Title: Virginity , Pregnancy
1 - Virginity , Pregnancy
-
- Delivery
2 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)
- 2. Genital signs
3GENITALS
- LABIA MAJORA
- LABIA MINORA
- VAGINAL WALL
- VESTIBULE
- POSTERIOR COMMISURE
- FORCHETTE
- FOSSA NAVICULARIS
- HYMEN
4 TYPES OF HYMEN
- SEMILUNAR
- ANNULAR
- INFANTILE
- CRIBRIFORM
- VERTICAL
- SEPTATE
- IMPERFORATE
- CARUNCULAE MYRTIFORMIS
5features 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
6- 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.
7 False Virgins
- Hymen is intact but the woman has had sexual
intercourse.
8Point 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
95.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
10Medico legal importance of virginity
- In Civil cases
- Nullity of marriage
- Divorce
- Defamation of character
- Rape
11 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
- Presumptive signs
- Probable signs
- Positive or conclusive signs
12Presumptive 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.
13- Changes in Breasts
- Breasts enlarged nodular(2nd month)
- Surface veins prominent
- Areola enlarged, pigmented with prominent
Montgomerys tubercles (2nd month). - Nipples enlarged
- Colostrum (3rd month).
-
- Changes in Vagina
- Jackquemiers sign or Chadwicks sign violet
or bluish discolouration of vaginal mucosa
(after 4th week).
14PROBABLE SIGNS OF PREGNANCY
- Enlargement of abdomen
- Height of uterus.
- Palmers sign- regular rhythmic
contractions of uterus at 4th to 8th week.
15 Fundal height
16- Hegars sign
- -Bimanual examination
- at 6th - 8th week
17- 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
18 PROBABLE SIGNS OF PREGNANCY
- Braxton-hicks 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 womans blood and their excretion in
urine
External ballottement
Internal ballottement
19- Immunological tests
- Inhibition (Indirect) Latex slide test
- Direct Latex slide test
- Haemagglutination inhibition test.
-
- RIA and ELISA
20POSITIVE 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.
21 Signs of pregnancy in Dead
- Products of conception
- Enlarged Uterus other uterine change.
- Corpus luteum
22Medicolegal 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.
23- 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.
24- Pseudocyesis / False Pregnancy / Spurious
Pregnancy / Phantom Pregnancy. - Superfoetation
- Superfecundation
- Foetus Papyraceous / Foetus Compressus
25 26 QUESTIONS
- 1. Uterine soufflé may be heard by auscultation
at the end of- - 10wks
- 12wks
- 14wks
- 16wks
- 2. Foetal parts can be detected by X ray usually
by- - 8wks
- 12wks
- 14wks
- 16wks
27- 3. A pregnant woman sentenced to death cannot be
hanged till- - Delivery
- Delivery and attainment of 6 months of age by new
born - Delivery and one year after that
- None of the above
- 4. Pseudocyesis is found in-
- Young married woman
- Aged unmarried girl
- Menopausal ladies
- Adolescent girl
28- 5. Impregnation of an ovum discharged from a
previous ovulation has been developed is called- - Fecundation
- Superfecundation
- Super foetation
- None of the above
- 6. Which of the following statements is true for
virgo intacta- - Breasts are large and nodular
- Labia majora not apposed with each other
- Fossa navicularis is disappeared
- Labia minora completely covered by labia majora
29 DELIVERY
- Definition
- Expulsion of products of conception from within
the uterus at term.
30Signs 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.
31- 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)
32Signs ofRecent 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
33Signs 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
34Sign ofRecent 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
35Signs 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
-
36Different measures immediately After3days After1 week after2weeks after3weeks
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 of placental attachment 10cm 7cm 4cm 2.5cm 1.5cm
37Point 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 21
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
38 Abortion
- Definition
- Termination of pregnancy due to premature
expulsion of product of conception at any time
from the uterus.
39TYPES OF ABORTION
- SPONTANEOUS
- NATURAL
- ACCIDENTAL
- 2. INDUCED
- LEGAL
- CRIMINAL
-
40Medical 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
41Duration 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.)
42 Places for MTP
- Any government or semi-government hospital
- Any non-government hospital approved by
government or CMO or district health officer
43Qualification 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.
44 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
45 Common methods of MTP
- Medical mifepristone and misoprostol
- Dilatation and curettage (DC)
- Vacuum aspiration technique or surgical abortion
- Intra-embryonic instillation of PG
- Extra-embryonic instillation of hypertonic saline
- Surgical
46 Complications
- Immediate
- Haemorrhagic shock
- Perforation of uterus, perineum or intestine
- Laceration of cervix or vagina
- Incomplete abortion
- Embolism
- Thrombophlebitis
47- Delayed
- PID
- Menstrual irregularities
- Sterility
- Endometritis
- Cervicitis
- Vaginitis
48 Criminal Abortion
- Abortion done against the provision of MTP act.
49Legal 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 IPCif woman dies by this act
- Punishment upto 10 years and fine
50- 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
51Methods 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
52I. Abortifacient drugs
- 1. Drugs acting directly on the Uterus
- ECBOLICS (Increase Uterine Contraction)
- Eg. Ergot
- Hydrastis canadensis
- Quinine
- Lead ( lead oleate or lead plaster)
- Decoction of cotton root bark
- Nitrobenzol
- Picrotoxin and strychnine
53- B. EMMENAGOGUES (Increase Menstrual Flow)
- Eg. - savin
- borex
- apiol
- rue
- laburum
- oestrogen
- sanguinarin
- caulophyllin
- hallebore
542. Irritants of Genito-urinary tract
- Oil of pennyroyal
- Oil of tansy
- Oil of turpentine
- Cantharides
- KMnO4
553. Irritants of GI tract
- Saline cathartics eg. - MgSO4
- Purgatives eg. - aloes
- - calomel
- -
castor oil - -
croton oil - Emetic eg. tartar
564.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
57II. General violence
- Intensional
- Severe pressure on abdomen by blow, kick,
jumping or kneeling - Violent exercise horse riding, cycling, jumping
from height, severe jolting, carrying or lifting
heavy weights - Cupping
- 4. Very hot and cold bath alternately
58III. 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
59CAUSE OF DEATH AND DANGERS OF CRIMINAL ABORTION
- A. Cause of Rapid death
- Haemorrhage
- Perforation
- Vagal shock
- Fat embolism
- Air embolism
60B. Cause of delayed death
- Peritonitis
- Local infection getting complicated
- Tetanus
- Septicaemia
- Pyaemia
61C. Remote causes
- Renal failure
- Meningitis
- Endocarditis
- Pneumonitis
- Hepatitis
- D. Toxic effects of Abortifacient drugs
- - causing early or delayed deaths
62Duties 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.
63Examination 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
64 Examination of Dead body
- Sudden death of a woman of child bearing age
should give rise the suspicion of criminal
abortion if - The deceased was pregnant and deeply cyanosed
- Instrument to procure the abortion or
abortifacient drugs are found at scene of death. - Underclothing appears to be disturbed after
death. - Fluid ,soapy material or blood coming out of
vagina.
65- Following points should be proved to convict the
abortionist - The dead woman was pregnant
- The accused was responsible for the act which
resulted in the interruption of pregnancy - The accused acted for purpose of procuring
illegal abortion - Death occurred as a result of attempt to
interrupt the pregnancy
66Medical 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.
67 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.
68 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
69Questions
- 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
70Questions(contd)
- 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
71Questions (contd)
- 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
72Questions (contd)
- 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
73Questions (contd)
- 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