pregnancy abortion

7/28/2019 Pregnancy Abortion

1/45


2/45

PREGNANCYPREGNANCY


3/45

Learning Objectives:Learning Objectives:

Recognize medicolegalRecognize medicolegal

circumstances in which a womancircumstances in which a woman

is examined for pregnancy.is examined for pregnancy.

List important signs to diagnoseList important signs to diagnose

pregnancypregnancy

Recognize medicolegalRecognize medicolegal

circumstances in which a womancircumstances in which a woman

is examined for delivery.is examined for delivery.

Distinguish between recent andDistinguish between recent and

remote signs of delivery in theremote signs of delivery in the


4/45

Medicolegal ConditionsMedicolegal Conditions

DivorceDivorce more alimonymore alimony

InheritanceInheritance widowwidowDisputed PaternityDisputed Paternity

illegitimate pregillegitimate preg

RapeRape moremorecompensationcompensation

Capital sentence of deathCapital sentence of death


5/45

Diagnosis ofDiagnosis of

PregnancyPregnancy

Skin changesSkin changesBreastBreast

AbdomenAbdomen

PelvisPelvis

Pregnancy testsPregnancy tests

UltrasoundUltrasound

Fetal movementsFetal movements

Fetal heartFetal heart

soundssounds

Sure signsSure signsProbableProbable signssigns


6/45

A- HistoryA- History AmenorrheaAmenorrhea

Morning sicknessMorning sickness

Frequency of micturitionFrequency of micturition

ConstipationConstipationBreast enlargementBreast enlargement


7/45


8/45

- ys ca-signssigns

1-1- Skin changesSkin changes PigmentationPigmentation1-1- SkinSkin Stria GravidarumStria Gravidarum

Streching of skinStreching of skinStria rubraStria rubra :: pink Striapink Stria

albicans: whitealbicans: white

abd. Wall / thighs / buttocksabd. Wall / thighs / buttocks

2-2- FaceFace CloasmaCloasma Pregnancy mask Pregnancy mask

3-3- Abd. WallAbd. Wall Linea nigraLinea nigra UmbUmb


9/45


10/45

Linea nigraLinea nigra


11/45

2-Breast changes


12/45

2-Breast changes

2nd month (early)Enlarged, dilated veins

2nd month (late)Pigment. Nipples+ 1ry aerola

Enlarg.Montgomery Tubercle

3rd monthColostrum


13/45

Breast changesBreast changes


14/45

3-3- AbdomenAbdomen

Uterine enlargementUterine enlargement

First 3 monthsFirst 3 months pelvicpelvicorganorgan

After 12 weeksAfter 12 weeks abdominalabdominal


15/45

enlargementenlargement


16/45


17/45

4- Pelvis4- Pelvis

VaginalVaginal mucosamucosa deep violetdeep violet(chadwik sign)(chadwik sign)

vascularityvascularity

CervixCervix softsoft

(Hegars sign)(Hegars sign)

8th week8th week


18/45

Sure signs ofSure signs of

pregnancypregnancy Palpation of fetalPalpation of fetal partsparts 1616ththweekweek

Palpation of fetalPalpation of fetal movementmovement2020thth weekweek

Auscultation of fetalAuscultation of fetal heart sounheart soun

2222thth

weekweek Detetion of fetal skeleton by XDetetion of fetal skeleton by X

rayray

afterafter 1616thth weekweek


19/45

Fetal heart soundsFetal heart sounds

* Stethoscope Doppler* Stethoscope Dopplerflowmeterflowmeter

* 120 140 / min, regular* 120 140 / min, regular

** To differentiate betweenTo differentiate between

Uterine soufle:Uterine soufle:

is synchronous withis synchronous with

maternal pulsematernal pulse

Fetal heart sound:Fetal heart sound:

Conditions in whichCon t ons n w c


20/45

Conditions in whichCon t ons n w c

Fetal heart sounds areFetal heart sounds are

not heardnot heard Fatty abdominal wallFatty abdominal wall

Excess liquor amniExcess liquor amni Death in uteroDeath in utero

Before 18Before 18thth week durationweek duration


21/45

X rayX ray afterafter 1616ththweekweek

Diagnose pregnancyDiagnose pregnancy

Diagnose twin pregnancyDiagnose twin pregnancy Age of the fetusAge of the fetus

Congenital anomaliesCongenital anomalies

Intra uterine fetal deathIntra uterine fetal death


22/45

Ultra soundUltra sound

Diagnose*Pregnancy

*Diseases

Estimate *Duration*Age of fetus


23/45


These depend on presence ofHuman ChorionicGonadotrophin (HCG) in

maternal serum and urine.Human ChorionicHuman Chorionic

GonadotrophinGonadotrophin

*Is a glycoprotein hormone*Is a glycoprotein hormone

secreted by the developpingsecreted by the developping

placentaplacenta ((blastocyst)blastocyst) shortlyshortlyafter fertilizationafter fertilization


