Criminal Abortion & Its Medicolegal Aspects are described along with IPC sections prevalents

1. Criminal Abortion
&
Its Medico-Legal Aspects
Presented by:
Dr. Himanshi
JR (Academic)
Department of Forensic Medicine &
Toxicology
AIIMS, Patna

2. What is Abortion?
• Clinically, abortion is the expulsion or
extraction of the foetus or embryo
weighing less than 500gms from the
uterus, spontaneous or induced.
• About 20% of all conceptions end in
abortion and 80% of these occur in 1st
trimester abortion.

3. Miscarriage
• It is synonymous with abortion but is usually used for termination of pregnancy in
2nd trimester.
Premature labour (Preterm labour)
• Premature labour is defined as one where the labour starts before 37th completed
week (<259 day), and after 22nd week (154 day) counting from 1st day of last
menstrual period.
Legally
• Abortion is premature expulsion of fetus from the mother womb at any time of
pregnancy, before full term of pregnancy is completed with or without the consent
of mother.

4. Types of Abortion
Types of abortion
Clinical Classification
Threatened abortion
Inevitable abortion
Incomplete abortion
Complete abortion
Missed abortion
Recurrent abortion
Septic abortion
According to method induced
Natural
Spontaneous
Accidental
Artificial
Therapeutic/
Justifiable
Criminal

5. Various Definitions
S.No. Types Definition
1. Threatened Abortion It is the clinical entity where the process of abortion has started but has not
progressed to a state from which recovery is impossible.
2. Inevitable abortion It is the type of abortion where the changes have progressed to a state from
where continuation of pregnancy is impossible.
3. Complete abortion When products of conception are expelled en masse.
4. Incomplete abortion When the entire products of conception are not expelled, instead a part of it is
left inside the uterine cavity.
5. Missed abortion When the foetus is dead and retained inside the uterus for more than four
weeks.
6. Septic abortion Any abortion associated with clinical evidence of infection of the uterus and its
content.
7. Induced abortion Deliberate termination of pregnancy before the viability of fetus.

6. S. No. Artificial Abortion Definition
1. Legal/Justifiable abortion When an abortion is performed in accordance with legal
provisions.
2. Criminal abortion A criminal abortion is the induced destruction and expulsion of
the foetus from the womb of the mother unlawfully.
Artificial Abortion

7. Methods of Procuring Criminal Abortion
Methods of Procuring Criminal Abortion
Upto end of 4 weeks
Violent exercise
Hot Baths
Purgatives
After Missing the first period Upto end of 2nd month
Abortifacient Drugs
After 2nd month till
Parturition
Mechanical
Interferences

8. Two Methods Are In Common Use To
Procure Criminal Abortion
Methods to
Procure Criminal
abortion
By drugs
By Application of
violence
General violence
Local violence
Miscellaneous
Methods

9. Abortifacient Drugs
Abortifacient
Drugs
Drugs Acting
Directly on the
Uterus
Ecbolics Drugs that increase uterine contractions
Emmenagogues Drugs which increase uterine flow.
Irritants of
Genitourinary Tract
Locally Produce reflex Uterine contractions
Systematically Produce inflammation of Kidneys
Irritants of GIT
Substances causing irritation of the colon, may produce
hyperaemia and contraction of the uterus also.
Local Applications of
Irritants
Corrosives
Irritants
Systemic Poisons
Organic irritants
Inorganic Irritants

10. General Violence
General Violence
Cupping
Used in Advanced Pregnancy
A wick is placed over the hypogastrium and
lighted, a mug is placed over it with mouth
downwards. Lighted wick consumes oxygen
producing partial vacuum and then mug is
pulled upwards, Mug sticks to the
hypogastrium due to partial pressure,
forcible pulling separates placenta.
Direct Violence
Jumping
Kicks & Blows
Kneading
Massage of the
uterus
Tight Lacing
Violent Exercise
Carrying or lifting weights
Cycling
Driving over rough roads
Horse riding
Jumping from heights
Running upstairs and downstairs
May cause abortion by
1. Producing haemorrhages between the uterus & the membranes, or
2. By congestion of pelvic organs.

11. Local Violence..
• This method usually used in 3rd to 4th month when other methods have failed.
• Although it is dangerous it is most consistently successful method.
• The choice of methods and its results depends upon the skill of operator.

