1. VIRGINITY, PREGNANCY
&
DELIVERY
By
Dr.Krishna Kant Singh
M.D.(Hom.)
Asst. Professor, Dept. of OBG
Shaheed Raja Hari Prasad Mall State Homoeopathic Medical College
&
Hospital, Barhalganj-Gorakhpur
Homeobook.com
2. VIRGINITY??
Also known as “Virgo Intacta”
Definition: Virgin is a female who has not
experienced any sexual intercourse
at all.
Defloration means loss of virginity.
Signs of virginity :
1. Extra genital signs (in breast)
2. Genital signs
Homeobook.com
4. TYPES OF HYMEN
The hymen is a fold of mucous membrane about 1mm thick,
situated at the vaginal outlet.
1) SEMILUNAR
2) ANNULAR
3) INFANTILE
4) CRIBRIFORM
5) VERTICAL
6) SEPTATE
7) IMPERFORATE
8) CARUNCULAE MYRTIFORMIS
Homeobook.com
6. Features Virginity Defloration
1.Basic difference No experience of sexual intercourse Have experience of sexual intercourse
2.Hymen Intact Torn except in false virgin
3.Introitus Does not admit more than tip of little finger,
it is painful
May admit 2 fingers , it is painless
4.Vagina. Marked rugosity on wall
Full length of a finger cannot be admitted
Rugosity diminishes
Full length of finger can be admitted
5.Fossa navicularis Less conspicuous More conspicuous after sexual intercourse
6.Fourchette Intact Healed tear
7.Labia minora Smaller pinkish, covered with majora enlarged, pigmented, not covered
8.Labia majora Thick, fleshy, both majora are in close
apposition
Less fleshy, not in full apposition
9.Breasts Smaller, firm, pinkish smaller areola, and
small nipple
Larger, flabby, pendulous, wider areola,
large and raised nipple
Homeobook.com
7. vTrauma or Accident
vSurgical operation or Gynaecological examination
vSanitary tampons
vForeign body – sola pith (APTAE VARIS)
vScratching due to irritation from uncleaniness
vMasturbation
vUlceration – d/t diphtheria , fungus, etc.
Other conditions which may affect signs
of virginity
Homeobook.com
9. Point of difference True virgin False virgin
1.Basic difference The woman has no experience of sexual
intercourse
Has experience of sexual intercourse
2.Hymen Not ruptured. It is thin flap of tissue of
regular shape and appearance
Not ruptured. It is thick , fleshy or fibrous elastic
with folds
3.Introitus Does not admit more than the tip of little
finger, it is painful
May admit 2 fingers, it is not painful
4.Vagina. Marked rugosity on wall
Full length of a finger cannot be admitted
Rugosity diminishes
Full length of finger can be admitted
Homeobook.com
10. 5.Fossa navicularis Less conspicuous More conspicuous after sexual
intercourse
6.Fourchette Intact Healed tear
7.Labia minora Smaller pinkish, covered with majora enlarged, pigmented, not covered
8.Labia majora Thick, fleshy, both majora are in close
apposition
Less fleshy, not in full apposition
9.Breasts Smaller, firm, pinkish smaller areola and small
nipple
Larger, flabby, pendulous, wider
areola, large and raised nipple
Homeobook.com
11. Medico Legal Importance of Virginity
In Civil cases:
1. Nullity of Marriage (Sec. 12, Hindu Marriage Act) i.e. marriage never to have existed in
Law.
A marriage can be nullified:
(1) When either party was under the age of marriage contract.
(2) When one party was of unsound mind or a mental defective at the time of marriage.
(3) When one party was already validly married.
(4) Where the marriage has not been consummated due to impotence or willful refusal.
(5) Where the woman was pregnant by another man at the time of marriage.
1. Divorce (Sec. 13, Hindu Marriage Act)
3. Defamation of character
4. Rape
Homeobook.com
12. PREGNANCY
• It is a physiological condition develops in a female with in her
child bearing age due to fertilisation of ova by spermatozoa
results in developing embryo or foetus in the uterus till its birth.
