it describes the types and causative factors of abortion.

1. Abortion
Dr. Perwaiz Ahmed Makhdoom
Assistant Professor
Department of Forensic Medicine & Toxicology
Sindh Medical College,
Dow University of Health Sciences, Karachi.

2. Abortion
Definition.
It means expulsion of products of conception at
any period of gestation before full term.
Abortion, Miscarriage, Premature or Preterm
labour.
Law recognizes no difference b/w these terms.
In medicine sometimes these terms are referred
to first, second, and third trimester respectively.

3. Types of abortion:
- Natural abortion or Spontaneous
abortion or Accidental abortion.
- Unnatural or Artificial abortion.
A - Legal or Justifiable abortion.
B - Criminal or illegal abortion (unsafe
abortion).

4. Natural, Spontaneous, Accidental
abortion.
15 to 20% of all abortions are spontaneous.
Causes may be in mother, fetus or
accidental.
Threatened abortion.
Inevitable abortion.
Missed abortion.
Habitual abortion.

5. Unnatural Abortion.
Justifiable abortion. When abortion is
performed in accordance with the legal
provisions.
Criminal, illegal or unsafe abortion.
when performed with the intention of
getting rid of the products of conception.

6. Justifiable abortion.
In certain countries Medical Termination of
Pregnancy act is in force.
Grounds for legal or justifiable abortion.
1. Therapeutic.
2. Eugenic.
3. Humanitarian.
4. Social.

7. Therapeutic grounds for legal abortion.
Conditions in which continuance of pregnancy
would involve risk to the 1- life of mother or 2-
grave injury to physical or mental health. e.g.
1.Active TB. Severe diabetes.
2.Renal failure. Severe heart failure.
3.Nephrotic syndrome.
4.Pulmonary hypertension.
5.Hepatic failure.
6.Toxaemia of pregnancy.
7.Malignancy.
8.Threatened insanity.

8. Eugenic grounds for legal abortion.
These include conditions where there is a
risk that the child born will be mentally or
physically compromised. e.g.
- Small pox, chicken pox, severe viral
hepatitis.
- Exposure to X rays or other radiations.
- When mother has received cytotoxic
drugs.
- Chromosomal abnormalities or inheritable
mental disorders in parents.

9. Humanitarian grounds for legal
abortion.
Where pregnancy has resulted from rape or
incest.
Social grounds for legal abortion.
1. Pregnancy due to contraceptive failure.
2. Poverty.
3. Already a subnormal child in home. etc

10. Criminal, illegal, unsafe abortion.
Two methods are common for procuring
criminal abortion.
1. Use of drugs.
2. Use of violence.

11. Drugs used for criminal abortion.
These drugs are called abortificients.
1. Drugs acting directly on uterus.
2. Drugs acting indirectly on uterus.

12. Drugs acting directly on uterus
These are 1- Echbolics 2- Emmenagogues.
1-Echbolics. Are group of drugs which increase
uterine contractions.
e.g. ergot, quinine, cotton root bark, pituitary
extract, and prostaglandins
2- Emmenagogues. Are group of drugs
which increases menstrual flow.
e.g. synthetic estrogens, oil of savin, borax
etc.

13. Drugs acting indirectly on uterus.
Commonly used drugs are emetics,
purgatives and metals.
e.g. castor oil, croton oil, colocynth etc.
These drugs are taken in the hope that after
causing violent stimulation of GIT, they will
reflexly stimulate uterus too. But this effect
is not constant.

14. Use of violence for causing criminal
abortion.
1. Use of general violence.
2. Use of local violence.
General violence. ( usually during first
and second month)
Severe exercise, cycling, riding, jumping
from height, alternate hot cold baths, tight
lacing of abdomen, massage of uterus etc
are undertaken in order to procure
abortion.

15. Local violence. ( during third and fourth month)
May be caused by unskilled, semi skilled or skilled
person.
Self instrumentation. Use of needle, pencil, hair pin
etc.
Abortion stick. A thin wooden stick 15-20 cms in
length or twig from some irritant plant e.g. madar
(calotropis gigantae), chitra (plumbago), kaner (nerium
odorum) is used with its tip soaked with marking nut
juice. This stick is inserted and left in place for few days
to irritate and cause dilatation of cervix.

16. Medico legal importance of abortion.
Law in Pakistan.
Isqat e haml
Isqat e janin

17. Isqat-e-Hamal:
Causing a women with child whose organs
have not been formed, to miscarry, with
out good faith for the purpose of life of
women or providing necessary treatment.
Punishment.
Two years Jail Imprisonment or Fine or
Both.

18. Isqat Janin:
Causing a women with child with some of
whose limbs are formed, to miscarry with
out good faith for the purpose of saving
the life of mother.
Punishment.
Five years Jail Imprisonment, or Fine or
Both.

