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

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

  1. 1. Pregnancy ,Delivery Dr SM Arman Hossain 1
  2. 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. 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. 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. 5. Signs & symptoms of pregnancy A. Presumptive signs B. Probable signs C. Certain signs/Positive signs 5
  6. 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. 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. 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. 9. Hegar’s sign & Linea nigra 9
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 34. Abortion • Definition • Types • Criminal abortion • Indication of MTP • Abortion procedure • Complications of criminal abortion • Medico legal importance • Doctor & abortion 34
  35. 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. 36. Types of abortion A. Spontaneous 1.Natural 2.Accidental B. Induced 1.Legal or justifiable 2.Criminal 36
  37. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  87. 87. Thanks To All 87
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Pregnancy, Delivery, Abortion, infant death, marriage, divorce.

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