12. Local Violence.. Abortion Pastes
Uterine pastes contain a soft soap and aromatic substances. They produce necrosis and infection of
the uterine wall similar to that produced when soap is injected into the uterus in a large quantity.
Iodine Containing Paste
Utus Paste
Soap + Myrrh
Resinoid + Potassium
Iodide
Fetex Paste
Benzoin + Iodine +
Thymol + Potassium
Iodide + Saponified
Vegetable Oil Paste
Interruptin
Contains elemental
Iodine
Lead Containing
Paste
Diachylon
Contains lead Salt
(Lead Oleate) + oil

13. Local Violence.. Abortion Pastes
• 10-30 ml is injected into the uterus through the external os.
• It detaches the parts of placenta from the uterine wall similar to syringing
method.
• The main hazards are fat embolism sensitivity to the constituent of the paste
mainly iodine.

14. Local Violence.. Abortion Sticks
Salient
Features
It is a thin wood or
bamboo stick about 12-
18cm long.
Construction
Traditional Sticks
At one end of stick, a piece of cloth or cotton
wool is wrapped, which is soaked with one
or more irritants.
Abrus precatorius, Arsenic Sulfate, arsenious
oxide, asafoetida, marking nut juice,
mercuric chloride, red lead
Variation
Instead of stick a twig of some irritant plant
may be used
Calotropis, Cerbera thevetia, Nerium
odorum, Plumbago rosea
Method of use
Introduced in uterus and
retained there till uterine
contractions begin.

15. Local Violence..
Air Insufflation
Air is introduced in the
uterus through vagina
by means of douche
tips, oro-genital
contact, pumps and
syringes in a false
belief that air would
dislocate placenta
causing abortion.
It may cause death by
air embolism.
Curettage
Some criminal
abortions are
produced by
dilatations curettage
under general
anesthesia by unskilled
persons.
It may cause injury to
genital organs and
perforation.

16. Local Violence.. Dilatation of Cervix
• It is another crude method in which a tent is introduced into the
cervical canal.
• This is strip of a substance that absorbed water and became
greatly enlarged such as Laminaria digitale or slippery elm
(Ulmus fulva Michx) or a compressed sponge.
• These vegetable materials are hard and compact when
dehydrated, so that a strip about 3-8cm long could be slid into the
cervix.
• When the water is absorbed from surrounding tissues, the
cervical canal becomes widely dilated and abortion might take
place.
• The risks are perforation of cervix and also infection, especially
if the strip is tore into the tissues.
• The substances used often crude vegetable material, could be the
source of infecting microorganism including anaerobes.
A. Laminaria tent prior to
introduction
B. Marked swelling due to
hygroscopic action when
kept in cervical canal.

17. Local Violence..
Electricity
Placement of
Poles
Generally +ve poles are
placed over lumbosacral
region, -ve over the cervix.
Low voltage
current is passed
Uterus contracts & expels
contents

18. Local Violence..
Gum Elastic Bougies
In more advanced
pregnancies gum elastic
bougies, catheters or
balloons are introduced
into the uterus via cervix.
Mechanism : Irritation of
the cervix
Complication: Sepsis

19. Local Violence.. Rupturing of the membranes
1. Method
• Done by introduction of an instrument into the cavity of the uterus.
2. Who can do it
• Abortionist
• Women herself
3. Mechanism
• Rupture of membranes Escape of liquor amnii induction of abortion
4. Time of abortion: Within few hours to 3 days. Maybe delayed for several
weeks.
5. Complications: Perforation of vaginal uterine wall, Breakage of
instruments or parts of instruments within uterine cavity, Infection.

20. Local Violence.. Syringe Aspiration
Large
syringe is
taken
A catheter of
plastic tubing
is attached to
it
Introduced
within the
uterus
Negative
Suction
applied
Negative
Suction
ruptures
chorionic
Sac
Precipitates
abortion

21. Local Violence.. Syringing
• The ordinary enema syringe with a hand bulb is
commonly used to inject fluid into the uterus, the hard
nozzle being inserted into the cervix.
• Sometimes Higgenson’s syringe is used.
1. One end is dipped into the solution and the other
into the uterus.
2. Repeated compression of the bulb pushes the
fluid into the uterus.
3. If there is imperfect filling of the bulb a mixture
of air and fluid is forced into uterine cavity at a
pressure higher than that present in uterine veins.
Ordinary Enema Syringe
Higgenson’s syringe

