3.
DEFINITIONn…
Delivery is the culmination of a pregnancy or gestation period with the
expulsion of one or more newborn infants from a woman’s uterus. The
process of normal human childbirth is categorized in three stages of
labor: the shortening and dilation of the cervix, descent and birth of the
infant, and birth of the placenta.
4. Women is pale, exhausted,
with increase in pulse and
slight fever
Perineum is sometimes
lacerated and age of it
may help in estimate
the date of delivery
Labia are tender,
swollen, and lacerated
Cervix is soft and its
edges torn. Internal os
begins to close in 24 hrs
and external os is soft
and admits 2 fingers
Vagina may show
recent tears which
usually heal by 7th day
Abdominal walls are wrinkled,
Irregular, white or with silvery
subcutaneous scars
Uterus is felt like hard
tumor immediately
after delivery. On 6th
day it is midway b/w
umbilicus and pubis
Lochia has a peculiar
sour,disagreeble odor.
In first 5 days it is
bright red and contains
large clots
Intermittent Uterine
Contractions.
Signs Of Recent Delivery in living
5. Signs Of Remote Delivery in living
ABDOMEN-
Abdominal walls tend to
show multiple white
scars on lateral aspects.
BREASTS-
They are lax, soft and
pendulous. Nipples are
enlarged with areola
darkened.
VULVA-
Vagina is partially open
as labia do not
completely close the
orifice.
CERVIX-
Irregular and show
scars. External os is also
irregular and fissured
6. Signs Of Recent Delivery in DEAD
All local signs present in recent delivery of
living may be present. Some other changes
after death are…
Uterus is flabby for up to 2 days
and then gradually shrinks and
resumes its firmness with its
cavity obliterated.
A large corpus luteum is usually
found in one of the ovaries.
The ovaries and fallopian
tubes are usually congested.
The bladder shows oedema and
hyperaemia and frequently
submucous extravasation of
blood.
7. Signs Of Remote Delivery in DEAD
1
•UTERUS is larger, thicker and
heavier.
2
•The Walls are concave from inside
forming a wider and rounded cavity.
3
•The body of uterus is twice the length
of the cervix.
9. Medico-Legal
Aspects
1
• A Widow can allege that she gave birth to an infant to
inherit her husband’s property
2
• When a murdered newly born infant is found, a woman
suspected to be its mother is examined for signs of recent
delivery
3
• When babies mixed in maternity hospitals, the different
mothers are examined to determine the time passed since
delivery and compare this with the infant’s age.
10. CONTINUED…
4
• Under Sec312 voluntarily caused criminal abortion
is liable for imprisonment up to 3 years.
5
• Under Sec314, if a pregnant woman dies from
miscarriage by offender, he is liable to be
imprisoned up to 7 years.
6
• Under Sec316,causing death of quick unborn child
by any act amounts to culpable homicide and he
can be punished up to 10 years imprisonment.
11.
Pseudocyesis/ spurious/
phantom pregnancy
Psychological disorder where the woman has a false but firm belief that
she is pregnant, though no pregnancy exists
Generally observed in infertile women or women nearing menopause
who desire a child intensely
Most women suffer from hormonal/psychic disorders
May present with all subjective symptoms of pregnancy
May have false labor pains, intestinal movements, secretions from
breasts
Obstetrical examination with USG with immunological tests clear the
patient of her imagination
13.
Patient may sue doctor for miscarriage/ abortion
Information to be disclosed in front of a witness such as nurse/ relative
Essential to collect & preserve any evidence confirming this condition-
UPT, USG Scan
13
MLI OF PSUDOCYESIS
16.
Fertilization of 2 ova discharged from the ovary at the same period of
ovulation by 2 different acts of coitus committed at short intervals
Also refers to instances of 2 different males fathering fraternal twins-
more accurately termed hetero paternal superfecundation
Possibility of twins also being half siblings. Eg: 1 black 1 white
Gross variations in complexion & features of the 2 babies- give rise to
doubt of adultery & infidelity
16
SUPERFECUNDATION
18.
Fertilization of 2 ova discharged from ovary at different periods of
ovulation
Fertilization of 2nd ovum in pregnant woman
One fetus always more developed than other
May be born at same time showing different maturation or may be born
at different periods
Possibility more with septate/ double uterus
18
SUPERFETATION
20. Legitimacy And
Paternity
“Legitimacy is the legal state of a person born in lawful
marriage. If a person is born during the continuance of a legal
marriage, or within 280 days after the dissolution of marriage
by divorce or death of the husband, HIS/HER birth is presumed
to be legitimate.[Sec112, IEA]”
21.
“The child becomes illegitimate or “BASTARD”, if it can be proved that
the husband could not possibly be the father of child by suitable producing
evidence.”
under the age of puberty
impotent
physical incapable to beget children
did not have the access during the time the child was born
incompatible blood groups
22.
Question of legitimacy arises ?
Inheritance
Supposititious child or fictitious child
Paternity
Atavism
Developmental defects
Blood group tests
DNA fingerprinting
23.
