGNOSIS OF PREGNANCYJAYDIP NINAMA
 
Normal vs cryptic pregnancy Noaman Ali study
Normal vs cryptic pregnancy Noaman Ali studyNormal vs cryptic pregnancy Noaman Ali study
Normal vs cryptic pregnancy Noaman Ali studyNomanRaj1
 
Pregnancy lec
Pregnancy lecPregnancy lec
Pregnancy lecKazi Oly
 
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptxDELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptxBAISHWANARBANERJEE1
 
S and s of pregnancy and hyperemesis gravidarum
S and s of pregnancy and hyperemesis gravidarumS and s of pregnancy and hyperemesis gravidarum
S and s of pregnancy and hyperemesis gravidarumukasha musa hashim
 
15.pregnancy+delivery.pptx
15.pregnancy+delivery.pptx15.pregnancy+delivery.pptx
15.pregnancy+delivery.pptxSatrajitRoy5
 
Diagnosis of pregnancy
Diagnosis of pregnancy Diagnosis of pregnancy
Diagnosis of pregnancy BRITO MARY
 
PREGNANCY AND PRENATAL CARE new.pptx
PREGNANCY AND PRENATAL CARE new.pptxPREGNANCY AND PRENATAL CARE new.pptx
PREGNANCY AND PRENATAL CARE new.pptxMelvinAddun1
 
multiple pregnancy ppt..pptx
multiple pregnancy ppt..pptxmultiple pregnancy ppt..pptx
multiple pregnancy ppt..pptxSnehlata Parashar
 
multiple pregnancy ppt..pptx
multiple pregnancy ppt..pptxmultiple pregnancy ppt..pptx
multiple pregnancy ppt..pptxSnehlata Parashar
 
4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx
4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx
4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docxtamicawaysmith
 
Diagnosis of pregnancy and maternal assessment
Diagnosis of pregnancy and maternal assessmentDiagnosis of pregnancy and maternal assessment
Diagnosis of pregnancy and maternal assessmentDeepthy Philip Thomas
 
Pediatric and adolescent gynecology koc univ. web
Pediatric and adolescent gynecology koc univ. webPediatric and adolescent gynecology koc univ. web
Pediatric and adolescent gynecology koc univ. webSüleyman Engin Akhan
 

Similar a Pregnancy, Delivery, Abortion, infant death, marriage, divorce. (20)

Hs powerpoint
Hs powerpointHs powerpoint
Hs powerpoint
 
Diagnosis.pptx
Diagnosis.pptxDiagnosis.pptx
Diagnosis.pptx
 
DIAGNOSIS OF PREGNANCY
DIAGNOSIS OF PREGNANCYDIAGNOSIS OF PREGNANCY
DIAGNOSIS OF PREGNANCY
 
Normal vs cryptic pregnancy Noaman Ali study
Normal vs cryptic pregnancy Noaman Ali studyNormal vs cryptic pregnancy Noaman Ali study
Normal vs cryptic pregnancy Noaman Ali study
 
Reproductive system
Reproductive systemReproductive system
Reproductive system
 
Pregnancy lec
Pregnancy lecPregnancy lec
Pregnancy lec
 
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptxDELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
DELIVERY MTP ACT PCPNDT ACT AIIMS KALYANI.pptx
 
S and s of pregnancy and hyperemesis gravidarum
S and s of pregnancy and hyperemesis gravidarumS and s of pregnancy and hyperemesis gravidarum
S and s of pregnancy and hyperemesis gravidarum
 
15.pregnancy+delivery.pptx
15.pregnancy+delivery.pptx15.pregnancy+delivery.pptx
15.pregnancy+delivery.pptx
 
Diagnosis of pregnancy
Diagnosis of pregnancy Diagnosis of pregnancy
Diagnosis of pregnancy
 
PREGNANCY AND PRENATAL CARE new.pptx
PREGNANCY AND PRENATAL CARE new.pptxPREGNANCY AND PRENATAL CARE new.pptx
PREGNANCY AND PRENATAL CARE new.pptx
 
multiple pregnancy ppt..pptx
multiple pregnancy ppt..pptxmultiple pregnancy ppt..pptx
multiple pregnancy ppt..pptx
 
multiple pregnancy ppt..pptx
multiple pregnancy ppt..pptxmultiple pregnancy ppt..pptx
multiple pregnancy ppt..pptx
 
4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx
4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx
4.1 What Are Prenatal and Neonatal Stages of DevelopmentWhen co.docx
 
Diagnosis of pregnancy and maternal assessment
Diagnosis of pregnancy and maternal assessmentDiagnosis of pregnancy and maternal assessment
Diagnosis of pregnancy and maternal assessment
 
Abortion presentation
Abortion presentationAbortion presentation
Abortion presentation
 
Pediatric and adolescent gynecology koc univ. web
Pediatric and adolescent gynecology koc univ. webPediatric and adolescent gynecology koc univ. web
Pediatric and adolescent gynecology koc univ. web
 