22. Local Violence.. Syringing contd..
• Fluid detaches the part of amniotic sac and placenta from the uterine walls,
followed by hemorrhage, uterine contraction and abortion.
• Soap water is often used as injection material
• Solution of irritating substances soluble in water eg. lysol, cresol, corrosive
sublimate, alum, inorganic acids, potassium permanganate, formalin, arsenic
compounds, lead compounds etc.
• These substances may be absorbed through vaginal and uterine mucosa and
cause toxemia, shock and death.
• Extensive tissue destruction may lead to infection and fatal hemorrhage.
• Death may result from air embolism.
• Sudden death may occur due to vagal inhibition.

23. Miscellaneous Methods
• Alternate hip baths in very hot or cold water.
• Partial abortion by untrained abortionist
Completed by trained doctor because it becomes threatened.
1. Abortionist ruptures membranes and sends patient to the doctor.
2. Women applied some corrosives substance to vagina to produce
ulceration and bleeding and further visits the doctor to complete the
abortion.
3. Women complains that her uterus is displaced, unsuspecting doctor
passes a sound resulting in the abortion.

24. Therapeutic Methods to Procure Safe
Abortion..
• These are abortions done in preview of
Medical indication.
• Methods of therapeutic Abortion
1. In first trimester (up to 12 weeks)
2. In second trimester (up to 13-20
weeks)
Sr. No. In first trimester (up to 12 weeks)
1. Menstrual regulation
2. Suction evacuation and/or
curettage
3. Dilatation and evacuation
• Rapid Method
• Slow method
4. Prostaglandin
5. Mifepristone
6. Methotrexate

25. Therapeutic Methods to Procure Safe
Abortion..
Sr. No. In second trimester (up to 13 -20 weeks)
1. Intrauterine instillation of hypertonic solution 1. Intra-amniotic: 20% saline, 40% urea,
mannitol
2. Extra-amniotic: Ethacrydine lactate
2. Prostaglandin F2α or E2 and their analogues Used intramuscularly, or vaginal suppository,
extra or, intra amniotically
3. Oxytocin infusion Usually used along with either of the above two
methods
4. Hysterotomy Abdominal route is commonly employed than
the vaginal one.

26. First trimester Abortion or up to 12 week
contd..
i. Menstrual Regulation (MR) or Endometrial extraction
• Menstrual regulation is the aspiration of the endometrial cavity within 14 days
of missed period in a previously normal cycle when the presence of a early
pregnancy cannot be diagnosed accurately.
• Method: It is done under strict aseptic precaution via paracervical block.
Introducing a 4-5 mm plastic cannula into the uterine cavity and employing
suction with a 50 ml plastic syringe the endometrium is sucked out.
ii. Suction evacuation and/or curettage
• It is a procedure in which the products of conception are sucked out from the
uterus with the help of a cannula fitted to a suction apparatus.

27. First trimester Abortion or up to 12 week
contd..
iii. Dilation and Evacuation
• The operation consists of dilatation of the cervix and evacuation of the products
of conception from the uterine cavity.
1. Rapid Method: This can be done as an out door procedure with diazepam sedation
and paracervical block anaesthesia.
2. Slow Method: Slow dilatation of the cervix is achieved by inserting laminaria tent
(hygroscopic dilator) into the cervical canal (Recently, Isbagul tents or synthetic
dilators like diazepam, lamicol are also used). This is followed by evacuation of
uterus after 12 hours.
iv. Prostaglandin
• Before surgical methods of termination cervical ripening can be achieved by
use 1gm PGE, vaginal pessary (gemiprost) in the posterior fornix.
• This is done 3 hours before the procedure.
• It is also used as an adjuvant to mifepristone and methotrexate therapy

28. First trimester Abortion
Sr. No. Method
V. Mifepristone
(RU-486)
• This is a progesterone antagonist.
• Termination is effective up to 9 weeks of pregnancy
• A single dose of 600 mg is give orally
• If abortion fails to occur within 36 hours, prostaglandin E,
methylester pessary (gemeprost) 1mg or, 800 µg is introduced
vaginally to complete the abortion process
• Nearly 95% of women will abort within four hours. If it fails surgical
method of termination should be applied.
• Misoprostol another PGE analogue is equally effective and has
fewer side effects.
VI. Methotrexate • Termination is effective up to 8 weeks of pregnancy
• A single injection of Methotrexate (50 mg/ml) I.M. followed by
prostaglandin E1 analogue (misoprostol) vaginally is given.

