Virginity ,
Pregnancy
&
Delivery
Virginity
Also known as Virgo Intacta.
Definition: Virgin is a female who has not
experienced sexual intercourse.
Signs of virginity :
1. Extra genital signs (in breast)
GENITALS
LABIA MAJORA
LABIA MINORA
VAGINAL WALL
VESTIBULE
POSTERIOR COMMISURE
FORCHETTE
FOSSA NAVICULARIS
HYMEN
TYPES OF HYMEN
1) SEMILUNAR
2) ANNULAR
3) INFANTILE
4) CRIBRIFORM
5) VERTICAL
6) SEPTATE
7) IMPERFORATE
8) CARUNCULAE MYRTIFORMIS
features virginity Defloration
[Link] difference No experience of sexual Have experience of sexual
intercourse intercourse
[Link] Intact Torn except in false virgin
[Link] Does not admit more than tip May admit 2 fingers , it is
of little finger, it is painful painless
[Link]. Marked rugosity on wall Rugosity diminishes
Full length of a finger cannot Full length of finger can be
be admitted admitted
[Link] navicularis Less conspicuous More conspicuous after
sexual intercourse
[Link] Intact Healed tear
[Link] minora Smaller pinkish, covered with enlarged, pigmented, not
majora covered
[Link] majora Thick, fleshy, both majora are Less fleshy, not in full
in close apposition apposition
[Link] Smaller, firm, pinkish smaller Larger, flabby, pendulous,
areola, and small nipple wider areola, large and
Other conditions which may affect signs of virginity
Trauma or Accident
Surgical operation or Gynaecological examination
Sanitary tampons
Foreign body sola pith (APTAE VARIS)
Scratching due to irritation from uncleaniness
Masturbation
Ulceration d/t diphtheria , fungus, etc.
False Virgins
Hymen is intact but the woman has had
sexual intercourse.
Point of True virgin False virgin
difference
[Link] The woman has no Has experience of sexual
difference experience of sexual intercourse
intercourse
[Link] Not ruptured. It is thin flap of Not ruptured. It is thick , fleshy or
tissue of regular shape and fibrous elastic with folds
appearance
[Link] Does not admit more than May admit 2 fingers, it is not
the tip of little finger, it is painful
painful
[Link]. Marked rugosity on wall Rugosity diminishes
Full length of a finger cannot Full length of finger can be
be admitted admitted
[Link] Less conspicuous More conspicuous
navicularis after sexual
intercourse
[Link] Intact Healed tear
[Link] Smaller pinkish, enlarged,
minora covered with majora pigmented, not
covered
[Link] Thick, fleshy, both Less fleshy, not in
majora majora are in close full apposition
apposition
[Link] Smaller, firm, pinkish Larger, flabby,
smaller areola and pendulous, wider
Medico legal importance of virginity
In Civil cases:
[Link] of marriage
[Link]
[Link] of character
[Link]
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:
[Link] signs
[Link] signs
[Link] or conclusive signs
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
Striae gravidarum
Sympathetic change -increased salivation
-PICA (perverted appetite)
-irritable temper.
Changes in Breasts
:
Breasts enlarged & nodular(2
nd
month)
Surface veins prominent
Areola enlarged, pigmented with
prominent
nd
Montgomerys tubercles
(2 month).
Nipples enlarged
Colostrum (3rd month).
Changes in Vagina :
Jackquemiers sign or Chadwicks
sign: violet or bluish discolouration
th
of
vaginal mucosa (after 4 week).
PROBABLE SIGNS OF PREGNANCY
Enlargement of abdomen
Height of uterus.
Palmers sign- regular
rhythmic contractions
of uterus at 4th to 8th week.
Fundal height
Hegars sign
-Bimanual examination
at 6th - 8th week
Goodells sign -softening of cervix
at 4th month
Osianders sign increase
pulsation felt through lateral fornices at
8th week
Piskaceks sign asymmetrical
enlargement of uterus if there is lateral
implantation.
Goodells sign
PROBABLE SIGNS OF PREGNANCY
Braxton-hicks sign -After 15-16
weeks of pregnancy
Ballottement: internal and external
(during 4th and 5th month)
External ballottement
Uterine souffl at end of 4th month
Biological tests : Presence of
gonadotropins in pregnant womans
blood and their excretion in urine
Internal ballottement
Immunological tests :
a)Inhibition (Indirect) Latex slide test
b)Direct Latex slide test
Haemagglutination inhibition test.