• Signs of pregnancy in living:
1. Presumptive signs
2. Probable signs
3. Positive or conclusive signs
Homeobook.com
13. Presumptive signs of pregnancy
• Amenorrhoea
• Morning sickness
• Changes in breasts
• Changes in the Vagina
• Urinary disturbances- increased frequency of micturition
• Chloasma - 24th week
• Quickening - 16 – 20 weeks
• Linea nigra - 20th week (Also known as Pregnancy Line)
• Striae gravidarum
• Sympathetic change -increased salivation
-PICA (perverted appetite)
-irritable temper.
Homeobook.com
14. Changes in Breasts:
• Breasts enlarged & nodular(2nd
month)
• Surface veins prominent
• Areola enlarged, pigmented with
prominent Montgomery’s
Tubercles (2nd month).
• Nipples enlarged
• Colostrum (3rd month)
Changes in Vagina:
• Jackquemier’s Sign or
Chadwick’s Sign: violet or bluish
discolouration of vaginal mucosa
(after 4th week).
Homeobook.com
15. PROBABLE SIGNS OF PREGNANCY
• Enlargement of abdomen
• Height of uterus.
• Palmer’s Sign- Regular rhythmic
contractions of uterus at 4th to 8th
week.
Homeobook.com
17. •Hegar’s Sign:
-Bimanual examination demonstrates
softening in the consistency of the uterus,
and the uterus and cervix seem to be two
separate regions at 6th - 8th week
•Goodell’s Sign:
- It is a significant softening of
the vaginal portion of the cervix from
increased vascularization by 4th month
of pregnancy.
Goodell’s sign
Hegar’s Sign
Homeobook.com
18. • Osiander’s Sign – Increase pulsation felt through lateral
fornices at 8th week
• Piskacek’s Sign – Asymmetrical enlargement of uterus if there
is lateral implantation.
Homeobook.com
19. PROBABLE SIGNS OF PREGNANCY
• Braxton-hick’s sign -After 15-16
weeks of pregnancy
• Ballottement: internal and external
(during 4th and 5th month)
• Uterine soufflé at end of 4th month
• Biological tests : Presence of
gonadotropins in pregnant woman’s
blood and their excretion in urine
External Ballottement
Internal Ballottement
Homeobook.com
20. • Immunological Tests :
a) Inhibition (Indirect) Latex slide test
b) Direct Latex slide test
• Haemagglutination inhibition test.
• RIA and ELISA
Homeobook.com
21. POSITIVE SIGNS OF PREGNANCY
• Auscultation of foetal heart sounds- positive after 18-20 wks
• Palpation of foetal part
• Feeling foetal movements
• Radiograph of foetus -after 3 months
• USG : 6 wks - Gestational sac
7 wks - Embryo
10 wks - Heart beat
14 wks - Head and Thorax
• Presence of foetal cells in mother’s blood.
Homeobook.com
22. Signs of Pregnancy in Dead
• Products of conception
• Enlarged Uterus & other uterine change.
• Corpus luteum
Homeobook.com
23. Medicolegal Importance of Pregnancy
(A). In Civil cases:
• Nullity of marriage
• Inheritance of property
• Higher maintenance allowance in case of divorce
• Compensation cases
• Illegitimate baby
• Maternity leave
• Compensation case if allegation of pregnancy against
unmarried woman or widow.
Homeobook.com
24. (B). In Criminal cases:
•Execution of death sentence.
•Advantage during trial in court.
•It is positive proof in a trial of rape.
•An unmarried pregnant woman bring a
charge of criminal breach of trust against a man.
•Adultery.
•In criminal abortion and to foeticide or infanticide.
•Motive for suicide or murder.