29. Mid Trimester Termination (13-20 weeks)
A. Between 13-15 weeks
• Prostaglandins and their analogues are very much effective. They are extensively
used especially in the 2nd trimester. The act on the cervix and the uterus.
• Transcervical intra amniotic instillation of hypertonic saline (20%) or extra
amniotic instillation of 0.1% ethacrydine lactate may be tried.
• Hysterotomy: Usually done abdominally but can also be done vaginally.
Concurrent sterilization is a must.

30. Between 16 -20 weeks
i. Intrauterine instillation of hypertonic solution
a. Intra amniotic
• In this intra amniotic instillation of hypertonic saline is infused mainly
through abdominal route but vaginal route can also be used.
• Amount of saline is calculated by number of weeks of gestation
multiplied by 10 ml.
• In place of hypertonic saline 40% urea (80gm of urea in 200ml of
distilled water) along with syntocinon drip or, intra amniotic
prostaglandin is effective with minimal complication and toxicity.
• There is liberation of prostaglandin following necrosis of the amniotic
epithelium and the deciduas
• This in turn excites uterine contraction and helps in the expulsion of the
fetus.

31. Between 16 -20 weeks
b. Extra amniotic Intrauterine instillation of hypertonic solution
• It is done by extra amniotic instillation of 0.1% ethacrydine lactate (dose 10
ml/week) transcervically through a no. 16 Foley’s catheter.
• The catheter is passed up the cervical canal for about 10cm above the internal
os between the membrane and myometrium and balloon is inflated with 10ml
saline
• Stripping of membrane with liberation of prostaglandin from the decidua and
dilation of the cervix by the catheter are some of the known factors for
initiation of abortion.

32. Between 16—20 weeks
Prostaglandin
Prostaglandins and their analogue are very much effective in the second trimester.
They act on the cervix and the uterus.
Routes of administration
Vaginal • PGE1 analogue (Misoprostol) 200micro gm every 12 hrs.
• PGE2 (Dinoprostone) suppository 20 mg every 3 hrs
Intramuscular • 15 methyl PGF2 alpha (Carboprost tromethamine) 250 micro gm 3 hourly for a
maximum.
• sulprostone (PGE2 analogue ) 500 micro gm 8 hourly
Extra-amniotic • PGF2 alpha – 200-500micro gm
• PGE2 --200micro gm solution
Intra-amniotic • PGF2 alpha – 25-50mg in one or two sitting
• PGE2 (dinoprostone) – 5-10mg in one or two setting
• 15 methyl PGF2alpha (Carboprost) 2 micro-gm in one sitting.

33. Between 16—20 weeks
ii. Oxytocin
• Oxytocin is administered by intra venous drip along with any of the
chemical used either intra amniotically or in extra amniotic space to
augment abortion process
• Drip can be increased up to 50 mili units or more /min.
iii. Hysterotomy

34. Evidence of Criminal Abortion
Evidence of
Criminal Abortion
When to suspect
criminal Abortion
Deceased is pregnant and deeply cyanosed
Instruments found sticking out of private parts
Instruments or Abortifacient drugs found at the scene of death
Underclothing's are disturbed, torn, soiled with blood or drugs
Discharge from vagina show blood or soapy fluids
Sources of evidence of
criminal Abortion
History
Details of her whereabouts before falling sick
Clinical Examination in Living
Autopsy in dead
Examination of the aborted material

35. Evidence of Criminal Abortion.. In Living..
• In the living abortion cases comes to doctor when
1. Women alleges abortion after trauma (received in accident, quarrel etc.) to
get compensation
2. Women is charged with criminal abortion and tires to conceal it.
• Examination is done with colposcope. It shines the light onto the vagina and
cervix and enlarges the normal view by up to 60 times.

36. Evidence of Criminal Abortion.. Contd
Signs of Recent Abortion.. In Living..
Sr. No. Signs of Recent Delivery
1. General Indisposition • Women is pale, exhausted and ill looking
• Increased Pulse & Slight fever.
2. Breast Changes
Breast • Full, enlarged, tender with a knotty feeling
• Superficial veins are prominent
• Colostrum or milk may be expressed by compression
Areola • Dark, Montgomery tubercles (areolar glands) present
Nipples • Enlarged
3. Abdominal Changes • Abdominal walls are Pendulous, wrinkled, show linea albicantes and
linea nigra.
• In case of c/s : abdomen shall show incision or scar.
4. Perineal Changes Sometimes Lacerated.

