The medicolegal aspects of pregnancy, delivery and abortion

THE MEDICOLEGAL
ASPECTS OF
PREGNANCY,
DELIVERY AND
ABORTION
Dr. Maha Farid,
MBBCh, MS, PhD.
Dept. Of Forensic Medicine and Clinical Toxicology
Faculty of Medicine
Helwan University
1/24/2020 MLA of Pregnancy, Delivery & Abortion _MF, PhD. 1

Learning Objectives
■ Understand the conditions where diagnosis of pregnancy has
medicolegal significance.
■ Identify the situations when diagnosis of delivery and postpartum
status have medicolegal importance.
■ Recognize the articles of the Egyptian Law that are concerned with
abortion.
■ Distinguish the different types of abortion, spontaneous, therapeutic
and criminal abortion.
■ Acknowledge the medicolegal implications related to different types
of abortions.

Pregnancy in Forensic Medicine
■ Inheritance → to produce an heir.
■ Rape → to receive more compensation.
■ Capital sentence → delay the execution of death penalty.
■ Adultery → charged if her away from legal husband.
■ Criminal Abortion → confirm the pregnancy.

The Gestation Period
■ Normal gestation period:
• 280 days = 40 weeks = 10 lunar months.
■ According to the Egyptian Law:
■ Shortest → 6 months
■ Longest → 12 months.
■ The child born after a shorter than 6 months and longer than 12
months gestational period can be disputed by his father.

Diagnosis of Pregnancy
Pregnancy
Living
Sure signs
Inspection
Fetal
movements
Palpation Fetal parts
Auscultation Fetal sounds
Ultrasonography Most reliable
Pregnancy tests
Detection of
HCG hormone
Probable
signs
Dead

Ultrasonography
■ Confirmation of pregnancy.
■ Determination of the gestational age.
■ Determination of the fetal sex after 20 weeks.
■ Diagnosis of multiple pregnancy.
■ Diagnosis of congenital malformation.
■ Diagnosis of Intrauterine Growth Retardation (IUGR).
■ Diagnosis of fetal viability and Intrauterine Fetal Death → Spaulding Sign.

Spalding sign by abdominal US

Pregnancy Tests
■ Human Chorionic Gonadotrophic (HCG) hormone.
■ Urine and Blood.
■ Sure sign of pregnancy.
■ Direct or indirect agglutination tests.
■ False +ve:
– Miscalculations and HCG sensitive tumors.
– MLI: Lead to homicidal crimes.
■ False –ve:
– Miscalculations and very early in pregnancy.
– MLI: Delayed medical intervention in cases of ectopic pregnancy.

Postmortem Diagnosis of
Pregnancy
■ Uterine Enlargement.
■ Presence of ovum or fetus in the
uterus.
■ Microscopical evidence of chorionic
or fetal tissues in the uterus.
MLA of Pregnancy, Delivery & Abortion _MF, PhD. 1/24/2020 9

Delivery
MLI of Diagnosis of Delivery
• Infanticides
• Inheritance.
• Disputed paternity.
• Interchange of infants in maternity hospitals.
This Photo by Unknown Author is licensed under CC BY-NC-ND

Signs of Delivery
■ In The living:
– Recent delivery:
• General:
• Exhausted, pale, rapid weak pulse.
• Abdomen is flabby with wrinkled skin and stretch marks.
• Breasts are full and engorged → colostrum.
• Local:
• Swollen and contused vulva.
• Episiotomy or perineal tear.
• Lochia.
• Soft cervix.

Signs of Delivery
■ In the living:
– Remote delivery
• General:
• Abdominal wall: lax, linea albicans and linea nigra.
• Breasts: soft, lax, nipples are darker in colors.
• Local
• Vulva: scar of episiotomy or tear.
• Vagina: smooth mucosa and dilated.
• Cervix:: slit like external os.
■ In the dead:
– Autopsy : Macroscopic and Microscopic of the uterus.

The External Cervical Os

Abortion
■ Definition: The expulsion of the
gravid uterine contents any time
before the fetus reaching full term.
■ This also includes miscarriage and
pre-term labor.

MLI of Abortion
■ Trauma including domestic violence.
■ Malpractice leading to abortion.
■ A female charged of conducting abortion to herself.

Abortion
Induced
Therapeutic
Criminal
Abortifacient
Drugs
Violence
Local
General
Spontaneous

Legal
Aspects for
Therapeutic
Abortion
■ Consult another specialist and obtain a
written consultation indicating the necessity
of the induction of abortion.
■ Written Consent of the patient and her
husband.
■ Maintain adequate medical reports about
the case with all the details.
■ Appropriate preparation of the patient
before the procedure.
■ Must be performed in a well-equipped
hospital or medical facility.

Criminal
Abortion
■ Unjustifiable (any reason other than
saving the life of the mother).
■ Performed by:
– Woman herself.
– Lay abortionist including
midwives.
– Medical personnel.

Methods of Criminal Abortion
■ General violence.
■ Abortifacient Drugs
– Ecbolic Drugs: direct effect on the uterine muscles. Ex. Lead oleate and Prostaglandins.
– Irritants of the uterine muscles: drastic purgative Ex. Castor oil, Colocynth.
– General Protoplasmic Poisons: Ex. Arsenic, Mercury and Lead.
■ Local Violence
– Foreign body insertion.
– D and C.

Complication
s of Criminal
Abortion
■ Hemorrhage.
■ Shock.
■ Air embolism.
■ Infection.
■ Venous thrombosis.
■ Amniotic embolism.
■ Ruptured uterus/Uterine
perforation.
■ Renal or hepatorenal failure.

Examining a
suspected
case of
criminal
abortion
■ Written Consent.
■ Detailed history.
■ External examination:
– Signs of Pregnancy
– Signs of Delivery.
– Signs of Violence or infection.
– Examination for signs of chronic
diseases.
■ Local Examination.
■ Laboratory Investigations.
■ Examination of the products of abortion.

Role of The Practitioner in Cases of Abortion.
■ Written consent.
■ Adequate ground for termination of pregnancy.
■ Urgent life-threatening conditions.
■ Urge the victim of a suspected criminal abortion to report the incident to the authority
without affecting his/her duties towards the patient.
■ If a woman is dead after an abortion, the physician should report to the police in case of
any suspicion and don’t issue the death certificate without investigation.
■ The physician must avoid giving information about drugs that may cause abortion in
order not to be accused of causing unjustifiable induced abortion.

Additional
Readings
■ Features of the fetus
according to the
gestational age.

The medicolegal aspects of pregnancy, delivery and abortion

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