Journal of Labor and Childbirth
Extended Abstract
Updated easiest and accurate confirmation of early pregnancy during
Autopsy
Neelam Shrivastava1, D. K. Satpathi2 and Rini Khare3
1
Gandhi Medical College, India
2,3
Laxminayaran Medical College, India
One of the causes, for suicide in young and unmarried females is
relationship without wed log which turns into pregnancy and due
to failure of relationship to hide the shameful condition and guilt,
female commits suicide. Sometimes during autopsy, misdiagnosis of
pregnancy cause embar-rassing condition to parents and on the other
side, if finding is not detected which leads escape of accused from
punishment. Therefore, an accurate test of pregnancy is essential. In
prevailing prac-tice, size of uterus and corpus luteum is compared with
non pregnant uterus for diagnosis of preg-nancy but in early pregnancy,
size of uterus and corpus luteum does’t increase considerably and
findings usually missed. The proposed method is easy and confirmatory
test for the same which is done by examining urine or blood serum for
HCG (Human Chorionic Gonadotrophin) of deceased by HCG strip.
Sometimes test may come positive if deceased aborted within 15 days.
Method
Previously during autopsy in suspected case of pregnancy urine is
collected in a sterile container with the help of sterile catheter or
directly from bladder during autopsy if available then urine is tested
for pregnancy with the help of HCG strip or pregnancy card (which
are available cheaply). Pregnancy confirmation is given by getting 2
red transverse lines in HCG strip. Higher one of them is controlled
and lower one is test line. If 2 red transverse lines in HCG strip appear
then pregnancy test is positive. Single line is negative test of pregnancy
and if any line doesn’t appear then test is invalid. This is the test which
is routinely used in obstetrics department to confirm pregnancy. It
can also be confirmed by ultrasonography in which gestational sac is
examined in uterus if bladder is full. It comes positive in form of small
sac as early as 5 days overdue of menstrual period but now all these
cumbersome job is not required when autopsy surgeon is opening the
abdomen then direct-ly put hCG strip into the urine or blood vertically
and apply the test. In this way no apparatus and USG is required, only
International Conference on Natural products & traditional medicine
July 13-14, 2020 | Amsterdam, Netherlands
Open Access
thing required is hCG strip or card. In case of blood serum test require
little more time that is 5-10 minutes as serum is viscous and take time for
test. If pregnancy is positive then the product of conception along with
uterus should be preserved for DNA test to identify the alleged father of
conception, which prevent allegation of negligence on autopsy surgeon.
Precaution
This HCG stripe must be vertical and level of urine or blood should
reach unto the mark. .Container and catheter must be sterilized.
Uterus Uterus
Theory
After fertilization, which occurs 14 days before next menstrual period
and get implanted in uterus which occurs, after 5 days of fertilization
that is 21st day from 1st day of cycle. During develop-ment of fetus just
after implantation HCG is produced by the syncytiotrophoblast of the
placenta and secreted into blood of mother as well as fetus and can be
detected in the maternal serum or urine as early as 8 to 9 days following
ovulation. In the early pregnancy doubling time of HCG con-centration
in plasma is 1.4 to 2 days. Blood and urine value reach maximum level
reaching 100 IU to 200 IU per ml between 60 to 70 days of pregnancy.
The concentration falls slowly 10 to 20 IU per ml between 100 to 130
days and remains constant throughout pregnancy. HCG level in urine
and blood disappear from circulation within 2 weeks following delivery.
This is immunologic test of pregnancy. It is a simple rapid accurate test.
Principle of the test: The Visual hCG Test is a sandwich enzyme
immunoassay (8-9) for the deter-mination of human chorionic
Volume 1 • Issue 4 • 2018
Journal of Labor and Childbirth
Extended Abstract Open Access

gonadotropin in urine or serum. The method employs two monoclonal antibodies to selectively identify hCG in urine/serum with a high degree of
sensitivity. In the strip, hCG react with antibody present in strip and indicator and shows two lines as a positive test.

When urine of non-pregnant is tested then there is no HCG to neutralize. Different indicated strip is available for instance HCG coated latex particle
for essay test. This hormone increases every day and reaches maximum and can be test in 20 weeks of pregnancy then it declines. Hormone secreted
by syncytiotrophoblast comes in blood and urine, which can be tested by proposed method.

