Medicolegal view

Dr. Aly Samy Somaa

MB.ChB,Msc,ABFMD,MD

LECURER , FORENSIC MEDICINE,MCST

07/26/2022 Dr. Aly Samy 2015 1

Objectives:
To know the following

definition and classification of Abortion

the type of Abortion of AND medico-legal

importance
factors affecting the wound
estimate the date of Abortion

different types of Abortion

complications of Abortion
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 Definition of Abortion

Abortion is premature expulsion of

products of conception from womb,
either spontaneous or induced

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 Medicolegal meaning
• > Abortion means expulsion of products of
conception in the first trimester of pregnancy.
• > Miscarriage means expulsion of product of
conception in second trimester.
• > Premature delivery refers to expulsion of
fetus after 7 months of pregnancy but before
term.
• Legally there is no difference between
Abortion
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 Classification of Abortion
classified into following two major groups

ural (spontaneous) .1

Artificial (Induced) .2

:Induced abortion may be

Justifiable abortion (therapeutic) •
Criminal abortion •

Unsafe Abortion and Fabricated Abortion

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 CRIMINAL ABORTION.

Any abortion, which does not come under the rules of

the Medical Termination of pregnancy (MTp) , is
.considered as criminal abortion

Thus, in other words, it is an unlawful expulsion of

product of conception at any stage of gestation by any
unqualified person or a qualified doctor and is
.punishable under the law

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 MOTIVES FOR CRIMINAL ABORTION
Unmarried
girls
A poor family

Female feticide

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 METHODS TO INDUCE CRIMINAL
ABORTION ARE :

Use of abortifacient drugs

Application of
mechanical
. violence
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 I. Use of abortifacient drugs
• Ecbolics: These drugs initiate uterine contraction and causes abortion. Examples
are;
• Ergot preparations Synthetic estrogen and Quinine
• 2. Emmenagogues: These drugs promote uterine congestion and induce bleeding
• thus expelling product of conception. Examples are:
 Borax * Oil of savin
• 3. Irritants: These are of following types
• Genitourinary tract irritants - these agents produce inflammation of genitourinary
tract and reflexly irritate the uterus and induce uterine contraction example
Cantharides, turpentine oil.
• Gastrointestinal tract irritants these agents cause reflex contraction of uterine
muscles - example; croton oil etc.
• Systemic poisons - For example: arsenic, mercury, fruit of papaya etc.
• Abortion pills etc.

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 II. VIOLENCE
• General violence - may act directly or indirectly on uterus.
• Severe form of exercise -Application of blows or kicks over abdomen or pressure
on abdomen
• Cupping: a flame light is placed on abdomen and a metal mug is placed over the
flaming light.
• 2. Local method
A. By unskilled or semiskilled person.
• Rupture of membrane by abortion stick, metal rod, knitting needle, hair Pin etc.
– Application of abortion Paste
– Use of root of plant as Abortifacient agent
– Syringing: either for aspiration of fluid or forced filling of uterine cavity with
fluid and air.
B) By skilled Person
– Low rupture of membrane
– Vacuum aspiration
– Dilatation and evacuation
– Use of Prostaglandins.
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 COMPLICATION OF CRIMINAL ABORTION

• Immediate • Delayed
• l. Hemorrhage • l. Septicemia
• 2. Perforation of uterus • 2. Tetanus
• 3. Shock due to vagal • 3. Endometritis
inhibition resulting from
instrumentation • 4. Renal failure
• 4. Fat embolism • 5. Peritonitis
• 5. Air embolism • 6. Sterility
• 6. Amniotic fluid embolism • 7. Recurrent abortion
• 7. Incomplete abortion
• 8. Local injury
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 Causes of Death in Criminal Abortion

l. Vaso-vagal shock
Hemorrhagic shock .2
Perforation of uterus .3
Septicemia .4
Embolism .5
Disseminated intravascular .6
coagulation
 

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 DUTIES OF REGISTERED MEDICAL
PRACTITIONER IN CRIMINAL ABORTION
Doctor should record history of the incident, .1
the method
.adopted to procure abortion
If death is imminent, doctor must arrange for .2
.dying declaration
If female dies, he should report matter to the .3
police
Medical Evidence of Abortion
.Examination of female .1
.Examination of aborted material .2

