Forensic medicine MTP lecture PPT for 3rd prof MBBS students.

1. MTP
(MEDICAL TERMINATION OF PREGNANCY)
BY - RITIK CHANDERIYA
IIIrd PROF MBBS @MIMS Bhopal
(BATCH 2020)

2. Abortion :- Premature expulsion of the fetus from the mother’s womb at
any time of pregnancy, before full term of pregnancy is completed.
• Natural :- may occur any time due to natural cause
• Spontaneous
• Accidental
• Artificial :-
• Therapeutic
• Criminal

3. Causes of Natural Abortion :-
• Defect in the ova, including chromosomal defect is
the most common cause of abortion in the first
trimester.
• Developmental defect of the fetus (common cause).
• Low implantation of zygote.
• Disease of decidua or placenta.
• Rh incompatibility.
• Malformed uterus
CAUSES OF SPONTANEOUS ABORTION
• Hypertension. .
• Diabetes mellitus.
• Hormonal deficiency.
• Emotional disturbances.
• Syphilis.
• Nephritis.
• Arsenic or lead toxicity.
• Drug toxicity

4. Accidental abortion :-
• Intentional – Blows, Kicks, Massage, etc.
• Violent Exercise – Horse riding, Cycling, heavy weight lifting, etc.
• Violent shaking
PS – if uterus & ova are healthy, abortion will not occur.

5. ARITIFICIAL ABORTION
• Legal or Therapeutic Abortion (MTP)
• Criminal Abortion :-
• Destruction and expulsion of the fetus from womb of the mother unlawfully i.e. when
there is no therapeutic indication for the operation.
• Case of criminal abortion is investigated only when the women die and rarely when
someone gives information to the police.

6. MEDICAL TERMINATION OF PREGNANCY,
ACT 1971

7. Indications :- Under this act, pregnancy can be terminated in following
condition.
• Therapeutic – affects women's physical or mental health
• Eugenic – affects child physical or mental health
• Humanitarian – pregnancy caused by rape
• Social – Failure of contraceptive method (in case of married women only)
• Environmental – socioeconomic environment injure women’s health

8. RULES :-
1) Who can terminate pregnancy?
2) Place of MTP?
3) Consent
4) Duration of pregnancy
5) Medico legal aspects

9. Place of abortion?
• RMP if assisted 25 cases of MTP in recognized hospital (MD, Diploma in OBG)
Who can terminate?
• Govt hospital
• Hospital recognized by Govt for this purpose
• Pvt hospital after taking license
MBBS, MD (OBG)

10. Consent
• Written consent from woman
• Written consent of guardian if woman is minor or mentally ill
Woman’s statement is enough in case of rape
Her statement is enough for age proof
Register has to be maintained
If husband requests for abortion of her wife?

11. - consent of husband is not necessary
- can’t be done on request of husband if woman is not willing

12. Duration
• If <12 weeks – single doctor
• If >12 weeks – two doctors must agree that there is an indication

13. PUNISHMENT
• SEC.312 IPC : Whoever (including pregnant women herself) voluntarily causes criminal abortion
with the consent of the pt. is liable for imprisonment upto 3 yrs and with/without fine, and if
women is quick with child, then imprisonment may extend upto 7 yrs & fine.
• SEC.313 IPC : If miscarriage is caused without the consent of the women, whether women is
quick or not, then the person is punished with life imprisonment or imprisonment upto 10 yrs &
fine.
• SEC.314 IPC : If pregnant women dies from the act done with the intent to cause miscarriage,
then imprisonment is upto 7 yrs & fine. If the act done without the consent of the women, then
the person is punished with the life imprisonment or upto 10 yrs & fine.

14. 3 periods
1)end of first month – violent exercise
2)end of second month – abortifacient drugs
3)third or fourth month – mechanical interference
Methods for inducing criminal abortion :-
• Abortifacient Drugs
• General Violence
• Local Violence

15. A) Ecbolics – uterine contractions but do not dilate
cervical canal which is required to expel fetus
 Ergot – m/c used, has uterine action
 Hydrastis canadensis – similar but less intense
than ergot
 Quinine – direct action on uterine nerves
 Lead – causes tonic contractions
B) Emmenagogues – causes in menstrual flow
 Savin
 borax
 Estrogen
1. Drugs acting directly on uterus :-
 Abortus – The non viable product of abortion or immature
placental or fetal tisse.
1. Abortifacient Drugs - either produce congestion of uterine mucosa
- uterine contractions

16. 2. Genito-urinary tract irritants :-
 produce reflex uterine contractions
 Eg:- oil of turpentine, cantherides, etc.
3. Gastro-intestinal tract irritants :-
 irritation of colon may produce hyperaemia
and contraction of uterus
 Eg:- Mg sulfate, castor oil, etc.
4. Drugs having poisonous effect :-
a) Inorganic – Lead, Cu, Hg, etc.
b) Organic – unriped fruit of papaya and
pineapple, moringa, seeds of carrot, etc.

