1. LECURER , FORENSIC MEDICINE,MCST
Abortion
Medicolegal view
Dr. Aly Samy Somaa
MB.ChB,Msc,ABFMD,MD
LECURER , FORENSIC MEDICINE,MCST
9/21/2018
Dr. Aly Samy 2015
Dr. Aly Samy ,PSMCHS

2. Objectives: To know the following
definition and classification of Abortion
the type of Abortion of AND medico-legal importance
factors affecting the wound
estimate the date of Abortion
different types of Abortion
complications of Abortion
9/21/2018
Dr. Aly Samy 2015

3. Definition of Abortion
Abortion is premature expulsion of products of conception from womb, either spontaneous or induced
9/21/2018
Dr. Aly Samy 2015

4. Medicolegal meaning
> Abortion means expulsion of products of conception in the first trimester of pregnancy.
> Miscarriage means expulsion of product of conception in second trimester.
> Premature delivery refers to expulsion of fetus after 7 months of pregnancy but before term.
Legally there is no difference between Abortion
9/21/2018
Dr. Aly Samy 2015

5. Classification of Abortion
Abortion is classified into following two major groups
1. Natural (spontaneous)
2. Artificial (Induced)
Induced abortion may be:
Justifiable abortion (therapeutic)
Criminal abortion
Unsafe Abortion and Fabricated Abortion
9/21/2018
Dr. Aly Samy 2015

6. CRIMINAL ABORTION.
Any abortion, which does not come under the rules of the Medical Termination of pregnancy (MTp) , is considered as criminal abortion.
Thus, in other words, it is an unlawful expulsion of product of conception at any stage of gestation by any unqualified person or a qualified doctor and is punishable under the law.
9/21/2018
Dr. Aly Samy 2015

7. MOTIVES FOR CRIMINAL ABORTION
Unmarried girls
A poor family
Female feticide
9/21/2018
Dr. Aly Samy 2015

8. METHODS TO INDUCE CRIMINAL ABORTION ARE :
Use of abortifacient drugs
Application of mechanical violence .
9/21/2018
Dr. Aly Samy 2015

9. I. Use of abortifacient drugs
Ecbolics: These drugs initiate uterine contraction and causes abortion. Examples are;
Ergot preparations Synthetic estrogen and Quinine
2. Emmenagogues: These drugs promote uterine congestion and induce bleeding
thus expelling product of conception. Examples are:
Borax * Oil of savin
3. Irritants: These are of following types
Genitourinary tract irritants - these agents produce inflammation of genitourinary tract and reflexly irritate the uterus and induce uterine contraction example Cantharides, turpentine oil.
Gastrointestinal tract irritants these agents cause reflex contraction of uterine muscles - example; croton oil etc.
Systemic poisons - For example: arsenic, mercury, fruit of papaya etc.
Abortion pills etc.
9/21/2018
Dr. Aly Samy 2015

10. II. VIOLENCE
General violence - may act directly or indirectly on uterus.
Severe form of exercise -Application of blows or kicks over abdomen or pressure on abdomen
Cupping: a flame light is placed on abdomen and a metal mug is placed over the flaming light.
2. Local method
A. By unskilled or semiskilled person.
Rupture of membrane by abortion stick, metal rod, knitting needle, hair Pin etc.
Application of abortion Paste
Use of root of plant as Abortifacient agent
Syringing: either for aspiration of fluid or forced filling of uterine cavity with fluid and air.
B) By skilled Person
Low rupture of membrane
Vacuum aspiration
Dilatation and evacuation
Use of Prostaglandins.
9/21/2018
Dr. Aly Samy 2015

11. COMPLICATION OF CRIMINAL ABORTION
Immediate
l. Hemorrhage
2. Perforation of uterus
3. Shock due to vagal inhibition resulting from instrumentation
4. Fat embolism
5. Air embolism
6. Amniotic fluid embolism
7. Incomplete abortion
8. Local injury
Delayed
l. Septicemia
2. Tetanus
3. Endometritis
4. Renal failure
5. Peritonitis
6. Sterility
7. Recurrent abortion
9/21/2018
Dr. Aly Samy 2015

12. Causes of Death in Criminal Abortion
l. Vaso-vagal shock
2. Hemorrhagic shock
3. Perforation of uterus
4. Septicemia
5. Embolism
6. Disseminated intravascular coagulation
9/21/2018
Dr. Aly Samy 2015

13. DUTIES OF REGISTERED MEDICAL PRACTITIONER IN CRIMINAL ABORTION
1. Doctor should record history of the incident, the method
adopted to procure abortion.
2. If death is imminent, doctor must arrange for dying declaration.
3. If female dies, he should report matter to the police
Medical Evidence of Abortion
1. Examination of female.
2. Examination of aborted material.
9/21/2018
Dr. Aly Samy 2015