19. C.K. PARIKH’S TEXT BOOK OF FORENSIC MEDICINE
PROFESSOR NASEEB. R. AWAN’S PRINCIPLE AND
PRACTICE OF FORENSIC MEDICINE
KRISHAN VIJ’S TEXT BOOK OF FORENSIC MEDICINE
BERNARD KNIGHT’S FORENSIC PATHALOGY
PROFESSOR UMER KHAN’S TEXT BOOK OF FORENSIC
MEDICINE
R. K. SHARMA’S TEXT BOOK OF FORENSIC MEDICINE
MENTAL HEALTH ORDINANCE 2001. NADEEM LAW
BOOK HOUSE, LAHORE.
References

21. VIRGINITY
IMPORTANT TERMS
i. VIRGIN – WOMEN WHO HAD NO SEXUAL
INTERCOURSE.
LEGAL TERM – VIRGO INTACTA
ii. DEFLORATION – LOSS OF VIRGINITY.
iii. SEXUAL INTERCOURSE
LEGAL TERM – CARNAL KNOWLEDGE

22. On the lighter side
Putting the scientific facts aside, hymen has gotten its name from the
Greek god Hymenaeus. He is believed to be the god of marriages
and weddings. If there�s an individual that comes to mind when
marriages or weddings are referred to, chances are, it is a woman.
Every woman cherishes these things, maybe in a number of different
ways from one another. But it all boils down to one thing; Marriage
and weddings are sacred. This is the reason why the hymen is named
after that Greek god Hymenaeus.
Hymenaeus is represented as a young man with a wreath of flowers
and a torch. He is asked to attend a wedding for it to be fruitful and
happy. Else disaster would come about.
http://www.revirgination.net/hymen-picture.html

23. SIGN OF VIRGINITY
GENITAL SIGNS:
i. LABIUM MAJUS
WELL DEVELOPED, ROUNDED THICK,
FIRM, ELASTIC, LIE IN CLOSE
OPPOSITION TO EACH OTHER,
COMPLETELY COVERING THE MINORA,
CLITORIS, CLITORIS & VAGINAL ORIFICE.
POST COMMISSURE INTACT.
ii. LABIUM MINUS
PINKISH / ROSE COLORED
FOURCHETE INTACT

24. iii. CLITORIS – SMALL, SENSITIVE
iv. VESTIBULE – NARROW
v. VAGINA – NARROW TIGHT WITH A SLIT
LIKE OPENING
DIMENSION 6cms WIDE, 7.5cms Long
and 9cms DEEP.
VAGINAL CANNAL – COLLAPSED
MUCOUS SURFACE – LINED BY FOLDED PINK
COLORED RUGAE.
CONTINUE

25. VI HYMEN: TWO FOLDS OF MUCOUS
MEMBRANE DERIVED FROM POST VAGINAL
WALL, FUSED IN MIDLINE EXCEPT FOR A
SMALL CENTRAL OPENING GUARDING THE
V. ORIFICE.
i. THICKNESS = 1mm
ii. CONSISTENCY: VARIES FROM THIN
PARCHMENT LIKE MEMBRANE TO FIRM,
ELASTIC FLESHY OR CARTILAGINOUS.
iii. BLOOD SUPPLY: SUFFICIENT
DEMONSTRABLE BLEEDING ON RUPTURE.
iv. SIZE: IN UN-RUPTURED STATE, SMALL
CENTRAL OPENING WILL BARELY ALLOWS
THE TIP OF LITTLE FINGER.

26. POSITION OF HYMEN IN
CHILDREN
 SITUATED RELATIVELY HIGH IN
VULVO-VAGINAL PASSAGE. SO NOT
RUPTURED IN CHILDREN SUBJECTED
TO SEXUAL OFFENCE.

27. SHAPES OF HYMEN AL
OPENINGS
1. ANNUALAR
2. SEMILUNAR OR CRESENTRIC
3. FIMBRIATED
4. CRIBRIFORM
5. SEPTATE
6. IMPERFORATE
7. CRUNCULAE MYTI FORMIS

28. RUPTURE OF HYMEN
CAUSED BY
 ACT OF 1ST COITUS
 FALLING ON PROJECTED OBJECTS
 BY INTRODUCING FOREIGN OBJECTS TO
GET SEXUAL GRATIFICATION.
 MEDICAL MANEUVERS
 PRURITUS FROM THREAD WORM
INFESTATION

29. NON RUPTURE OF HYMEN EVEN
AFTER REPEATED SEXUAL I/C
 LOOSE OR MUCH FOLDED
 DISTENSIBLE
 THICK & TOUGH IN NATURE
 ELASTIC & FLESHY

30. EXAMINATION OF HYMEN
 BILATERAL TRACTION
 INTRODUCTION OF GLAISTER-KLINE
RODS.
POSITION OF HYMENAL TEAR
AFTER COITUS AFTER MASTURBATION

31. AGE OF HYMENAL TEAR
 BLOOD STAINED, REDDISH, SWOLLEN
& TENDER
 BLEED ON TOUCHING 24-48H
 HEALING IF SMALL TEAR 2-3 DAYS
 HEALING OF LARGE TEAR 5-7 DAYS
FRESH

33. Virginity should be an emotional and a psychological thing, not
purely physical. Virginity is a virtue. Only a woman and her whole
being should answer to that, not just her one negligible body part.
It is but the culture that implies a woman�s virginity to be
decided upon the hymen. A lot of feminist groups and even
medical organizations are all working together enlighten the
public about the facts and the fallacies behind hymens. It is
through hope, that in the near future, tightly knit conservative
places would embrace the whole hymen concept and eventually
transform their way of thinking.

34. MLI
 False accusation of sexual assault
 Virgo intacta