1. Pregnancy, Abortion & Delivery
DR: Asmaa Fady
Assistant professor of forensic medicine and Clinical Toxicology
اسم ورقم المقرر – Course Name and No.
6/5/2019

2. Learning Objectives By the end of the lecture, the student should:
understand Medico-legal aspects of pregnancy
Recognize Signs of pregnancy
Estimate Period of gestation and Estimate intrauterine age of new born.
Diagnose therapeutic & criminal abortions and method used to induce them.
Determine cause (s) of death: (complications) in criminal abortion.
Medicolegal importance and diagnosis of delivery.
اسم ورقم المقرر – Course Name and No.
6/5/2019

3. Medicolegal importance of pregnancy
1- In cases of rape. 2- When a woman is committed to death, she may allege pregnancy to delay execution. 3- In cases of divorce, the woman may allege pregnancy to obtain more alimony. 4- Inheritance, a widow may allege to be pregnant to inherit her husband 5- Married women living apart from their husbands when they are accused of having illegitimate pregnancy.
اسم ورقم المقرر – Course Name and No.
6/5/2019

4. Diagnosis of pregnancy:
Probable signs
Breast
Abdomen
Vulva- vagina- uterus
Immunological tests
Sure signs
ultrasonography
اسم ورقم المقرر – Course Name and No.
6/5/2019

5. Probable signs of pregnancy
1- Breast signs:
Enlarged breasts, dark areolas, Montgomery’s follicles, colostrum secretion.
2- Abdominal wall signs:
Enlargement of the abdomen with linea nigra in the middle line and striae gravidarum on the sides due to abdominal distension and tearing of the subcutaneous tissues.
3- Vulva signs:
becomes darker in color.
4- Vaginal signs:
the vagina becomes warm; its pink color turns dark violet with pulsation and excess of mucus. These changes are due to increased vascularity and venous stasis.
اسم ورقم المقرر – Course Name and No.
6/5/2019

6. Probable signs of pregnancy
5- Uterine signs:
Amenorrhea.
Size of the uterus: The uterus enlarges gradually.
Hegar’s sign: Softening of the lower uterine segment at about the 6th week of the pregnancy.
Goodell’s sign: Softening of the os from below upwards at the 2nd month due to increased vascularity
Braxton-Hicks sign: Intermittent uterine contractions and relaxation after the 4th month, they are palpable painless contractions that increase by uterine massage
اسم ورقم المقرر – Course Name and No.
6/5/2019

7. Probable signs of pregnancy: Immunological test:
It gives positive result 2 weeks after the first missed period.
Advantages of this test are:
The test is simple and rapid.
No special equipment is required.
The test is sensitive.
A false positive result may be (2 weeks after abortion or delivery).
positive result may be obtained in cases other than pregnancy e.g chorionic epithelioma.
اسم ورقم المقرر – Course Name and No.
6/5/2019

8. Sure signs of pregnancy
Ultra-sonography:
can detect fetal heart beat as early as the twelfth week. It can also indicate the size of the baby’s head, follow the baby’s growth and detect physical abnormalities
اسم ورقم المقرر – Course Name and No.
6/5/2019

9. Period of gestation
Average normal period is usually about 280 days or 40 weeks or 10 lunar months.
The law considers 6 months as the shortest period of pregnancy, and the 12 months as the longest maximal period.
اسم ورقم المقرر – Course Name and No.
6/5/2019

10. Abortion means Expulsion of uterine contents of the gravid uterus before full term
Diagnosis of abortion
mother
clinical
lab
Fetus
Fetal Age

11. Types of abortion induced Therapeutic Criminal spontaneous
To save the mother’s life:
Dilatation and curettage.
Suction aspiration.
Hystereotomy
reasons other than saving the mother’s life:
General violence.
Local violence.
Introduction of foreign bodies into vagina.
Introduction of plug containing irritant substance (arsenic) into vagina.
douche nozzle containing glycerin or iodine.
Abortifacient drugs.