5.abnormal pregnancy.ppt
5.abnormal pregnancy.ppt5.abnormal pregnancy.ppt
5.abnormal pregnancy.ppt
 
Normal Pregnancy
Normal PregnancyNormal Pregnancy
Normal Pregnancy
 
Diagnosis of pregnancy
Diagnosis of pregnancyDiagnosis of pregnancy
Diagnosis of pregnancy
 

Más de Dr Arman Hossain

Therapeutic management for Low Back Pain by Dr Arman Hossain
Therapeutic management for Low Back Pain by Dr Arman HossainTherapeutic management for Low Back Pain by Dr Arman Hossain
Therapeutic management for Low Back Pain by Dr Arman HossainDr Arman Hossain
 
The Brain Anatomy by Dr Arman Hossain
The Brain Anatomy by Dr Arman Hossain The Brain Anatomy by Dr Arman Hossain
The Brain Anatomy by Dr Arman Hossain Dr Arman Hossain
 
Trace evidence blood group
Trace evidence blood groupTrace evidence blood group
Trace evidence blood groupDr Arman Hossain
 
Forensic medicine and its branches
Forensic medicine and its branchesForensic medicine and its branches
Forensic medicine and its branchesDr Arman Hossain
 
Death & changes after death
Death & changes after deathDeath & changes after death
Death & changes after deathDr Arman Hossain
 

Más de Dr Arman Hossain (9)

Neurogenic Bladder 2.pdf
Neurogenic Bladder 2.pdfNeurogenic Bladder 2.pdf
Neurogenic Bladder 2.pdf
 
Neurogenic Bladder 1.pptx
Neurogenic Bladder 1.pptxNeurogenic Bladder 1.pptx
Neurogenic Bladder 1.pptx
 
Therapeutic management for Low Back Pain by Dr Arman Hossain
Therapeutic management for Low Back Pain by Dr Arman HossainTherapeutic management for Low Back Pain by Dr Arman Hossain
Therapeutic management for Low Back Pain by Dr Arman Hossain
 
The Brain Anatomy by Dr Arman Hossain
The Brain Anatomy by Dr Arman Hossain The Brain Anatomy by Dr Arman Hossain
The Brain Anatomy by Dr Arman Hossain
 
Trace evidence blood group
Trace evidence blood groupTrace evidence blood group
Trace evidence blood group
 
Legal procedure
Legal procedureLegal procedure
Legal procedure
 
Forensic medicine and its branches
Forensic medicine and its branchesForensic medicine and its branches
Forensic medicine and its branches
 
Death & changes after death
Death & changes after deathDeath & changes after death
Death & changes after death
 
Forensic Psychiatry
Forensic Psychiatry  Forensic Psychiatry
Forensic Psychiatry
 

Último

introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 

Último (20)

introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 

Pregnancy, Delivery, Abortion, infant death, marriage, divorce.