37. Evidence of Criminal Abortion.. Contd
Signs of Recent Abortion.. In Living..
Sr. No. Signs of Recent Delivery
5. Uterus
Morphology • Feel Contracted and retracted body of the uterus feels like hard muscular tumour
• Upper border lies 3cm below the umbilicus‘.
• Diminishes in size at rate of 1.5cm/day.
1st week Upper border midway between umbilicus and pubis
2nd week Descends into pelvis and becomes pelvic organ.
9th week Returns to normal condition
6. Cervix
Immediately after
delivery
• Cervix soft & dilated
• Edges torn & lacerated transversely.
24hrs • Internal os begins to close
• External os is soft and patent and admits 2 fingers
End of 1st week One finger is admitted with difficulty
End of 2nd week External os is closed

38. Evidence of Criminal Abortion.. Contd
Signs of Recent Abortion.. In Living..
Sr. No. Signs of Recent Abortion
7. Labia • Bruised
• Swollen & tender
• Lacerated
8. Vagina • Smooth walled
• Rugae begin to appear by 3rd week
• Capacious & Relaxed
• Shows recent tears which heal by 7th day
9. Lochia • It is discharge for the first fortnight during perperium.
• The discharge originates from the uterine body, cervix & Vagina.
• It has peculiar offensive fishy smell.
• Its reaction is alkaline tending to become acidic towards the end.
Amount For 1st 5-6 days average amount is estimated to be 250ml.
Normal
duration
May extend upto 3weeks.

39. Evidence of Criminal Abortion.. Contd
Signs of Recent Abortion.. In Living..
9. Lochia contd..
Colour
& Composition
Lochia rubra
(Red)
1-4 days Blood, shreds of fetal membranes and decidua,
vernix caseosa, aguno hairs & Meconium
Lochia serosa
(Yellowish to pink or
pale brownish)
5-9 days Less of RBC but more of leucocytes, wound
exudates, mucus from the cervix & microorganisms
(anaerobis streptococci and staphylococci)
Lochia alba
(Pale white)
10-15 days Plenty of decidual cells, leucocytes, mucus,
cholestrin crystals, fatty & granular endothelial cells
and microorganisms.
Significance • If it smells offensive, is scanty/absent or excessive : Infection
• Persistence of red colour beyond normal: subinvolution or retained bits if
contraception
• Beyond 3weeks : Local genital infection
10. Lab tests Blood and urine continue giving positive pregnancy tests for 7-10days.

40. Evidence of Criminal Abortion.. Contd
Abortion during first 2-3months &
First 4-5months.. In Living..
Sr. No. Abortionduring first 2-3months Abortionduring first 4-5months
1. Signs Ill defined and disappear in few days.
Therefore early examination is
essential.
-
2. Genital Organs
External Os &
vaginal wall
Slight softening Softened
Internal os - Inserts one finger
Uterus Slightly enlarged More enlargements, contains tags of
membranes

41. Evidence of Criminal Abortion.. Contd
In Living..
Sr. No. At all the times
1. General • Six penny bruises maybe seen over the thighs, perineum etc.
• Haemorrhage more marked as duration of pregnancy increases.
• Peritonitis
• Signs of diseases predisposing to natural abortion (may disapprove
allegations of criminal abortion)
2. Abdomen Signs of injury, If abdominal trauma was used as method of abortion.
3. Vaginal wall & external os Erosions & Lacerations
4. Cervix Show marks of velsellum forceps, fissures, lacerations indicate use of
instruments.
5. Uterus • Metritis.
• Organism: clostridium welchii, streptococci, staphylococcus, e.coli.
Paradoxically bacterial growth is encouraged by application of strong
antiseptic which causes tissue necrosis.

42. Material expelled from the uterus
• It should be examined if available.
• Material must be placed in water, so clotted and congealed blood over the material
be removed for better examination.
• Microscopic examination: to see the blood clot, fetus, fibrinoid or polyp.
• If it is blood clot: perform grouping, precipitin test, DNA profiling to see if
compatible with alleged mother.
• If it is fetus: DNA profiling to confirm compatibility with the mother.
• Collection of blood, vomit, urine for chemical analysis.

