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
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
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.
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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
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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.
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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 :
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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.
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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
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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.
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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
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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.
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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.
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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.
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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.
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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.
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84. Medico legal importance of legitimacy
Question of legitimacy arises in–
1.Inheritance
2.Affiliation case
3.Suppositious children
4.Disputed paternity
5.Impotence
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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
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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%
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