  • 1. Pregnancy ,Delivery Dr SM Arman Hossain 1
  • 2. Pregnancy Definition of pregnancy : Pregnancy is the state of female which is produced due to the implantation of fertilized ovum in the uterine endometrium and ultimately give rise to a fetus. Pregnancy is a condition of having a developing embryo or fetus in the female, when an ovum is fertilized by a spermatozoon. 2
  • 3. Duration • Average: 280 days • Maximum: 354 days • Min:180 days • Zygot : Fertilized ovum • Embryo : After implantation to 8th weak • Fetus :After 8th week 3
  • 4. Viable age/ Viability • It is the erliest age at which, if the child is born alive, is physically capable to lead a seperate life outside the body of the mother, depends on many biological & physiological factors as also on the extrinsic factors. • It means capability of a foetus to lead life after birth independently. • Avarage viable age: 210 days or 7 months • Earliest viable age: 180 days or 6 moths 4
  • 5. Signs & symptoms of pregnancy A. Presumptive signs B. Probable signs C. Certain signs/Positive signs 5
  • 6. Presumptive signs 1. Amenorrhoea 2. Morning sickness 3. Changes in the breast 4. Changes in the vagina -Jackquemier’s sign:After 4thwk. 5. Pigmentation of skin 6. Sympathetic disturbances 7. Frequency of micturition 8. Constipation 9. Appearance of linea nigra & striae graviderum 10. Altered food choice 11. Quickening – Multi :16-18th, Primi:18-20th wk. 6
  • 7. Probable signs 1.Progressive enlargement of abdomen 2. Height of the uterus 3.Softening of cervix of uterus (Hegar’s sign) :7-10th wk. 4.Intermittent uterine contraction (Palmer’s sign) : 4-8th wk. 5. Cervix: Goodell`s sign is positive at about 4 months. It is the extreme softening of the cervix & there is also bluish discoloration of the cervix. 4.Uterine souffle : It is a soft blowing murmur, which is synchronous with mother’s pulse. Present at the End of 4th month. 5.Ballotment test 6.Pregnancy test 7
  • 8. Certain signs/ Positive sign 1.Foetal movement : After 20th wk 2.Auscultation of foetal heart sound : 18-20th wk, 120-160 b/m 3. Palpation of foetal parts 2.Imaging -USG –6th wk, -Radiology –after 3rd month, -MRI, etc 8
  • 9. Hegar’s sign & Linea nigra 9
  • 10. Jacquemier’s sign/ Chadwick’s sign Color of the vaginal mucosa is changes from pink to violet, depending to blue as a result of venous obstruction is called Jacquemier’s sign/ Chadwick’s sign Braxton Hick’s sign: It is characterized by intermitten painless uterine contraction of the fetus. Each contraction lasts about one minute, followed by relaxation for about 2-3 minutes. It is a probable sign of pregnancy. 10
  • 11. Tests for pregnancy /Pregnancy tests 1.Biological tests -Aschheim-Zondek test Frank test Friedman test, Hogben test/Xenopus test, Galli- Mainini/male frog test. 2.Immunological/serological tests – Agglutination-inhibition test, Haemoagglutination-inhibition test, RIA & ELISA 3.Imaging - USG,Radiology, MRI etc. 11
  • 12. Medico legal importance of pregnancy criminal cases : 1.Execution of death sentence 2.Court procedure - suspended in advanced pregnancy 3.Pregnancy claimed to be the result of rape 4.Pregnancy in an un-married girl of 16 years or less and in married girl of 15 years or less pointed towards commission of the offence of rape 5. Suit for breach of promise of marriage 12
  • 13. Medico legal importance of pregnancy 6. False blame by a girl against a man & blackmailing 7.Charge of adultery against the man, who is responsible for the woman’s pregnancy 8. Pregnancy may ascertain the motive behind suicide or homicide of an unmarried woman or widow 9. In case of alleged concealment of pregnancy, birth and infanticide. 10. Alleged criminal abortion 13
  • 14. Medico legal importance of pregnancy Civil cases : 1.Nullity of marriage 2.Pregnancy and divorce 3.Inheritance of property 4.To get more alimony a woman may claim to be pregnant incase of divorce 5.Compensation cases - In accidental death of husband – damage suit for pregnant wife 6.Illegitimacy & posthumous baby 7.Leave facility for pregnant woman. 14
  • 15. Unusual pregnancies 1. Twin/Multiple pregnancy 2. Superfoetation 3. Superfecundation 4. Foetus papyraseous or compressus 5. Pregnancy without knowledge of the pregnant woman 6. Pregnancy without real sexual intercourse 15
  • 16. Pseudocyesis/Spurious pregnancy/False pregnancy/Phantom Pregnancy It is a condition where a woman shows most of the signs & symptoms of pregnancy such as enlargement of abdomen, weight gain , nausea , morning sickness but she is not pregnant. Commonly subjects suffer from some kind of psychic & hormonal disorder. The woman believes that she is pregnant. May false labour pain at full term. It is mostly found in –childless women, women nearing the menopause Pathological conditions –pelvic/abdominal tumours, fatty abdomen. 16
  • 17. Superfoetation Fertilization of a second ovum in a woman who is already pregnant is called superfoetation This is a type of twin pregnancy where, during the continuation of pregnancy an ovum is liberated in a subsequent cycle which gets fertilized followed by progressive development of both the fertilized ova 17
  • 18. Superfecundation Fertilization of two ova discharged from the ovary at the same menstrual period by two seperate act of coitus commited at short intervals Two ova are discharge at a time in one ovulation period the two ova may be fertilized by sperms of two different act of coitus, occuring within a short period. 18