12. Complications (cause of death) of abortion
Neurogenic shock.
Hemorrhage.
Thromboembolism.
Acute poisoning.
Sepsis
Precautions before performing therapeutic abortion:
1. The decision after consultation of two specialists and a written opinion about the necessity of induction of abortion should be taken.
2. A written consent must be taken from the woman and her husband.
3. It should be done in general or maternal hospital.
4. It must be done by a specialist.
5. The cases must be recorded in the hospital files.
6/5/2019

13. Intrauterine fetal age assessment
Length, weight & placenta
Sex and skin
Limbs, eyes, nail & hair
Ossific centers

14. 1st month
1 cm
Chorionic villi appears
Flat limb buds

15. 2nd month 4 cm Chorionic villi aggregated to one side
Distinguished limbs
Mouth & nose are separate
Ossific center, clavicle, lower jaw & vertebral bodies

16. 3rd month Ossific center: shafts of long bones 9 cm, 30 gm.
Well formed placenta
Fingers are well developed
Undifferentiated sex
Ossific center: shafts of long bones

17. 4th month 16 cm, 100 gm weight. 100 gm. Placenta Distinguishable sex
Hair and nails begin to appear

18. 5th month Ossific center: calcaneum, pubis & ischium
25 cm gm. Weight.
200 gm. placenta.
Lanugo hair
Ossific center: calcaneum, pubis & ischium

19. 6th month 30 cm, 650 gm. Weight., 300 gm. placenta
age of viability with medical assistance
30 cm, 650 gm. Weight.,
300 gm. placenta
Eye lashes and eye brows appear
Pupillary membrane disappeared
Red wrinkled skin
Testes at kidney level
3 Ossific center at
manubrium sterni

20. 7th month Ossific center: Talus 35 cm, 1.50- 1.75 kg, 400 gm. placenta
(age of viability with separate existence)
35 cm, kg, 400 gm. placenta
Still wrinkled
Testes reach internal inguinal ring
Ossific center: Talus

21. 8th month Ossific center: lower femur 40 cm, 2-2.5 kg, 500 gm placenta
Deposition of subcutaneous fat
Finger nails reach tips of fingers
Testes reach external inguinal ring
Ossific center: lower femur

22. Full term 45- 50 cm, 3- 3.5 kg weight and 600 gm. placenta
Umbilical cord length 50 cm
Testes in scrotum
Nails beyond tips of fingers
Head circumference 13 inches
3 cm scalp hair
Closed posterior fontanelle
Dark meconium
Ossific center: lower femur becomes 0.5 cm in diameter, ossific centers appear at cubiod, upper tibia, head of humorous

23. Ossific Centers??? 2: (clavicle, lower jaw, vertebrae (العظام الصغيرة
3: shaft of long bones العظام الطويلة
5: CIP
6: 3OC in manubrium sterni.
7: talus
8: LF
9: LF—0.5 cm, UT, HH, cuboid

24. Medico-legal importance of delivery:
1-Inheritance: when a widow alleges that she gave birth to an infant to inherit her husband. 2-Infanticide: when a murdered newly born infant is found, a woman suspected to be its mother is examined for signs of recent delivery. 3-Interchange of infants: when babies mixed in maternity hospitals, the different mothers are examined to determine the time passed since delivery and compare this with the infant’s age. 4-Disputed maternity.
اسم ورقم المقرر – Course Name and No.
6/5/2019

25. Signs of recent delivery
1-General signs of exhaustion: pallor, rapid weak pulse, etc. 2-Breasts: firm, full and contains colostrum. 3-Abdominal wall: lax, wrinkled and flabby with lineae nigra and stria gravidarum. 4-External genitals: perineal bruises, swelling or tears. 5-Lochia: Bloody for the first 5 days after delivery; Its color becomes pale yellow for another 5 days. It starts to disappear after 10 – 12 days in the normal puerperium. 6-External cervical os: It admits 2 fingers immediately after delivery, one finger a weeks after delivery and it closes two weeks after delivery 7-Uterus: estimation of the time passed since delivery depends on the fundal level of the uterus.
اسم ورقم المقرر – Course Name and No.
6/5/2019

26. Signs of remote delivery
Breasts: Soft, lax, pendulous with enlarged nipples and dark areolae.
Abdominal wall: Lax with lineae albicans.
Perineum: Scars of old perineal tears.
Vagina: Smooth mucosa, dilated and patulous. It has a partially open orifice (the vaginal mucosa is wrinkled in nullipara).
Cervix: External cervical os is transverse (slit-shaped) and may show old lacerations (the os is small, round, and non-lacerated in nullipara).
اسم ورقم المقرر – Course Name and No.
6/5/2019

27. اسم ورقم المقرر – Course Name and No.
6/5/2019