Homeobook.com
27. 1. Uterine soufflé may be heard by auscultation at the end of-
a) 10wks
b) 12wks
c) 14wks
d) 16wks
2. Foetal parts can be detected by X ray usually by-
a) 8wks
b) 12wks
c) 14wks
d) 16wks
Homeobook.com
28. 3. A pregnant woman sentenced to death cannot be hanged till-
a) Delivery
b) Delivery and attainment of 6 months of age by new born
c) Delivery and one year after that
d) None of the above
4. Pseudocyesis is found in-
a) Young married woman
b) Aged unmarried girl
c) Menopausal ladies
d) Adolescent girl
Homeobook.com
29. 5. Impregnation of an ovum discharged from a previous ovulation
has been developed is called-
a) Fecundation
b) Superfecundation
c) Super foetation
d) None of the above
6. Which of the following statements is true for virgo intacta-
a) Breasts are large and nodular
b) Labia majora not apposed with each other
c) Fossa navicularis is disappeared
d) Labia minora completely covered by labia majora
Homeobook.com
31. Signs of Recent Delivery in Living
General appearances of indisposition :
Woman looks pale, exhausted and ill.
(A). Breasts:
• Enlarged, full, firm, tense.
• Darkening of areola.
• Prominent Montgomery tubercles .
• Surface veins are prominent .
• Striae are seen.
• Colostrum can be squeezed out for 2-3 days after delivery.
Homeobook.com
32. (B). Abdomen:
• Striae gravidarum (pink)
• Lineae albicantes (silvery white)
• Linea nigra (black)
(C). External genitalia :
• Labia are tender, swollen and lacerated.
• Fourchette is ruptured.
• Perineum is lacerated.
• Internal os begins to close within 24 hrs
• External os is patent admitting two fingers initially and later one finger with
difficulty at the end of a week.
• Vaginal discharge known as Lochia ( for 2-3 weeks) :
During first 4-5 days - lochia rubra (red)
During the next 4 days - lochia serosa (pale or serous)
After 9th day - lochia alba (yellowish grey or turbid)
Homeobook.com
33. Signs of Recent delivery in Living
• Extent of signs depends upon whether the woman is
primiparous or multiparous
• Breast: Pendulous
• Hyperpigmentation present
• Montgomery's tubercles are prominent
• Stria are present
• Abdomen: abdominal wall is lax
• Linea albicantes
• Linea nigra
Homeobook.com
34. Signs of Remote delivery in Living
• External genitalia: labia are lax
• Vaginal rugae are lost
• Fourchette is lost
• Hymen: carunculae myrtiformis
• Os in Nulliparous: - Internal os is well defined
- External os is rounded and orifice closed
• Os in Multiparous: - Internal os is not well defined
- External os is transverse irregular and may
admit a tip of finger
Homeobook.com
35. Sign of Recent delivery in the Dead
• Same as are found in living
• Additional findings are found in uterus and its appendages
• Uterus is firm and returns to a permanent reduced size
• Placental site can be identified by its dark colour and
coarse granular appearance and covered with blood clots,
lymph and decidua.
• Ovaries and fallopian tubes are congested
• Histopathological examination:
- trophoblastic cells and chorionic villi are present in
endometrium
- one large corpus luteum is present in one ovary
Homeobook.com
36. Signs of Remote delivery in Dead
• Same as are found in remote delivery in living
• Additional findings are present in uterus and its appendages
• Uterus is concave inwards.
• Fundus is above the line of fallopian tube
• Length of body is twice the length of cervix in multiparous and it
is equal in nulliparous.
• External os is enlarged, irregular and patulous and admits tip
of finger
• Internal os is not well defined
• Arbor vitae: lost in parous woman
Homeobook.com
37. Different
measures
Immediately After 3 days After 1 week After 2 weeks After 3 weeks
Outer length 20cm 17cm 14cm 12cm 10cm
Outer breadth 13-14cm 10cm 8cm 7cm 6cm
Thickness 5cm 5cm 4cm 3cm 2.5cm
Inner length 15cm 12cm 10cm 8cm 7cm
Weight 1kg 7oogm 500gm 300gm 80-100gm
Diameter of the
site of placental
attachment
10cm 7cm 4cm 2.5cm 1.5cm
Homeobook.com
38. Point of differences Nulliparous Parous
Size 7cm x 5cm x 2 cm 10cm x 6cm x 2.5cm
Weight 40 gm 80-100 gm
Ratio b/w Body/Cervix Equal 2:1
Upper surface of fundus Less convex More convex
Uterine cavity convex concave
Scar for placental attachment absent present
External os round transverse
Internal os Circular, well defined Ill defined, margin wrinkled
Homeobook.com
39. ABORTION
Definition:
Termination of pregnancy due to premature
expulsion of product of conception at any time from
the uterus.”