  • 19. Difference betweeen Superfecundation & Superfoetation Trails Superfecundation Superfoetation 1. Time of fertilization Fertilization of the two or more ova from the same menstrual cycle by sperm from seperate sexual acts It can occur where there are two uteri, or where the menstrual cycle continues through pregnancy. 2. Age of the fetus May be same/ difference between two fetal age is small Must not same & there is atleast 1 menstrual cycle difference between the two fetus 3. Occurence More possibility than superfoetation Extremely rare in human 19
  • 20. Fetus Papyraseous/ Compressus In twin pregnancy one fetus may grow & develop more at the cost of another. The latter may eventually die & get compressed & flattened gradually. Such a fetus is termed as Fetus Papyraseous/ Compressus. 20
  • 21. Delivery Delivery : It means parturition or expulsion of the product of conception from the uterus after full term of pregnancy. It is the spontaneous expulsion of the product of conception from the uterus of a pregnant woman at full term in normal way. It is the expultion or extraction of the child at birth 21
  • 22. Signs of recent delivery o In living : 1.General indisposition: Woman is pale, exhausted & ill looking 2.Breasts: Breasts are full, enlarged and tender with a knotty feeling and colostrums or milk may be present. Areola is dark, nipple is enlarged. 3.Abdomen: Pendulous, wrinkled & show striae graviderum 4.Uterus: Contracted & retracted body of the uterus feels like hard muscular tumour 22
  • 23. Signs of recent delivery 5.Vagina: Smooth walled, relaxed, capacious & may show recent tears which is usually heals by the seventh day. The rugae begin to reappeare about the third week. 6.Labia: Tender, swollen & bruised or lacerated. 7.Cervix of uterus: Soft & dilated. Internal os begins to close in the first 24 hours. 8.Lochial discharge –Lochia rubra:4-5 days, Lochia serosa:4-5 days, Lochia alba :upto 2-3wks 9. Perinium: Sometimes lacerated. 10. .Intermitten uterine contraction 23
  • 24. Signs of recent delivery o In dead body: All local signs present in recent delivery of living may be present. Some other changes after death are... 1. Uterus is flabby for up to 2 days and then gradually shrinks and resumes its firmness with its cavity obliterated. 2. The ovaries and fallopian tubes are usually congested. 3. The bladder shows edema and hyperemia and frequently submucous extravasation of blood. 24
  • 25. Signs of remote delivery Signs of remote delivery (Includes some permanent sings of pregnancy & permanent signs of delivery) In living – 1. Abdomen : Abdominal walls tend to show multiple white scars on lateral aspects. 2. Breasts: They are lax, soft and pendulous. Nipples are enlarged with areola darkened. 3. Vulva: Vagina is partially open as labia do not completely close the orifice. 4. Cervix: Cervix is Irregular and show scars. External os is also irregular and fissured 25
  • 26. Signs of remote delivery Signs of remote delivery in dead body – 1. Uterus: Uterus is larger, thicker and heavier.The Walls are concave from inside forming a wider and rounded cavity.The body of uterus is twice the length of the cervix. 2. Cervix: Cervix is irregular in form & shortened. Its edges show cicatrices. The external os is not well defined. 26
  • 27. Medico legal importance of delivery The legal issues linked with delivery are – 1. Abortion 2.Infanticide 3.Concealment of birth 4.Suppositious child (False delivery) 5.Blackmailing 6.Contested legitimacy 7.Nullity of marriage 8.Divorce 9.Chastity 10.Defamation 27
  • 28. ML importance of delivery 11.Inheritence 12.Execution of death sentence 13.Trial 14.Delivery after being pregnant as a result of rape 15.Delivery before 16 is evidence of rape 16.Homicide & suicide 17.Leave after delivery 28
  • 29. Difference between parous & nulliparous uterus points Nullirous uterus parous uterus 1.Size 2.Weight 3.Ratio between body & cervix 4.Upper surface of fundus 5.Uterine cavity 6.Scar for placental attachment 7.External os 8.Internal os 1.Smaller (7x5x2cm) 2.40 gm 3.Length of body & cervix almost equal . 4.Less convex & is in the same line of broad ligament 5.The inner walls are convex & that makes a triangular cavity with less space 6.Absent 7.Small roundish dimple like depressed opening 8.Circular, well defined 1.Larger (10x6x2.5cm) 2.80-100 gm 3.Length of body is almost twice the length of cervix . 4.More convex & is at a higher level than line of broad ligament. 5.The inner walls are concave & that makes a comparatively large & spacious cavity. 6.Present 7.Tranverse slit like opening. 8.Ill defined , margin wrinckled 29
  • 30. Suppositious child Suppositious child : A suppositious child is one belonging to another person produced by a women claiming her own. Motives/ ML importance: 1. Inheritance of property 2. Blackmailing a male 3. When a widow claims higher compensation from husband’s emplyer. 30
  • 31. Posthumous child It is a child born after the death of its father, the mother being conceived by the said father. Medico legal importance: • Legitimacy, • paternity, • inheritance of property • increased compensation from father’s emplyer • Compensation cases against slanders against the mother. 31