Observation

Routinely it is in practice to confirm pregnancy in hospitals by HCG strip. Hundreds of cases have been confirmed by this method yearly. Test
is positive even after 7 days or more after collecting the urine as in the case of Smt. X1 was collected 7 days before and tested which comes
positive there-fore if we get urine in decomposed body then pregnancy can be tested by proposed method. (Note-Names are decoded)

Post mortem POLICE NAME OF

DATE HOURS AGE RESULT OF TEST
NUMBER STATION DECEASED
22-06-2014 1264/14 X1 Y1 36 HRS 21 YRS U P T negative
12-08-2014 1636/14 X2 Y2 24 hrs 22 YRS UP T NEGATIVE
22-06-2014 1270/14 X3 Y3 24 HRS 25 yrs U P T POSITIVE
22-06-2014 1267/14 X4 Y4 24 hrs 16 YRS u p t POSITIVE
22-06-2014 1271/14 X5 Y5 24 hrs 22 yrs u p t negative
26-08-2015 1738/15 X6 Y6 24 HRS 26 YRS u p t positive
05-09-2015 1798/15 X7 Y7 24 hrs 20 YRS u p t negative
16-09-2016 1872/16 X8 Y8 24 hrs 25 yrs U p t POSITIVE
16-09-2016 1876/16 X9 Y9 24 hrs 16 yrs u p t negative
22-09-17 1910/17 X10 Y10 24 hrs 17 YRS u p t negative
22-09-2017 1913/17 X11 Y11 24 HRS 26 YRS u p t negative
22-09-2018 1915/18 X12 Y12 24 HRS 10 YRS u p t negative
23-09-2018 1924/18 X13 Y13 24 HRS 25 YRS u p t POSITIVE
26-08-2019 1738/19 X 14 Y14 24 HRS 26 YRS u p t positive
05-09-2019 1798/19 X15 Y15 24 hrs 20 YRS u p t negative

International Conference on Natural products & traditional medicine Volume 1 • Issue 4 • 2018
July 13-14, 2020 | Amsterdam, Netherlands
Journal of Labor and Childbirth
Extended Abstract
Other Signs of Pregnancy
Nipple and Areola become more pigmented and montgomery’s tubercles
are prominent. Thick yel-low secretion (colostrum) sometimes can be
expressed by squeezing breast.
False Positive
False positive test results may occur for several reasons, including
errors of test application, use of drugs containing the hCG molecule,
and non-pregnant production of the hCG molecule. Urine tests
can be falsely positive in those that are taking the medications:
chlorpromazine, phenothiazines and methadone among others. False
positives may also appear on tests used past their expiration date.
A woman who has been given an hCG injection as part of infertility
treatment will test positive on pregnancy tests that assay hCG, regardless
of her actual pregnancy status.
However, some infertility drugs (e.g., clomid) do not contain the hCG
hormone.
Some diseases of the liver, cancers, and other medical conditions may
produce elevated hCG and thus cause a false positive pregnancy test.
These include choriocarcinoma and other germ cell tu-mors, IgA
deficiencies, heterophile antibodies, enterocystoplasties, gestational
trophoblastic diseas-es (GTD), and gestational trophoblastic neoplasms.
These conditions should be ruled out before confirmation which
can be tested by gestational sac in uterus with the help of ultrasound
and examining organ during autopsy and past history. Positive
cases by urine/blood serum HCG examination can further be
confirmed under ultrasonography if bladder is full of urine.
Result
During autopsy 200 cases were examined during 2014 to 2019 in
Medico legal Institute Bhopal Madhya Pradesh, India in which 30
cases were control married women in which pregnancy was known
and uterus was considerably enlarge and test was positive with
HCG strip. Ten cases were found positive in unmarried women and
uterus was preserved along with product of conception for DNA
test. Rest of the cases examined was negative with this HCG test.
Conclusion
Proposed method is easy, 100% accurate confirmatory test which can
also be tested by gestational sac in ultrasound. The method proposed
as above will give a scientific conclusive and quick result by which we
can extract a scientific conclusive opinion immediately. Even sometimes
autopsy test comes positive if deceased aborted within 15 days.
Suggestion
Proposed method should be used for confirming early
pregnancy during autopsy and if found posi-tive, then
product of conception should be preserved for DNA test.
Conflict of Interest
There is no conflict of interest and this study will benefit public and
judiciary. No ethical clearance is needed.
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July 13-14, 2020 | Amsterdam, Netherlands
Open Access
Funding
Outsource funding is not required.
Acknowledgement
I am thankful to my family members, medic legal staff and OMICS group.
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