Abortion, its types and Medico-legal Importance, Infanticide and its Medico-legal Importance.

1. Abortion & Infanticide

2. FAQs
Define and Classify Abortion
Complications of Criminal Abortion
Short Note on The MTP Act 1971
Indications to perform MTP
Define Infanticide
Maceration With MLI
What is Hydrostatic Test
List the conditions where Hydrostatic Test is not necessary
Short note on Sudden Infant Death Syndrome.

3. Abortion
Premature expulsion of products of
conception from mothers uterus at any time
of pregnancy, before the complete period of
gestation.
Miscarriage - second trimester
Premature birth – third trimester

4. Types of abortion
Natural (Spontaneous)abortion
10 to 15% of all pregnancies
Most common in the 2nd and 3rd month
Artificial
Therapeutic abortion
Criminal abortion
Abortion carried against the provisions of MTP Act

5. Medical Termination of Pregnancy Act -
1971
MTP Act -1971, amended in 1975 & 2002
Indications:
Therapeutic – danger to mother’s life
Eugenic – child with congenital abnormalities
Humanitarian - rape
Social – contraceptive failure, economic burden

6. Provisions of MTP Act
 Qualification: RMP who assisted at least 25 MTP, MD or DGO
 Place: Government hospitals or licensed by Chief MO
hospitals
 Written consent is must
 First 12 weeks – opinion of single doctor
 Between 12 to 20 weeks - opinion of two doctors
 Any abortion violating these conditions will be treated as
criminal abortion

7. Techniques of procuring abortion under
MTP Act
Drugs: Mifepristone (RU486) & Misoprostol
DnC: Dilatation and Curettage
Vacuum Aspiration
Intraembryonic instillation of Prostaglandins
Extraembryonic instillation of Hypertonic saline

8. Techniques of procuring abortion under
MTP Act
Drugs: Mifepristone (RU486) & Misoprostol

9. Techniques of procuring abortion under
MTP Act
DnC: Dilatation and Curettage

10. Techniques of procuring abortion under
MTP Act
Vacuum Aspiration

11. Techniques of procuring Criminal
Abortion
Violent physical movements
Abortifacient drugs
Ecbolics - uterine contractions - ergot preparations
Emmenogogues – uterine congestion & bleeding
Mechanical trauma
Abortion stick
Laminaria tent

12. Techniques of procuring Criminal
Abortion
Syringing
Rupturing of amniotic membrane
Dilatation and curettage

13. Complications of criminal abortion
Haemorrhage
Shock - Vagal inhibition
Embolism – Air or Fat
Septicemia
Embolism - Air, amniotic fluid, fat
Perforation of vagina / uterus

14. Evidence of criminal abortion
Signs of interference with continuation of pregnancy
Presence of evidence (instruments, materials,
chemicals) used to procure abortion – Scene of crime
/ Vaginal tract
Injury over abdomen or genitalia with materials for
procuring abortion
Aborted material

15. Evidence of criminal abortion
Aborted material

16. Laws on Abortion
Sec 312 IPC:
Whosoever voluntarily causes criminal abortion is
liable for
Imprisonment up to 3 years and/ or fine
If the lady is quick with child imprisonment may extend up
to 7 years

17. Laws on Abortion
Sec 313 IPC:
If miscarriage is done without the consent of the lady,
imprisonment up to 10 years
Sec 314 IPC:
If a pregnant lady dies of an act intended to cause
miscarriage, imprisonment up to 10 years

18. The Prenatal Diagnostic Techniques (Regulation and
prevention of misuse ) Act, 1994
The Pre-Conception and Pre-Natal Diagnostic
Techniques (Prohibition of sex selection) Act
PCPNDT Act 2003
Prevents selective foeticide (female)
3 yrs RI, and fine up to Rs. 50,000/- and
suspension of registration for 2 yrs on first
offence
5 yrs RI, and fine up to Rs. 1,00,000/- and penal
erasure for repetition

19. Infanticide

20. Infanticide
Unlawful destruction of a newly born child
Regarded as murder in law
 S.302 IPC, death OR imprisonment for life &
also fine

21. Dead birth
Still birth
Live birth
Viability of a fetus

22. Dead- birth
Died in utero before the birth process began
Maceration – aseptic autolysis, child remains
in uterus surrounded by liquor amnii without
air 3-4 days

23. Maceration
Fetus lies flat and
flaccid
Sweetish
disagreeable smell
Skin -
reddish/purple in
color with blisters
containing serous
fluid

24. Maceration
Cranial bones – overlap each other “Spalding
Sign”

25. Mummification
Deficient supply of blood,
Liquor amnii is scanty,
No air

26. Live-birth
Child showed signs of life when only part of it
was out of mother
Signs of a live-birth:-
Listening to cry, feeling / seeing / hearing
heartbeats or slight muscular movements,
pulsating cord
Medical witness, PM examination

27. Live-birth i.e. born alive and died later
1. Shape of chest: flat/arched
2. Position of diaphragm: 4th-5th rib OR 6th-7th rib?
3. Changes in lungs:
volume, margins, consistency, color, weight,
hydrostatic test
4. Changes in stomach & intestines
5. Changes in kidney & bladder

28. Lungs of still born or dead
born child
Lungs of child born alive (Live
birth)
1 small, hard like liver, sharp
margins
Big, soft like sponge, round
margins
2 Uniformly reddish-brown Red-pink, mottled appearance
3 c/s – no froth only blood c/s – frothy blood
4 Fodere’s test - Weight of
lung – 30-40gms
Weight of lung - 60-70gms
5 Ploucquet’s test – Lung
wt.1/70th of body wt.
Lung wt. is 1/35th of the body wt.
6 Hydrostatic test Negative Hydrostatic test Positive

29. Hydrostatic test (Raygat’s test)
 Principle of the test: Specific gravity
of unrespired lung (Dead/ still born) is
1.04-1.05 while respired lung (Live
born) is 0.94.
 The lung of Dead/ still born baby
being solid, has a specific gravity more
than that of water. Hence, it sinks in
water

30. The
Lung of
Live
born
baby
Liver
used as
control

31. Sudden Infant Death Syndrome
COT DEATH / CRIB DEATH
Incidence - 0.2 to 0.4% of live birth
No presenting signs and symptoms
3-4 months of age
No definitive cause

32. Predisposing causes
Season – rainy and winter season
Premature birth
Sex – M:F = 3:2
Age – mid infancy
Social status – low and middle class family
Time of death – night / early morning
Sudden Infant Death Syndrome

33. Battered baby syndrome
Child abuse syndrome
Caffey’s syndrome
Maltreatment syndrome
Non accidental injury of childhood

34. Battered baby syndrome
A battered child is one who has received
repetitive physical injuries as a result of violence
by a parent or a guardian
Obvious discrepancy between the nature of
injury and the explanation by parents & delay
between the injury and medical attention
Repetition of injuries at different dates