Types of Abortion:
(A). SPONTANEOUS
(i) Natural
(Ii) Accidental
(B). INDUCED
(i) Legal
(ii) Criminal Homeobook.com
40. Medical Termination of Pregnancy (MTP) Act, 1971
• Came into force in 1972
• Amendments in 1975, 2002,
2003 and 2014.
• It has been implemented by the
latest amendment in MTP Act
in 2020.
• Inroduced in Lok Sabha on
02nd March, 2020, Passed by
Lok Sabha on 20th March,
2020 and by Rajya Sabha on
21st March, 2021.
Homeobook.com
41. MTP (amendment) Bill, 2014
• MTP (amendment) Bill, 2014 allows any HOMOEOPATHIC and
AYURVEDIC practitioner to conduct the medical termination of
pregnancy.
• CMO (Chief Medical Officer) of the district is empowered to
certify that a doctor has the necessary training to do abortions.
Homeobook.com
42. 4 weeks 8 weeks 12 weeks 16 weeks 20 weeks 24 weeks 28 weeks 32 weeks 36 weeks
1 Medical Practitioner needs
to advice for the termination
of pregnancy
2 Medical Practitioner needs
to advice for the termination
of pregnancy
As Per MTP Act, 2020
(Amendment)
Provisions of the act also
extended for Un-Married
Women.
Government to notify the
special categories.
As Per MTP Act, 1971
Beyond 24 weeks
Medical Board will took
decision setup in each
state and Uts.
The board will decide
whether any substantial
abnormality to terminate
the pregnancy.
Homeobook.com
43. Grounds for MTP
• Therapeutic : risk to pregnant woman
• Eugenic : risk to the child to be born
• Humanitarian : pregnancy caused by rape
• Socioeconomic : pregnancy due to failure of
contraceptive, Unwanted pregnancy with low SE status
• Environemental: no one to help from society
Homeobook.com
44. Duration of Pregnancy for MTP
Below 12 weeks :only one medical officer alone can take
decision for MTP
Between 12 to 20 weeks: decision is taken by two medical
officers for MTP
After 20 weeks: MTP can not be done, except in emergency
conditions.
(In emergency conditions decision can be taken by only a single
doctor.)
Homeobook.com
45. Changes proposed in conditions for terminating a pregnancy
at different gestational periods
Time since conception Requirement for Termination of Pregnancy
MTP Act , 1971 MTP (Amendment) Bill, 2020
Up to 12 weeks Advice of one doctor Advice of one doctor
12 to 20 weeks Advice of two doctors Advice of one doctor
20 to 24 weeks Not allowed Two doctors for some categories of
pregnant women
More than 24 weeks Not allowed Medical Board in case of substantial
foetal abnormality
Any time during the pregnancy One doctor, if immediately necessary to save pregnant woman's life
Homeobook.com
46. Places for MTP
• Any government or semi-government hospital
• Any non-government hospital approved by government or CMO or
district health officer
Qualification and Experience of Doctors for MTP
•Up to 12 weeks: By any RMP who has performed at least 25 cases of MTP
and out of which 5 have been performed independently in an approved place.
By doctor with any of the following:
- PG degree or diploma in OBG
- 6 month of house surgery in OBG
- Experience of one year or more in OBG at any hospital
•In emergency cases: By any RMP , at any place , irrespective of duration of
pregnancy.
Homeobook.com
47. • Termination due to failure of contraceptive method or device: Under the Act
a pregnancy may be terminated up to 20 weeks by a married woman in the
case of failure of contraceptive method or device. The Bill allows unmarried
women to also terminate a pregnancy for this reason.
• Medical Boards: All state and union territory governments will constitute a
Medical Board. The Board will decide if a pregnancy may be terminated after
24 weeks due to substantial foetal abnormalities. Each Board will have a
gynaecologist, paediatrician, radiologist/sonologist, and other members notified
by the state government.