RIA and ELISA
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 mothers blood.
Signs of pregnancy in Dead
Products of conception
Enlarged Uterus & other uterine change.
Corpus luteum
Medicolegal importance of pregnancy
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.
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.
Pseudocyesis / False Pregnancy / Spurious
Pregnancy / Phantom Pregnancy.
Superfoetation
Superfecundation
Foetus Papyraceous / Foetus Compressus
DELIVERY
Definition :
Expulsion of products of
conception from within the
uterus at term.
Signs of
Recent delivery in Living :
General appearances of indisposition :
Woman looks pale, exhausted and ill.
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.
Abdomen:
Striae gravidarum (pink)
Lineae albicantes (silvery white)
Linea nigra (black)
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)
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
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
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
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
Different immediately After3days After1 week after2weeks after3weeks
measures
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
Dia of the site 10cm 7cm 4cm 2.5cm 1.5cm
of placental
attachment
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 between 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
Abortion
Definition:
Termination of pregnancy due to premature
expulsion of product of conception at any
time from the uterus.
TYPES OF ABORTION
[Link]
A)NATURAL
B)ACCIDENTAL
2. INDUCED
A)LEGAL
B)CRIMINAL
Medical termination of pregnancy
(MTP)act 1971
Came into force in 1972
Amendments in 1975, 2002 and 2003
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
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.)
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 surgency 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.
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
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
Complications
Immediate:
Haemorrhagic shock
Perforation of uterus, perineum or intestine
Laceration of cervix or vagina
Incomplete abortion
Embolism
Thrombophlebitis
Delayed:
PID
Menstrual irregularities
Sterility
Endometritis
Cervicitis
Vaginitis
Criminal Abortion :
Abortion done against the
provision of MTP act.
Legal aspects of criminal abortion:
Sec.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
Sec 313 IPC: if abortion done without her consent
Punishment upto 10 years and fine
Sec 314 IPC:if woman dies by this act
Punishment upto 10 years and fine
Sec 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.
Sec 316 IPC : any act which cause death of
quick unborn child amount to culpable
homicide
Imprisionment upto 10 years and fine
Methods adopted for criminal abortion
I. Abortifacient drugs
Drugs acting directly on the Uterus
Irritants of Genito-Urinary tract
Irritants of GI tract
Drugs having poisonous effect on Body
II. General violence
III. Local violence
I. Abortifacient drugs:
1. Drugs acting directly on the Uterus :
[Link] : (Increase Uterine Contraction)
Eg. Ergot
Hydrastis canadensis
Quinine
Lead ( lead oleate or lead plaster)
Decoction of cotton root bark
Nitrobenzol
Picrotoxin and strychnine
B. EMMENAGOGUES : (Increase Menstrual
Flow)
Eg. :- savin
borex
apiol
rue
laburum
oestrogen
sanguinarin
caulophyllin
hallebore
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
[Link] 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
II. General violence:
Intensional
1. Severe pressure on abdomen: by blow, kick,
jumping or
kneeling
[Link] exercise: horse riding, cycling, jumping
from height, severe jolting, carrying or lifting
heavy weights
[Link]
4. Very hot and cold bath alternately
III. Local violence :
Syringing: by Higginsons 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
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
C. Remote causes :
Renal failure
Meningitis
Endocarditis
Pneumonitis
Hepatitis
D. Toxic effects of Abortifacient drugs:
- causing early or delayed deaths
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 womans
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.
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
Examination of Dead body
Sudden death of a woman of child bearing age
should give rise the suspicion of criminal abortion
if:
[Link] deceased was pregnant and deeply cyanosed
[Link] to procure the abortion or
abortifacient drugs are found at scene of death.
[Link] appears to be disturbed after
death.
[Link] ,soapy material or blood coming out of
vagina.
Following points should be proved to convict
the abortionist:
[Link] dead woman was pregnant
[Link] accused was responsible for the act which
resulted in the interruption of pregnancy
[Link] accused acted for purpose of procuring
illegal abortion
[Link] occurred as a result of attempt to
interrupt the pregnancy
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.
Medical evidence of abortion
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.
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
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