24/45


Urine Pregnancy testUrine Pregnancy test Latex testLatex test

Serum Preg testSerum Preg test RIARIA

ELISAELISA serum urineserum urine


25/45

Urine pregnancy tests

Rapid Simple based on antigen- antibody

reaction

Ex: GravindexGravindexLatexAgglutination test

REGNANCY TESTSREGNANCY TESTS


26/45

Urine + Grav antiserum +Grav antigenUrine + Grav antiserum +Grav antigen

No agglutinationNo agglutination

(positive)(positive)

AgglutinationAgglutination

(negative)(negative)

PregnantPregnant Not pregnantNot pregnant

REGNANCY TESTSREGNANCY TESTS


27/45


28/45


29/45


30/45

Conditions in which aConditions in which a isisexamined for deliveryexamined for delivery

InheritanceInheritance when a widow allegeswhen a widow allegesthat she gave birth to an infant.that she gave birth to an infant.

InfanticideInfanticide when a murdered newwhen a murdered newborn is found & a woman isborn is found & a woman issuspectedsuspected

Interchange of infantsInterchange of infants whenwhenbabies are mixed in hospitals.babies are mixed in hospitals.


31/45

DELIVERYDELIVERY

RECENTRECENT

Within 6 weeksWithin 6 weeks

REMOTEREMOTE

LaterLater

LivingLiving DeadDead

uterusuterus

Signs ofSigns of recentrecent delivery indelivery in


32/45

Signs ofSigns ofrecentrecent delivery indelivery in

livingliving Signs of exhaustion:Signs of exhaustion: pallor, weakpallor, weak

pulsepulse

Breasts:Breasts: enlargedenlarged

engorged : colostrum, milkengorged : colostrum, milk+ preg. signs+ preg. signs

Abdominal wall:Abdominal wall: laxlax

stria gravidarumstria gravidarum

linea nigralinea nigra

Genital signs:Genital signs:


33/45


34/45

Genital signsGenital signs

PERINEUMswallen

VAGINALochia

CERVICAL OSdilated

UTERUSinvolution


35/45

LochiaVaginal

discharge

LochiaVaginaldischarge

After 2 weeks:

disappears

After 2 weeks:

disappears

Another 5d pink

pale,yellow

Another 5d pink

pale,yellow

1st 5 daysbloody

1st 5 daysbloody


36/45

Cervical(Ext)o

sdilated

Cervical(Ext)o

sdilated

closed2 weeksafter

closed2 weeksafter

1 finger1 week

after

1 finger1 week

after2 fingersImmediatelyafter

2 fingersImmediatelyafter

Involution of theInvolution of the


37/45

Immediately2 fing aboveumbPM Wt = 1kg

Immediately

2 fing aboveumbPM Wt = 1kg

6 weeksNormal sizePM Wt = 100

g

6 weeksNormal sizePM Wt = 100

g

2 weeksPelvic organPM Wt = 370 g

2 weeksPelvic organ

PM Wt = 370 g

1 weekMid way bet Umb &SP

PM Wt = 500 g

1 weekMid waybet Umb &SP

PM Wt = 500 g

Involution of theInvolution of the

uterusuterus

Signs ofSigns of remoteremote delivery indelivery in


38/45

Signs ofSigns ofremoteremote delivery indelivery in

livingliving

Breasts:Breasts:

soft, pendulous, darksoft, pendulous, darkareola, enlargedareola, enlarged

nipplesnipples

Abdominal wall:Abdominal wall: lax, linea albicanslax, linea albicans

Labia:Labia: gapinggaping

Vagina:Vagina: dilated, patulousdilated, patulous

scars of old tearsscars of old tears

loss of vaginal rugaeloss of vaginal rugae


39/45

Cervix: Os uteriCervix: Os uteri ext cervext cervosos

NulliparaNullipara MultiparaMultipara

SmallSmall More patentMore patent

RoundRound Transverse: slit-Transverse: slit-

likelike

Smooth edgesSmooth edges

(non lacerated)(non lacerated)

Cicatricially-Cicatricially-notchednotched


40/45


41/45

Cervix: Os uteriCervix: Os uteri ext cervext cervosos


SmallSmall More patentMore patent

RoundRound Transverse:Transverse:

slit-likeslit-like

Smooth edgesSmooth edges

non lacerated)non lacerated)

Cicatricially-Cicatricially-notchednotched


42/45

Signs ofSigns ofremoteremote delivery indelivery in

deaddead


ShapeShape

uterusuterus

TriangularTriangular Round,Round, OO

large, heavylarge, heavy

CervixCervix Body of uterusBody of uterus

= cervix= cervix

Body of uterusBody of uterus

= double= double

cervixcervix

Internal osInternal os Not wellNot welldefineddefined

External osExternal os EnlargedEnlarged


43/45


44/45


45/45

Forensic Medicine & Toxicology

Alexandria Faculty of Medicine

pregnancy abortion

Documents