• Privacy: A registered medical practitioner may only reveal the details of a
woman whose pregnancy has been terminated to a person authorised by
law. Violation is punishable with imprisonment up to a year, a fine, or both.
Homeobook.com
48. Consent
• Only consent of pregnant woman is necessary
• No need to obtain consent from her husband
• In case of minor (less than 18 year of age),and mentally ill
woman, consent from guardian is required
Homeobook.com
49. Common methods of MTP
• Medical : Mifepristone and Misoprostol
• Dilatation and curettage (D&C)
• Vacuum aspiration technique or surgical abortion
• Intra-embryonic instillation of PG
• Extra-embryonic instillation of hypertonic saline
• Surgical
Homeobook.com
51. Criminal Abortion
• Abortion done against the provision of MTP act.
Legal aspects of criminal abortion:
ØSec.312 IPC: Criminal abortion with the consent of patient
• Punishment to both for upto 3 year,and +/- fine
• If the woman is quick with child then may extend upto 7years
ØSec 313 IPC: if abortion done without her consent
• Punishment upto 10 years and fine
ØSec 314 IPC:if woman dies by this act
• Punishment upto 10 years and fine
ØSec 315 IPC : Any act with the intent to prevent the child being born alive or cause its
death before birth
• Punishment : upto 10 years and/or fine.
ØSec 316 IPC : any act which cause death of quick unborn child amount to culpable
homicide
• Imprisionment upto 10 years and fine Homeobook.com
52. Methods adopted for criminal abortion
1. Abortifacient drugs
• Drugs acting directly on the Uterus
• Irritants of Genito-Urinary tract
• Irritants of GI tract
• Drugs having poisonous effect on Body
2. General violence
3. Local violence
Homeobook.com
53. 1.Abortifacient Drugs
1. Drugs acting directly on the Uterus :
A. ECBOLICS : (Increase Uterine Contraction)
Eg. Ergot
Hydrastis canadensis
Quinine
Lead ( lead oleate or lead plaster)
Decoction of cotton root bark
Nitrobenzol
Picrotoxin and strychnine
Homeobook.com
54. B. EMMENAGOGUES : (Increase Menstrual Flow)
Eg. :- savin
borex
apiol
rue
laburum
oestrogen
sanguinarin
caulophyllin
hallebore
Homeobook.com
55. 2. Irritants of Genito-Urinary tract:
• Oil of pennyroyal
• Oil of tansy
• Oil of turpentine
• Cantharides
• KMnO4
3. Irritants of GI tract :
• Saline cathartics eg.- MgSO4
• Purgatives eg.- aloes
calomel
castor oil
croton oil
• Emetic eg.- tartar
Homeobook.com
56. 4.Drugs having poisonous effect on Body:
• Inorganic: Pb , Cu , Fe ,Hg , Sb
• Organic: cantharides , unripe fruits of papaya and pine apple,
juice of calotropis , bark of plumbago rosea , methi ,saffron
Homeobook.com
57. 2.General Violence
Intensional-
1. Severe pressure on abdomen: by blow, kick, jumping or
kneeling
2. Violent exercise: horse riding, cycling, jumping from height,
severe jolting, carrying or lifting heavy weights
3. Cupping
4. Very hot and cold bath alternately
Homeobook.com
58. 3.Local Violence
• Syringing: by Higginson’s syringe
• Syringe aspiration
• Vacuum aspiration
• Rupture of membrane
• Use of laminaria tent /slippery elm
• Abortion sticks
• Utus paste (thymol, iodine, salt of mercury)
• Electric current
• Air insufflations
Homeobook.com
59. CAUSE OF DEATH AND DANGERS OF
CRIMINAL ABORTION
A. Cause of Rapid death:
• Haemorrhage
• Perforation
• Vagal shock
• Fat embolism
• Air embolism
B. Cause of delayed death:
• Peritonitis
• Local infection getting complicated
• Tetanus
• Septicaemia
• Pyaemia Homeobook.com
60. C. Remote causes :
• Renal failure
• Meningitis
• Endocarditis
• Pneumonitis
• Hepatitis
D. Toxic effects of Abortifacient drugs:
- causing early or delayed deaths
Homeobook.com
61. Duties of doctor in suspected criminal abortion
• Doctor must ask the patient to make a statement about the criminal
abortion.