  • 32. Post maturity/Post mature baby It means birth of a baby after 15 days of average duration of gestation. (After 280+15=295 days) Features of Post mature baby – 1.Over size (more than 20’’) 2.Increased length of hair ( more than 7”) 3.Over weight 4.Nails –prominence beyond fingers 5.Radiology –Ossification centers in upper end of tibia & cuboid bone of the fetus 32
  • 33. Prematurity/ Pre mature baby It means birth of a baby before 15 days of average duration of gestation. (After 280-15=265 days) Features of Pre mature baby – 1.Smaller size – less birth length 2.Less birth weight (<2.5kg) 3.Undescended testis 4.Eyes are more closed 5.Less developed nails 33
  • 34. Abortion • Definition • Types • Criminal abortion • Indication of MTP • Abortion procedure • Complications of criminal abortion • Medico legal importance • Doctor & abortion 34
  • 35. Abortion Definition: Legally abortion means termination of pregnancy by premature expulsion of the fetus, from the uterus , at any time of pregnancy. Abortion means the premature expultion of the fetus from the mother’s womb at any time of pregnancy, before full term of pregnancy is completed. Interruption of the conception of pregnancy before 20th wks with or without expultion of the fetus either spontaneously or induced is called abortion. 35
  • 36. Types of abortion A. Spontaneous 1.Natural 2.Accidental B. Induced 1.Legal or justifiable 2.Criminal 36
  • 37. Causes of spontaneous(natural/accidental) abortion (mostly during 2nd-3rd month, 15-20%) 1.Defect in the ova, including chromosomal defect 2.Developmental defect of fetus 3.Low implantation of zygote 4.Diseased condition of decidua or placenta 5.Rh incompatibility 6.Retroverted uterus 7.Submucus uterine fibroid 8.Malformed uterus 9.Uterine hypoplasia 10.Hyperpyrexia of mother 37
  • 38. Causes of spontaneous abortion 11.HTN 12.DM 13.Hormonal deficiency 14.Fatigue & general ill health 15.Sudden shock, emotional disturbance 16.Syphilis 17.Nephritis 18.Arsenic/lead toxicity etc. 19.Drug toxicity 20.Some vegetable poisoning 21.Trauma 38
  • 39. Legal or justifiable(Therapeutic abortion)MTP Indications Maternal conditions A. Medical conditions – 1.Respiratory conditions – Active PT 2.Renal conditions –chronic nephritis, NS, PCKD 3.Cardiovascular conditions –CCF, Malignant HTN, Rh heart disease 4.Endocrine & metabolic conditions –Sever thyroid disorders with cardiac problems, Uncontrolled DM 5.Gastrointestinal conditions –U.colitis 6.Neurological conditions –chorea, multiple sclerosis 39
  • 40. Cause of MTP(Medical Termonation of pg) B.Surgical conditions 1.Malignancy– Ca-breast/cervix/Ovary 2.Chronic pyloric stenosis C.Obstetric conditions 1.Toxemia of pregnancy 2.Threatened abortion with persistent or severe haemorrhage 3.Repeated C/S 4.Uterine fibroids 5.Ireducible prolapse of the gravid uterus D.Psychiatric conditions–Schizophrenia, severe depression 40
  • 41. Cause of MTP(Medical Termonation of pg) E. Conditions relating to ovum or foetus –Ectopic pregnancy, dead fetus, hydatidiform mole, placental detachment or disease, acute hydramnios, gross malformation. F. Humanitarian conditions: Pregnancy as result of rape. G.Social conditions : Widow, contraceptive failure 41
  • 42. Common methods of Therapeutic Abortion 1.Dilatation & curettage (D&C) – suitable for early pregnancy under GA. 2.Dilatation & oxytocin infusion 3.Low rupture of membrane 4.Use of utus paste (containing mercury) 5.Vacuum aspiration 6.Amniotic replacement by hypertonic glucose or saline solution. 7.Some prostaglandin preparations are used – locally/orally/IV to induce abortion. 8.Laparotomy 42
  • 43. Common procedure of criminal abortion in practice A. Abortifacient drugs 1.Ecbolics –directly contract pregnant uterus –ergots, quinine, strychnine 2.Emmenagogues – initiate menstrual flow– oestrogen,borax 3.Purgatives –julap, castor oil, senna. 4.Irritants –cantharides, oil of turpentine B.Use of general violence 1.Application of severe pressure or force on the wall of abdomen –blows, kicks, tight pressure 2.Heavy exercise –jumping, jolting, riding 43
  • 44. Common procedure of criminal abortion in practice 3.Cupping 4.Apptication of very hot/very cold hip bath 5.Combined mechanical violence & drug administration. C. Use of local violence 1.Application of hot or cold douches in vagina 2.Administration of objects into uterine cavity with out dilatation 3.Insertion of FB into the uterus 4.Syringe aspiration 5. Introduction of utus paste in uterus 44
  • 45. Complications of criminal abortion A. Local injuries : excoriation, lacerations/perforations in upper vagina/cervix/uterine wall B. Immediate effects 1.Shock & hemorrhage 2.Air embolism 3.Reflex vagal inhibition C. Delayed effects 1.Sepsis/ septicaemia/ pyaemia 2.Toxaemia 45
  • 46. Complications of criminal abortion 3.Peritonitis 4.Tetanus D. Remote effects 1.Jaundice , renal suppression, renal failure 2.Bacterial endocarditis, pneumonia, empyema, meningitis 3.Leg vein thrombosis –pulmonary embolism 4.DIC E. Poisonous effects of drugs 46
  • 47. Medicolegal importance of abortion 1.Abortion may be induced without proper indication or in acontravention to other provision of MTP Act , when it amounts to a crime. 2.When a doctor violets the provision of MTP Act, he is liable to be punished. 3.A pregnant or even non pregnant woman may malinger abortion, due to assault, to bring a false charge against a person. 4.Abortion may be feigned to bring a charge of rape by a man , for blackmailing the man. 47