Came into force on 1st April 1972 and amended in 2002 to provide for
termination of certain pregnancies by RMPs for protection &
preservation of lives of women
Indications for termination of pregnancy
1. Therapeutic- in order to prevent injury to the physical health of
pregnant women. Indications are:
A. Cardiac disease (Grade 3 and 4)
B. Chronic glomerulonephritis
C. Intractable hyperemesis gravidarum
D. Malignant hypertension
23
MTP ACT 1971
24.
E. Epilepsy/insanity
F. Cervical/ breast carcinoma
G. Diabetes with retinopathy
H. Toxemia of pregnancy
2. Eugenic: Risk of child being born with serious physical/ mental
abnormalities. Indications are:
A. Mother exposed to teratogenic drugs/ radiation in early pregnancy
B. Rubella, chickenpox, viral hepatitis/ other viral infections- if
contracted in 1st trimester
24
Contd
25.
C. Structural (anencephaly), chromosomal (Down’s Syndrome)/ gentic
anomalies of the fetus.
D. Parents having inheritable mental conditions/ chromosomal
abnormalities
3. Socio economic: Almost the sole indication to prevent grave injury to
physical & mental health of the pregnant lady. Indications are:
A. Unplanned pregnancy with low socio economic status
B. Pregnancy as a result of failure of contraception
4. Humanitarian: Pregnancy caused by rape
25
Contd
26.
Emergency case: Pregnancy can be terminated by any RMP even
without required experience at any place irrespective of duration of
pregnancy if it is necessary to save life of pregnant woman
Length of pregnancy: Cannot be terminated beyond 20 weeks of
pregnancy. Above 20 weeks may be done only on therapeutic grounds.
Decision can be taken by a single doctor up to 12 weeks of pregnancy.
Between 12 and 20 weeks, decision to be taken jointly by 2 doctors
MTP can be conducted at a hospital established/maintained by
Government or a place approved by Government or a District level
committee with CMO/DHO as chairperson of the committee
26
MTP ACT RULES
27.
For RMP conducting MTP up to 12 weeks, the doctor should have
experience of assisting an RMP in conducting 25 cases of MTP out of
which 5 cases should have been performed independently in an
approved hospital.
For RMP conducting MTP between 12-20 weeks, the doctor should
have:
1. PG Degree/ Diploma in OBG
2. 6 months of house surgeon experience in OBG Dept
3. 1 year or more in practice of OBG in any hospital
27
Contd
28.
Consent: Consent of woman mandatory except if she is minor <18
years/ mentally ill—consent of guardian obtained. Consent of husband
NOT necessary
Head of hospital to maintain a register recording details of patient
undergoing MTP for a period of 5 years. Professional secrecy to be
maintained.
Liable to be punished with RI for 2-7 years. Punished with fine of 1000
Rs. Cognizable offence-can arrest a doctor without warrant. Liable to
face disciplinary action including termination from service.
28
Contd
29.
1st trimester- Medical- Mifepristone, mifepristone and misoprostol,
methotrexate and mifepristone, tamoxifen and misoprostol. Surgical-
MVA, D&E, Suction evacuation & curettage
2nd trimester- D&E, Intra Uterine installation of hyperosmotic solution,
prostaglandins, oxytocin infusion, hysterotomy
Curettage most common in India & results in most deaths.
Death due to hemorrhage & sepsis- complications of perforation of
uterus. Suggest possibility of medical negligence.
29
METHODS OF INDUCING
ABORTION
30.
Pre conception and Prenatal Diagnostic Techniques (Regulation and
Prevention of Misuse) Act, enacted to check female feticide.
Provides for prohibition of sex selection before or after conception
Prenatal diagnostic procedures-any gynecological, obstetric or medical
procedure like USG, Foetoscopy, sampling of chorionic villi, amniotic fluid.
Prenatal diagnostic test- USG or any analysis of amniotic fluid, chorionic villi,
embryo
Prenatal diagnostic technique- include all prenatal diagnostic procedures and
tests
Recent amendment- allows MBBS doctors to conduct sonography on pregnant
women, provided they have undergone 6 months training imparted at
accredited institutions within the well defined syllabus
30
PCPNDT ACT 1994
31.
Prenatal diagnostic techniques to be used for detection of chromosomal
abnormalities, genetic metabolic diseases, haemoglobinopathies, sex linked
genetic diseases, congenital anomalies
Prenatal diagnostic techniques to be used in pregnant women if age > 35 years,
undergone 2 or more spontaneous abortions/fetal loss, has been exposed to
potentially teratogenic agents such as drugs, radiation, infections, pregnant
woman/ spouse has family history of mental retardation, genetic diseases.
Person conducting procedure including USG should NOT communicate to
pregnant woman/ relative sex of fetus by words, signs/ any other manner.
Register showing names & addresses of patients counselled, names of father/
spouses, dates on which they first reported
31
Contd
32.
Case related records, consent forms, lab reports, sonographic plates to
be preserved for 2 years from date of completion of counselling
Every offence under this Act is cognizable, non-bailable and non
compoundable
Punished with imprisonment up to 3 years and fine up to Rs 10000.
Subsequent convictions- 5 years imprisonment fine up to Rs 50000.
Name removed from Medical Council Register for 5 years for 1st offence
and permanently for subsequent offences
32
Contd