43. Evidence of Criminal Abortion.. Contd
In the dead..
• Following must be proved to convict the abortionist
1. That the women was pregnant
2. That the accused is responsible for the act which resulted in abortion.
3. That the accused intended illegal abortion.
4. That the death is due to abortion.

44. Post-mortem Findings
• Depend upon
1. mode of abortion practiced
2. time elapsed between abortion and death. In sudden deaths woman may be
found dead in a posture consistent with recent abortion, eg lower garments
pushed up, legs spread wide apart, syringe or other instrument within genital
canal, apparatus and paraphernalia strewn around.
3. Time elapsed between death and PM examination
• In all cases of criminal abortion, female genitalia must be excised out of the body
and examined.
• Maintain a full photographic record of all procedures conducted and findings.

45. Post-mortem Findings.. Abortion by drugs..
1. Local examination of genitals
• Corrosion, erosions, inflammation of vulva, vagina, cervix etc indicate local application of
corrosives and irritants.
• Preserve vaginal and vulval washings.
2. GIT : Look for signs of congestion, inflammation, irritant poisoning
• If present
a) indicate administration of GIT irritants.
b) Examine entire GIT carefully.
• Preserve entire GIT contents for chemical analysis
3. Urinary tract
• Look for signs of congestion, inflammation, irritant poisoning
• If present, indicate administration of cantharides, turpentine.

46. Post-mortem Findings.. Instrumental
Abortion..
1. Embolism Air, fat, Amniotic fluid
2. Infection: Seen in delayed deaths. Indicates instrumental
abortion.
Vagina walls May show pus. There may be frank discharge
Uterus • Uterine sepsis usually involves endometrium,
especially the placental site and pieces of
retained products
• Myometrium, tubes, adjacent pelvic organs [eg
ovaries], peritoneum is infected
Infection is rare in natural abortion

47. Post-mortem Findings.. Instrumental Abortion..
Injuries Site • On vagina, cervix, uterus.
• There may be abrasions, bruising, foreign bodies, haemorrhage, inflammation, lacerations,
perforations, punctures, ruptures etc.
• Bleeding in peritoneal cavity indicates puncture through and through the genital tract.
• In the vagina, injuries are present in the walls and especially in the posterior fornix.
Extent • Damage is more in unskilled or semi-skilled hands and also during attempts at self abortion.
• All organs constituting genital canal [vagina, cervix, uterus] may show perforations of various
sizes and shapes.
• The size of perforations may vary from a small ragged pinpoint to a much larger tear of oval,
round, stellate or irregular shape.
• Perforation of uterus indicates penetration into the abdominal cavity and abdominal injuries
must specifically be searched for.
• Perforations, tears etc may be found on bladder, intestines (small and large including rectum),
mesentery and omentum.
• If very long instruments [eg cycle spokes] are used, even diaphragm may be pierced causing
injuries to lungs and heart.
Nature type of instrument used eg pointed, blunt, penetrating etc.

48. Post-mortem Findings.. Instrumental Abortion..
Instrumental Abortion
Dissection of the uterus • Normally uterus is opened by vertical anterior incision.
• However in instrumental abortion it may be opened first by a classical
caserean section, which facilitates collection of any fluid retained in
the lower uterine segment.
Dissection of the vagina • Open longitudinally and examine for injuries.
• Note state of dilatation.
• Mucus plug in cervix would be found displaced or disintegrated.
• Injuries to cervix occur in about 50% Cases. May show all types of
injuries including cavitation of the wall, fissures, laceration &
perforation. There may be tenacullum marks on the external orifices.
• Canal may show grooves like parallel notches.

49. Post-mortem Findings.. Abortion by
syringing..
Sr. No. Abortion by syringing
1. Clothes May be soiled with fluid
2. Genital canal May show corrosion or tissue damage due to use of antiseptics, irritants or
corrosives.
3. Fluid • Dark red fluid found between uterine walls and fetal membranes with partial
detachment of placenta.
• If soap has been used, fluid may be foamy.
4. Venous system • Uterine, ovarian and pelvic veins and all veins extending from the sides of the
uterus up to the right heart, coronary vessels, superior and inferior vena cavae and
pulmonary conus may show bubbles of gas and slimy fluid.
• Veins may be “ballooned out” & may show segmentation and may have a
“beaded” appearance. On touching, have a characteristic elastic feel.
• Mechanism of entry: As fluid is pushed into the uterus under pressure, it enters
dilated uterine sinusoids along with air.