  • 48. Medicolegal importance of abortion 5. Abortion may be feigned to claim compensation by a working woman, linking the said abortion with her hazardous duty. 6.A woman may be falsely charged for inducing criminal abortion. 7.A woman who has aborted, may be falsely charged for infanticide. 8. A woman who has aborted, may bring a charge of negligence against her doctor. 48
  • 49. Doctor & abortion 1.The doctor should consult a professional colleague. 2.He should render proper treatment to the patient. 3.Law demand that the police authority should be informed about the crime. The doctor should other wise maintain professional secrecy. 4.Dying declaration 5. If woman dies, then the doctor should inform the police for arranging for PM examination & other investigations. 49
  • 50. Findings related to abortion in living Those depend upon the stage of pregnancy, abortion method & time elapsed since abortion at the time of examination. Signs of recent delivery may be present. 1.Relevent history. 2.Breasts may be found enlarged 3.Bruises may be found in abdominal wall & other parts of body, striae 4.Some sorts of injury in the external genitalia including fourchette 5.Vaginal canal may show excoriation, laceration or wounds of the mucus membrane 50
  • 51. Findings related to abortion in living 6.External os may show tears or lacerations & marks of forcep or other instruments. 7.Signs of any disease if present predisposing to natural abortion. 8.In first trimester abortion specific local signs include – hemorrhage (relatively small amount), softening of external os & maternal passage, slight increased size of uterus –normalized within few days. 9.In late abortion specific local signs include – hemorrhage (more), genital parts are markedly soft, internal os may admit one finger, uterus is enlarged. 10.Signs of violence & complication may be found. 51
  • 52. PM findings related to abortion A. External 1.Markes of general violence. 2.Marked cyanosis 3.Enlarged breasts 4.Striae on abdomen 5.External genitalia may show evidence of irritants & local injuries, bleeding, fetal remains. 52
  • 53. PM findings related to abortion B. Internal 1.The pelvic floor & organs may show lacerations, contusions, ruptures, inflammation, infection, hemorrhage, marks of instrumentation. 2.Cervix & os may be injured (laceration, tear, bruise), soft, evidence of dilatation, evidence of instrumentation & application of abortifacient. 3.Uterus –enlarged, placental attachment , injury, FB, remains of fetus, placenta, membrane. 4.Microscopic/ histopathological examination 5.Chemical examination –viscera & uterus 53
  • 54. Difference between natural & criminal abortion Points Natural abortion Criminal abortion 1.Cause 2.Infection 3.Marks of violence on abdomen 4.Injuries in genital organs 5.Toxic effects of drugs 6.Foreign bodies in genital tract 7.Foetus 1. Natural 2.Rare 3.Not present 4.Absent 5.Absent 6.Absent 7.Wounds are absent. 1.Induced 2.Frequent 3.May be present 4.Present 5.Present in vagina, cervix, GIT, UT 6.May be present 7.Wounds may be present. 54
  • 55. Feticide Feticide: Feticide means destruction of the fetus at any time before its birth by unlawful means. Related 3 important terms : • Still born • Live born • Dead born 55
  • 56. Still born When fetus of more than 28 weeks of gestational age (after viable age) did not breath or show any sign of life at any time after complete birth is called still born child. Death occurs during labour process. Causes of still birth – 1. Complicated labour 2.Flooding of the lungs with liquor amnii 3.Desquamation of bronchial epithelium MLI of still birth – • Question feticide, abortion & infanticide 56
  • 57. Live born & Dead born Live born: A child is regarded as live born when it takes breath or shows any signs of life after birth. Dead born : A dead born child is one which has died in the uterus before birth. It may show signs of rigor mortis, maceration or mummification just after birth. 57
  • 58. Signs of live birth During life- Hearing of cry, seeing of movement of body or limb, muscle contraction, heart sound. During autopsy – 1.Degree of maturity 2.Shape of the chest 3.Diaphragm level 4.Lungs 5.Changes in the stomach & intestine 6.Middle ear changes 7.Changes in the skin 8.Changes in caput succedaneum 9.Changes in the umbilical cord 10.Changes in the circulation 58
  • 59. Difference between Live born & Still born Points Live born Still born 1.Chest 2.Diaphragm 3.Lungs i.Position ii.Volume iii.Edges iv.Colour v.Appearance 1.Arched or dram shaped, its circumference is greater than that of abdomen , intercostal spaces are wider. 2.At the level 6th or 7th rib. 3.Lungs – i.Fill the thoracic cavity, overlapping the heart & the thymus gland with covering pleura. ii.Voluminous iii.Rounded iv.Mottled pink v.Marbled due to expanded 1.Flat, its circumference is less than that of abdomen , intercostal spaces are narrow. 2.At the level of 4th or 5thrib. 3.Lungs – i.Lying at the back of the thoracic cavity behind the heart & the thymus gland with covering pleura wrinkled & loose. ii.Small. iii.Sharp iv.Uniform, dark blue-red. v.Smooth, not marbled 59
  • 60. Difference between Live born & Still born Points Live born Still born vi.Consistency vii.Air vesicles viii.Squeezing under water ix.On cutting x.Hydrostatic test xi.Static test 4.Stomach-bowel test vi.Spongy, elastic, crepitant vii.Visible, sometimes individually viii.Bubbles produced are small & uniform in size. ix.Exudate frothy blood though not decomposed. x.Positive xi.Ration of weight of lung to body is 1:35 4.Positive vi.Dense, firm, liver like & non-crepitant. vii.Expanded air vesicles not seen on surface. viii.Not preoduced, if any are large & unequal in size due decomposition. ix.Exude little blood but no froth unless decomposed. x.Negative xi. Ration of weight of lung to body is 1:70 4.Negative. 60