17. 2) General Violence :-
• Severe pressure on abdomen by blows, kicks, massage, etc.
• Violent Exercise – Horse riding, cycling, lifting heavy weights, etc.
• Cupping – mug is turned mouth downward over a lighted wick and placed on hypogastrium
and mug is pulled, results in partial separation of placenta.

18. 3) Local Violence
• Syringing – Higginson’s syringe is used
• Rupturing of membranes – by introduction of instruments
• Syringe Aspiration
• Dilatation of cervix – dilate cervix irritate uterine mucosa
congestion expulsion of fetus
• Abortion stick
• Air Insufflation – air is introduced into vagina
• Curettage
• Pastes(contains Hg, KI, etc) – detach parts of placenta from uterine wall

19. bulb
Hard nozzle
Suction valve
(Eg : Calotropis)

20. Methods Of Therapeutic Abortion
• Mifipristone – inhibits action of progesterone, causes breakdown of endometrium & detachment of embryo from
uterine wall.
• Manual vacuum aspiration
• Oxytocin infusion
• Curettage
• Utus paste – soap medicated with iodine
• Prostaglandins – I/V or oral induce labour
• Amniotic fluid replacement therapy – in case of I/U death – fluid is replaced by 20% NS
• Electrical vacuum aspiration
• Abdominal Hysterotomy

22. COMPLICATIONS :-

23. Evidence Of Abortion (In Living)
CASES :-
• When a woman alleges abortion after a blow or quarrel in order to inflict
severe penalty on the accused
• When a woman is charged with abortion but wishes to conceal it
Signs of recent abortion are essentially those of recent delivery, but they
depend on the length of pregnancy.

24. SIGNS – If abortion in,
• b/w 2-3 months – ill defined, hemorrhage, softening of external os & vaginal
walls, slight enlargement of uterus which disappears in few days.
• b/w 4-5 months – hemorrhage is more marked, internal os may admit a finger.
PS- os is not injured in abortions of less than 6 months of pregnancy
• Vaginal canal may show erosions and lacerations.
• Cervix may show marks of valsellum forceps, fissures or lacerations, indicating
use of an instrument.

25. Evidence Of Abortion (In Dead)
SUSPICION
• Deceased is pregnant and deeply cyanosed
• Instrument to procure an abortion or abortifacient drug found at the crime
scene
• Underclothing appears to be disturbed after death
• Fluid, soapy or blood stained is coming out of vagina

26. Medico Legal Importance Of Abortion
• Abortion may be induced without proper indiccations or in a contravention
to other provisions of MPT act, when it amounts to a crime
• When a doctor violates the provision of MTP act, he is liable to be punished
• A pregnant or even not pregnant woman may malinger abortion, due to
assault, to bring a false charge against a person

27. • Abortion may be feign to bring charge of rape by a woman, for blackmailing
the man
• Abortion may be feign to claim compensation by a working woman, linking
the said abortion with her hazardous duty
• A woman may be falsely charged for inducing criminal abortion
• A woman who has aborted, may be falsely charged for infanticide
• A woman who has aborted, may bring a charge of negligence against her
doctor

28. Medico Legal Questions :-
• Was the deceased pregnant recently?
• Was there any evidence of abortion?
• Was there any evidence of criminal interference by intruments or the use of drugs?
• Was the cause of death related to abortion?

29. INSTRUMENTAL ABORTION
1. Has any instrument been used, and if so, when?
• Presence of any injury in vagina, cervix, uterus.
• Skilled or unskilled abortionist?
• Fluid content flooding from vagina
Time :-
• Vagal inhibition will produce instantaneous death.
• Death from air embolism occurs within seconds or in minutes.
• In hemorrhage, death occurs after some hours.
• Due to sepsis after weeks or months.

30. 2. What kind of instrument was used?
Injury is penetrating or non penetrating.
Sharp, pointed or blunt object
3. How may any injuries present be interpreted?
4. Was instrumentation self induced or assisted?
5. How did death occur?
• Immediate – Vagal inhibition, Air embolism, Hemorrhage, etc.
• Delayed – Septicaemia, Infection, Tetanus, etc.
• Remote – Jaundice, Pulmonary, Bacterial Endocarditis, etc.

31. Thank You
Reference :- Essentials of FMT
K.S.N. REDDY
O.P. MURTY