14. EXAMINATION OF FEMALE (DURING LIFE)
1. General: Female will have exhaust look, increase temperature, increase pulse.
2. Breasts; Are heavy, enlarged, areola and nipples are pigmented, colostrum/milk may ooze on squeezing the breasts .
3. Abdomen: Is lax and wrinkled. Striae may be present along with linea nigra. Involuting uterus may be palpable.
4. Perineum: Laceration or bruises may be noted, inflammation is evident
5. Labia: majora and minora will be inflamed and bruised
6. Vagina: Tags of membrane, partial aborted material, blood, foreign body, abortion stick etc. may be found. The vaginal wall is contused, abraded or lacerated. The wall is lax, dilated.
7. Cervix: The external os would be patulous, ulceration or erosions may be present. Cervical canal may be dilated with abrasions or lacerations.
8. Uterus: May be enlarged on bimanual examination or may be showing signs of involution.
9. Swab from cervical canal will reveal chemical used for procuring abortion and can be used for bacteriological examination.
10. Urine examination: hCG may be detected up to 7 days.
9/21/2018
Dr. Aly Samy 2015

15. EXAMINATION OF FEMALE (AFTER DEATH)
Clothes: Undergarments may show blood, clots, pieces of product of conception, stains of chemicals used etc.
Uterus: Enlarged, cavity may show presence of partially separated product of conception, foreign body, blood clots, presence of any paste or chemical, evidence of injury or perforation etc.
Evidence of infection .
Ovaries: Presence of corpus luteum
EXAMINATION OF ABORTED MATERIAL
''Police may request medical examiner to examine a substance alleged to have been expelled from uterus as product of conception.
9/21/2018
Dr. Aly Samy 2015

16. Medicolegal importance of placenta
1. At term placenta is about 500 gm in weight.
2. Period of gestation can be estimated.
3. Some poisons may be detected in placenta.
4. Retained placenta or pieces of placenta may be found in criminal abortion and may be the cause of death due to hemorrhage.
5. Disease can be ascertained.
6. Transfer of poisons, drugs, bacteria or antibodies across placenta (placental barrier) may result in fetal death, fetal
infections or fetal malformations.
9/21/2018
Dr. Aly Samy 2015

17. Medical Termination of Pregnancy INDICATIONS
1. Therapeutic
2. Eugenic
3. Humanitarian
When the pregnancy is caused by Rape
4. Social
When pregnancy has resulted due to failure of contraceptive method adopted by married woman or her husband for the purpose of limiting the number of children, then such pregnancy can be terminated on social grounds.
Important:
In an emergency, a Registered Medical Practitioner can terminate pregnancy at any place, irrespective of duration of pregnancy.
9/21/2018
Dr. Aly Samy 2015

18. Rules for Doing MTP
1. Only qualified Registered Medical Practitioner, who has assisted in at least 25 cases of MTP in a recognized hospital
A Doctor with MD in Gynecology and Obstetrics.
2. Place - MTP can be Carried Out at A hospital maintained or established by government . Non-government hospital approved by government
3. Consent
A female above 18 years of age with sound mind can give consent for MTP. In minor females (i.e. age less than 18 years) or mentally ill , consent of parents or guardian is necessary.
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Dr. Aly Samy 2015

19. Rules for Doing MTP cont.
4. Duration of Pregnancy
. When duration of pregnancy is below 12 weeks of gestation, one Registered Medical Practitioner (RMP) can terminate the pregnancy.
. When duration of pregnancy is above 12 weeks but less that 20 weeks (i.e weeks), then two RMP are required to terminate the pregnancy.
5. Documentation and Record
Date generated by mentioning the year against the serial number
. The admission register is a secret document.
It should be maintained for at least 5 years from the last entry.
9/21/2018
Dr. Aly Samy 2015

20. Methods of Inducing MTP
Up to 12 Weeks
l. Manual vacuum aspiration
2. Suction evacuation and/or curettage
3. Dilatation and curettage
4. Mifepristone
5. Methotrexate and misoprostol
Between 13 to 20 Weeks
1. Dilatation and evacuation
2. Oxytocin infusion
3. Induction by prostaglandins E, (misoprostol) (Used as intravaginally, intramuscularly or intra amniotically)
4. Hysterotomy - less common method
9/21/2018
Dr. Aly Samy 2015

21. Complications of MTP Immediate 1. Hemorhage and shock
2. Perforation of uterus, intestine
3. Laceration of cervix or vagina
4. Incomplete abortion
5. Endometritis
6. Embolism
Delayed
l. Menstrual disturbances
2. Sterility
3. Pelvic inflammatory disease
4. Recurrent abortion or premature labor
5. Psychological sequelae
9/21/2018
Dr. Aly Samy 2015

22. MEDICOLEGAL LMPORTANCE OF ABORTION
1. When abortion is induced without proper indication or in contravention to the provisions of MTP Act, it is considered as criminal abortion and is punishable by law.
When Doctor violates the provisions of MTP Act, he is liable to be punished by the law and similarly his act amount to misconduct in professional sense.
To bring a false charge of assault against any person, a female may plead that she has been assaulted and due to assault, abortion was induced.
A female may be falsely charged or implicated for inducing criminal abortion
9/21/2018
Dr. Aly Samy 2015