  • 61. Difference between still birth & Dead birth Trait Still birth Dead birth 1. Intra uterine age After 28th week of gestation No specific mention of its intra uterine age 2. Time of death Fetus was alive in the utero, but dies during the process of delivery Dead in utero 3. Causes Anoxia, prematurity, birth trauma or toxemia Congenital anomaly, ABO & Rh incompatibility 4. Predominance Seen mostly among illegitimate & immature male children No such predominance 5. Sign of prolong labour May present Not seen 6. Sign of intrauterine death May/ may not be present Must be present
  • 62. Infanticide Infanticide: Killing of a newly born baby within 15 days of its birth is infanticide. Causes of infant death : A. Natural causes 1.Prematurity 2.Asphyxia 3.Congenital malformation 5.Haemolytic disease including Rh-incompatibility 6.Neonatal infection 7.Early separation of placenta 8.Pre-eclamptia/ eclamptia in mother 9.Haemorrhage from birth trauma 10.SIDS 62
  • 63. Cause of Infanticide B. Unnatural causes 1.Accidental causes a)During birth: i.Prolonged labour ii.Pressure on or prolapsed cord iii.Knot of the cord or twisting round the neck iv. Injuries v.Death of the mother b)After birth: i.Suffocation ii.Precipited labour 2.Criminal causes –infanticide 63
  • 64. Motives of infanticide 1. Illegitimate child given birth by –widows, unmarried girls, married women during prolonged absence of her husband 2.Inheritance 3.Poverty 4.Familial problems/disharmony 5.Dowry system 6.Family pride 7.Custom 64
  • 65. Modes of infanticide A. Act of commission 1.Mechanical violence –suffocation, strangulation, throttling, drowning, fracture of head by blunt injuries. penetrating wounds, twisting neck, other injuries 2.Poisoning B. Act of omission –It is improper assistance during labour or neglect on the part of mother in regard to child care – failure to ligate cord, failure to provide nutrition to the baby, failure to protect from extremes of weather, failure of proper nursing. 65
  • 66. Autopsy of newborn Objectives 1.To determine whether DB/SB/LB. 2.To determine cause of death 3.To determine manner of death 4.To determine the intrauterine age & thereby the question of viability. Special consideration in autopsy of a newborn 1.External – Development, skin, maceration, caput, cord, placenta, lividity, FB in mouth or upper respiratory passage, natural orifices, injuries 2.Internal –Lungs, stomach, intestinal content, ossification centers. 66
  • 67. Hydrostatic test • It is based on the lowering of the specific gravity of the lungs due to expansion of their alveoli by inspiration during the act of breathing. • In the fetal condition & before distension with air , the lungs are heavier than water & after distension with air the become lighter than water. Hence if the undistended lung or its portion be thrown into water, it sinks, while after distension it floats, thereby indicating that respiration had taken place. • If the test is positive , it is a proof of respiration after birth. • Fallacies- emphysema by putrefactive gases, artificial respiration; consolidation, edema, congenital tumor, asphyxia neonatorum; partial breathing, still birth. 67
  • 68. Precipitate labour Precipitate labour may be defined as the sudden & rapid deliver of a fetus specially in case of multipara women with roomy pelvis without the knowledge of the mother. Types- 1.True precipitate labour 2.Pseudo or false precipitated labour 68
  • 69. Medico legal importance 1.Infanticide 2.Injury to foetus Complications 1.Suffocation –by falling into lavatory pan 2.Head injury & fracture of the skull –by falling on a hard object. 3.haemorrhage –by torn end of cord. 4.Drowning 69
  • 70. Viable age • Viable age –It means capability of a fetus to lead life after birth independently. • Avarage viable age: 210 days or 7 months • Earliest viable age: 180 days or 6 moths Features of viable age (7th month) – 1.Length :13-16 inches 2.Weight:2-4 lbs 3.Skin:Raw-looking & is covered with a thicker layer of vernix caseosa . 4.Eyelids:Non adherent, eyelash present, membrana pupilaries is avascular & undergoing atrophy. 70
  • 71. Viable age 5.Nails:Well developed but do not extend to the tip of fingers & toes 6.Caecum:Lies in right iliac fossa. 7.Meconium:Present through the large bowel 8.Testes:May be at internal inguinal ring 9.Convolution over cerebral hemispheres are in the stage of formation. 10.Centers of ossification: In talus, 2nd & 3rd segment of sternum. 71
  • 72. SIDS/cot death /Crib death Sudden infant death syndrome (SIDS): Sudden death of an infant which is unexpected by history & in whom a thorough autopsy fails to reveal an adequate cause of death. Features - 1.Age range –2wks-2 yrs. 1-7th month, 2-3rd month. 2.Sex –slight male preponderance 3.Twins 4.Season –more in colder/winter 5.Socieo-economic conditions –low, single, poor 6.Suspected factors –hypersensitivity to cows milk, infection. 7. Prematurity: Increased the risk 72