50. Causes of Death in Criminal Abortion
Sr. No. Causes
1. Immediate death • Vagal inhibition
• Air embolism
• Hemorrhage
• Fat embolism
• Poisioning
2. Delayed death • Septecimia
• Pyaemia
• General peritonitis
• Combined local infection & toxemia
• Tetanus
3. Remote death • Jaundice and Renal failure
• Bacterial endocarditis
• Pulmonary embolism

51. Amniotic Fluid Embolism
• Most cases of amniotic fluid emboli occurs during active labor
• It may also occur following abdominal trauma and amniocentesis
• Amniotic fluid enters into maternal blood circulation resulting in pulmonary
microvascular obstruction
• 50% of death occurs in first hour
• If death does not occur immediately, it causes disseminated intravascular
coagulopathy and fibrin deposits in many organs
• Amniotic fluid may cause the allergic response that may cause severe collapse and
death
• Diagnosis is done by histopathology of lung tissue for demonstration of mucin , fetal
squamous cells , meconium, lanugo hair, vernix, fat globules, cells from chorion and
amnion in the pulmonary vasculature.

52. Medico-legal Aspects
• Fabricated Abortion
• Fabricated abortion is false and malicious claim of an abortion by producing
a dead animal fetus.
• Women who have suffered trauma due to motor-vehicle accidents, or physical
assault may try to exaggerate the offence [to get more compensation] by
alleging that the trauma caused her to abort.
• A dead animal fetus, or even a dead human fetus, acquired from a hospital may
be produced to support claim. Detailed examination of fetus and DNA
profiling is necessary.

53. Medico-legal Aspects
• Trauma and Abortion
• If trauma is caused to the pregnant mother [eg motor vehicular accident, fall
from height, intentional blow], abortion may be induced.
• In such cases it becomes necessary for the doctor to determine if trauma
indeed resulted in abortion.
• If intention was to kill mother and abortion was caused instead, it would attract
S.316, IPC.
• Difficulties in establishing a causal relationship between trauma and abortion
• Abortion may already be in progress when trauma occurred and it merely
hastened the process
• Embryonic injury caused by trauma may not result in an abortion for several
weeks or even months

54. Medico-legal Aspects
• Criteria suggesting a causal relationship -
• Fetus and placenta should be normal before trauma
• Factors known to cause abortion should be absent. These include
1. Chronic infections in the mother [eg syphilis, toxoplasmosis]
2. Exposure to abortifacients [folic acid antagonists, lead, X-rays]
3. Physical attempt to induce abortion
4. Repeated h/o abortions without any cause
5. Uterine abnormalities [eg congenital defect of uterine development,
endometrial polyps, incompetent cervical os, leiomyomas]

55. Medico-legal Aspects
Criteria suggesting a causal relationship contd..
• Abortion should occur within 24 h of trauma
• The physical development of fetus and placenta should be compatible with the
period of pregnancy at the time of trauma
• There should be an adherent clot or a depression on the placental surface.
• Injuries to the fetus should be compatible with the time period of trauma.
• Miscellaneous
• If abortion is due to occupational exposure to poisons (benzene, gasoline,
H2S), employer is liable for compensation. Many toxic agents causing
abortions are included in Schedule III of Workmens’ Compensation Act 1923
(WCA 1923).
• Wrongful life suits

56. Doctor’s Duties In Cases Of Criminal Abortion
• Doctor must encourage the patient to give correct history. If she is hesitant, should not
force her to make a statement.
• Usual preliminary particulars should be noted.
• The information regarding woman having undergone abortion should be treated as
professional secret.
• He should gather as much information as possible regarding the manner in which
abortion was attempted or, performed and circumstances under which it was done. He
should record her general condition and the signs present in her genital organs and treat
her to best of his ability.
• If the patient is seriously ill, the police should be informed.
• If death is eminent, he should arrange for a dying declaration or a dying deposition by
informing the nearest magistrate.
• In case of death, death certificate should not be issued. The body must be sent for
postmortem.

57. References
• Textbook of Forensic Medicine and Toxicology By Dr. Anil Agrawal
• Forensic Medicine and Toxicology by Dr. KSN Reddy
• DC Dutta Textbook of Obstetrics

58. Thank you..