• If she refuses, he should not pursue the matter, but inform the
police.
• He should keep all the information secret to maintain professional
secrecy.
• He must arrange to record the dying declaration in case woman’s
condition is serious.
• If woman dies, he must not issue the death certificate, but should
inform police for post-mortem examination.
• Any foreign materials collected from genitals should be kept
preserved.
Homeobook.com
62. Examination of Living individual
• Requisition from the concerned authority
• Identification of female
• Written informed consent
• A female must be present
• Brief history
• Clothing must be examined
• Clinical examination: sign of ill health, GIT disturbances, exhaustion
• Local examination
• Laboratory investigations
Homeobook.com
63. Examination of Dead body
Sudden death of a woman of child bearing age should give
rise the suspicion of criminal abortion if:
1. The deceased was pregnant and deeply cyanosed.
2. Instrument to procure the abortion or abortifacient drugs
are found at scene of death.
3. Underclothing appears to be disturbed after death.
4. Fluid ,soapy material or blood coming out of vagina.
Homeobook.com
64. Following points should be proved to convict the
abortionist:
1. The dead woman was pregnant
2. The accused was responsible for the act which resulted in
the interruption of pregnancy
3. The accused acted for purpose of procuring illegal abortion
4. Death occurred as a result of attempt to interrupt the
pregnancy
Homeobook.com
65. Medical evidence of Abortion
In a Living victim:
• Breasts-pigmented
• Colostrum
• Linea nigra and albicans may present
• Congestion of labia majora and minora
• Tags of membrane may be present in uterus
• Swab taken from cervical canal may show chemical used
• HCG in urine up to 7 days
• Aborted material, if available ,should be subjected to visual or
histological examination.
Homeobook.com
66. In a dead victim (autopsy findings):
• Face may appear pale.
• Undergarment may show blood clots and fragments of
product of conception.
• Congestion of labia and post. commissure
• Signs of peritonitis.
• Vaginal fluid for chemical analysis.
• In case of suspected air embolism X-ray & CT-Scan.
• Uterus and ovary may also be sent for chemical
analysis to detect abortifacients.
Homeobook.com
67. Factor suggestive of Spontaneous / Natural Abortion
• Blighted embryo
• Degenerative change of chorionic villi
• Hydatidiform mole
• Attenuated trophoblastic layer and myxomatous avascular
stroma
• Macerated foetus and placenta
• Foetal abnormalities
Homeobook.com
69. 1.In India MTP act was first introduced in
a. 1947
B.1966
C.1971
D.1975
2.MTP act extends all over India ,except, the city/state
a.Delhi
b.Mumbai
c.Chennai
d.Jammu and kashmir
Homeobook.com
70. 3.under MTP act one doctor can terminate the pregnancy upto-
• A. six weeks
• B. twelve weeks
• C. Twenty weeks
• D. Twenty weeks
4.if criminal abortion is performed with the consent of the woman, the
doctor will be charged under section
• A.310IPC
• B.312IPC
• C.313IPC
• D.320IPC
Homeobook.com
71. 5. Age of pregnant woman to give consent in MTP act is
• A.12years
• B.16years
• C.18years
• D.21years
6.Injection of soap water into vagina during criminal abortion can
cause
• A.Air embolism
• B.fat embolism
• C.neurogenic shock
• D.peritonitis Homeobook.com
72. 7.Intra-amniotic injection of prostaglandins is successful in causing
abortion in the
• A. First trimester
• B. Second trimester
• C. Third trimester
• D. After viability of fetus
8. If criminal abortion is performed without the consent of woman , the
doctor will be charged under section
• A.310IPC
• B.312IPC
• C.313IPC
• D.320IPC Homeobook.com
73. • 9. Under MTP act pregnancy can be terminated at any stage on the
ground of
• A. Eugenic
• B. Therapeutic
• C. Social
• D. Humanitarian
• 10 Consent required for termination of pregnancy ,in an adult woman
is
• A. Husband and herself
• B. mother
• C. Mother
• D. Herself only Homeobook.com