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 EXAMINATION OF FEMALE
(DURING LIFE)
• 1. General: Female will have exhaust look, increase temperature, increase pulse.
• 2. Breasts; Are heavy, enlarged, areola and nipples are pigmented, colostrum/milk
may ooze on squeezing the breasts .
• 3. Abdomen: Is lax and wrinkled. Striae may be present along with linea nigra.
Involuting uterus may be palpable.
• 4. Perineum: Laceration or bruises may be noted, inflammation is evident
• 5. Labia: majora and minora will be inflamed and bruised
• 6. Vagina: Tags of membrane, partial aborted material, blood, foreign body,
abortion stick etc. may be found. The vaginal wall is contused, abraded or
lacerated. The wall is lax, dilated.
• 7. Cervix: The external os would be patulous, ulceration or erosions may be
present. Cervical canal may be dilated with abrasions or lacerations.
• 8. Uterus: May be enlarged on bimanual examination or may be showing signs of
involution.
• 9. Swab from cervical canal will reveal chemical used for procuring abortion and
can be used for bacteriological examination.
• 10. Urine examination: hCG may be
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 EXAMINATION OF FEMALE (AFTER DEATH)

 Clothes: Undergarments may show blood, clots, pieces

of product of conception, stains of chemicals used etc.
 Uterus: Enlarged, cavity may show presence of partially
separated product of conception, foreign body, blood
clots, presence of any paste or chemical, evidence of
injury or perforation etc.
 Evidence of infection .
 Ovaries: Presence of corpus luteum
 EXAMINATION OF ABORTED MATERIAL
''Police may request medical examiner to examine a
substance alleged to have been expelled from uterus as
product of conception.
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 Medicolegal importance of placenta

1. At term placenta is about 500 gm in weight.

2. Period of gestation can be estimated.
3. Some poisons may be detected in placenta.
4. Retained placenta or pieces of placenta may be found
in criminal abortion and may be the cause of death due
to hemorrhage.
5. Disease can be ascertained.
6. Transfer of poisons, drugs, bacteria or antibodies
across placenta (placental barrier) may result in fetal
death, fetal
infections or fetal malformations.

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 Medical Termination of Pregnancy
INDICATIONS
1. Therapeutic
2. Eugenic
3. Humanitarian
When the pregnancy is caused by Rape
4. Social
When pregnancy has resulted due to failure of
contraceptive method adopted by married woman or her
husband for the purpose of limiting the number of
children, then such pregnancy can be terminated on
social grounds.
Important:
In an emergency, a Registered Medical Practitioner can terminate pregnancy at any
place, irrespective of duration of pregnancy.
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 Rules for Doing MTP

1. Only qualified Registered Medical Practitioner, who has

assisted in at least 25 cases of MTP in a recognized
hospital
A Doctor with MD in Gynecology and Obstetrics.
2. Place - MTP can be Carried Out at A hospital
maintained or established by government . Non-
government hospital approved by government
3. Consent
A female above 18 years of age with sound mind can give
consent for MTP. In minor females (i.e. age less than 18
years) or mentally ill , consent of parents or guardian is
necessary.
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 Rules for Doing MTP cont.
4. Duration of Pregnancy
. When duration of pregnancy is below 12 weeks of
gestation, one Registered Medical Practitioner (RMP) can
terminate the pregnancy.
. When duration of pregnancy is above 12 weeks but less
that 20 weeks (i.e. 12-20 weeks), then two RMP are
required to terminate the pregnancy.
5. Documentation and Record
Date generated by mentioning the year against the serial
number
. The admission register is a secret document.
It should be maintained for at least 5 years from the last
entry.
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 Methods of Inducing MTP

• Up to 12 Weeks • Between 13 to 20 Weeks

• l. Manual vacuum • 1. Dilatation and evacuation
aspiration • 2. Oxytocin infusion
• 2. Suction evacuation • 3. Induction by
prostaglandins E,
and/or curettage (misoprostol) (Used as
• 3. Dilatation and intravaginally,
curettage intramuscularly or intra
• 4. Mifepristone amniotically)
• 4. Hysterotomy - less
• 5. Methotrexate and common method
misoprostol
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 Complications of MTP

• Immediate • Delayed
• 1. Hemorhage and shock • l. Menstrual disturbances
• 2. Perforation of uterus, • 2. Sterility
intestine • 3. Pelvic inflammatory
• 3. Laceration of cervix or disease
vagina • 4. Recurrent abortion or
• 4. Incomplete abortion premature labor
• 5. Endometritis • 5. Psychological sequelae
• 6. Embolism •  

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 MEDICOLEGAL LMPORTANCE OF ABORTION
 
1. When abortion is induced without proper indication or
in contravention to the provisions of MTP Act, it is
considered as criminal abortion and is punishable by law.
When Doctor violates the provisions of MTP Act, he is
liable to be punished by the law and similarly his act
amount to misconduct in professional sense.
To bring a false charge of assault against any person, a
female may plead that she has been assaulted and due to
assault, abortion was induced.
A female may be falsely charged or implicated for inducing
criminal abortion
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