  • 73. Battered baby syndrome/caffy syndrome • Battered baby: A battered baby is one who presents with signs of multiple injuries in its body which are not accidental in nature rather inflicted by its parents of foster parents. • Battered baby syndrome: Battered baby syndrome refers to injuries sustained by a child as a result of physical abuse, usually inflicted by foster parent or guardian. 73
  • 74. Features of battered baby 1.Age –1 yr 2Sex- male preponderance 3.Position in family- eldest or youngest, unwanted, illegitimate 4.Socio economic factor – Younger parents, isolated, lower education, lower class, family disharmony, emotional problems, criminal record, unemployed, unstable 5.History -Discrepancies 6.Precipitating factors –Crying, refusal to be quiet, soiling of napkins etc. 7.Injuries –Direct manual violence, soft tissue injuries, abrasion- bruise-lacerations of different ages. Injury to head, neck ,face. 8. Treatment –delay in seeking medial attention. Munchausen syndrome by proxy : 74
  • 75. Munchausen’s syndrome by proxy Munchausen by proxy syndrome (MBPS) is a relatively rare form of child abuse that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker. It is a peculiar & dangerous form of child abuse usually involving the mother, in which children are brought to doctors for induced sign & symptoms of illness with a fictitious history Age factor: it is frequent in children of few weeks of age to 21 years. 75
  • 76. Munchausen’s syndrome by proxy Diagnosis: • Illness is produced of alleged, or both by a parent • Repeated request for medical care of a child, leading to multiple medical procedure • Parental denial of knowledge of the cause of the symptoms • Regression of symptoms when the child is separated from parents 76
  • 77. Munchausen’s syndrome by proxy Method of production of illness: • Mother pries her finger and add blood to the urine of the child & take the sample to the doctor • The child’s nose is closed with two finger and the lower jaw is pushed up with the palm to block the airways • A pillow or towel is put over the face of the child & the face is pushed down into bed clothing • The mother gives insulin to the child & takes to the hospital with hypoglycemia • Vomiting • Diarrhea: laxatives, salt poisoning etc. 77
  • 78. Munchausen’s syndrome by proxy Usually, the cause of MBPS is a need for attention and Sympathy from doctors, nurses, and other professionals. Some experts believe that it isn't just the attention that's gained from the "illness“ of the child that drives this behavior, but also the satisfaction in deceiving individuals whom they consider to be more important and powerful than themselves. Because the parent or caregiver appears to be so caring and attentive, often no one suspects any wrongdoing. Diagnosis is made extremely difficult due to the the ability of the parent or caregiver to manipulate doctors and induce symptoms in the child 78
  • 79. Marriage Definition of marriage: Marriage is legally a contract between man & woman which implies physical union by coitus. Marriageable age (In Bangladesh) : • Male :21 yrs, • Female :18 yrs. 79
  • 80. Nullity of marriage It means marriage is declared never to have existed in law. Marriage becomes null & void due to some reasons. 1.When either party was under the marriageable age during marriage. 2.When either party was already validly married without knowledge of opposite party. 3.When one party was of unsound mind or a mentally defective at the time of marriage. 4.Where the marriage has not been consummated due to impotence or willful refusal. 80
  • 81. Divorce Divorce means legal dissolution of previously valid marriage. A woman can demand divorce from her husband in the following conditions – 1.Adultery 2.Rape, sodomy, bestiality 3.In case of incurable insanity, leprosy, AIDS. 81
  • 82. Legitimacy Legitimacy : It is condition of a person being born in wedlock. Legitimate child : Legitimate child is one who is born during the continuation of a valid marriage of its parents or within 280 days after dissolution of their marriage when mother remaining unmarried, unless it can be proved that the parties to the marriage had no sexual access to each other at any time when he could have been begotten. 82
  • 83. Illegitimate or Bastered child A child is considered illegitimate or bastered in the following situations – 1.It is born out of lawful wedlock between parents. 2.It is born within wedlock, but without the husband having the power of procreation. 3.The husband did not have the access to his wife during the time that the child was procreated. 4.It is not born with in a competent period after dissolution of marriage . 5.The blood groups of the child & the alleged father are not compatible. 83
  • 84. Medico legal importance of legitimacy Question of legitimacy arises in– 1.Inheritance 2.Affiliation case 3.Suppositious children 4.Disputed paternity 5.Impotence 84
  • 85. Investigations for legitimacy 1.Confirmation of impotence or sterility 2.Average period of gestation 3.Maximum period of gestation 4.Minimum period of gestation 5.Superfoecandation 6.Superfoetation 7.Paternity & maternity 8.Ever delivered a viable child. 9.Marriage & divorce 85
  • 86. Paternity Paternity : paternity means establishment of parenthood by different investigation. Contested or disputed paternity : When the paternity of a child is in question. Determination of paternity : 1.Complexion 2.Hereditary diseases 3.Atavism 4. Paternity tests i)Blood grouping –ABO, Rh & Mn system –50-60% ii. HLA test –99% iii)DNA profiling –about 100% 86