Abortion

By

Dr. Hussein Nofal ,MD. PhD
Ass. Prof. of Forensic Med.
WWW.SMSO.NET

abortion
 It

is Expulsion the contents of uterine before 7th month of pregnancy. 7th month ( 7th – 9th ) >>> Premature

 After

 Normal

delivery {birth} at 9th month (270 d) preg., naturally without any intervention ( surgical or medical )
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abortion
 It

is 3 types;  1 – spontaneous abortion;  - maternal or fetus diseases  2 – artificial (Theuraptic) abortion;  (aim: saving maternal life )  3 – criminal abortion  (aim: giving up the fetus)
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1 – spontaneous abortion;
 It

occurs because of pathological causes in the mother organs,  or in the fetal organs

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1 – spontaneous abortion;

Maternal pathological causes;  1 – viral diseases, influ., typhoid, typhus chicken box, endometritis, ..  2 – other diseases, Syphilis, TB  3 – general diseases, cardiac,cirrhosis, chronic nephritis, diabetes,
tumor, hyperthyroidism.

  


 

4 – hypo progesteron (menses < 21 days) 5 – fatigue 6 - psychiatric, sadness, pleasure, fearness, stress 7 – deformations, ( placenta, uterine, ) 8 – uterine infections 9 –uterine tumors
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tumors WWW.genetic  .chromosomal  .infectious  .amniotic  .  .SMSO.ovum  .  Fetal causes.NET . they are diseases of.fetal tissues  .1 – spontaneous abortion.

1 – spontaneous abortion.ovum with  .  Incidence of primigravida comparing with viviparous is = (primigravida) 1/20 (viviparous)  It Often occurs at menstruation dates  the abortion before 3rd month of preg.NET .SMSO. will be as an one object is thrown away of uterus  .whole fetal tissues WWW..  . which consist of.

placenta go out of uterine WWW.amniotic fluid flows  3 .detachment of placenta from endometrium  5 .amniotic sac expulses  2 .  So that happen as following.fetus go out of uterus  4 .  1 .NET .1 – spontaneous abortion.SMSO.

1 – spontaneous abortion.  If Some pieces of placenta remained inside uterine after abortion >>>>  continuous bleeding  & frequent bleeding for a long time WWW.SMSO.NET .

 The aim is saving the mother life . danger due to pregnancy WWW.SMSO.2 – artificial (Theuraptic) abortion.NET .  It is expulsion of uterine contents by surgical or medical interventions.

 1 – dangerous lesion for maternal life  2 – relation between danger & lesion. and there is non existing other medical procedure WWW.Abortion Conditions  Conditions are.NET .SMSO. or  severity of danger & lesion  3 – danger vanish by pregnancy stop  4 – abortion is the only saving procedure.

husband.NET . one of them gynecologist  2 – husband agreement  3 – women’s agreement. and it signed by . women or her family.Abortion Requirements  1- abortion decision is establishing by 2 doctors. 2 doctors.SMSO. WWW. or family’s  4 – abortion must perform in hospital  5 – medical report must be in 4 copies.

Abor.Indicative diseases of theur.SMSO.NET . – sever uterine hemorrhage (metrorrhagia)  in the first 3 months of pregnancy  2 – acute amniotic Hydrops  3 – pregnant vomiting is improbable to treat  4 – chorea gravidarum 1 WWW.

Lesions which pregnancy make them dangerous – nephritis + hypertension + uremia  2 – retinitis albuminurica  3 – cardiac failure  4 – multiple sclerosis 1 WWW.NET .SMSO.

NET .SMSO.Lesions considerably dangerous by pregnancy – active TB  2 – psychosis  3 – opticitis 1 WWW.

criminal by agreement of women A WWW.Criminal abortion – violent (police cases)  B .NET .SMSO.

A – violent (police cases) - called also police cases  . WWW.the pregnant women exposed to violent trauma.NET .SMSO. which threatened the pregnant and it caused abortion.

A – violent (police cases)   Forensic medical expert must do physical examination to assure of. and on genital region 4 . 1.pregnancy at the time of attack 2 .SMSO. and fetus ( pathological & histopathological investigations) 5 .injuries on abdomen.uterine contents 3 .non existence of any pathological cause of abortion in women.relation between the violence & abortion WWW. bacterial and immunological reactions to determine the renal & hormonal functions 6 . on back.urine chemical.NET      .

time of hemorrhage  3 – duration between accident & hemorrhage  4 – hemorrhage is accompanied by pain WWW.  1- time of accident  2 .NET .A – violent (police cases)  Forensic medical expert must do physical examination to assure of.SMSO.

criminal by agreement of women the majority of criminal abortion cases  the aim is to give up the fetus because of many reasons like.SMSO.economical  .social  .B .NET .  .fornication (adultery)  WWW.hating husband  .

chemical substances  2 – interventions by applying local violent instruments  3 -interventions by applying general violent instruments 1  WWW.NET .Criminal abortion Inductions – drugs.SMSO.

SMSO. .hypophysis ( oxytocin) .estradiol .prostaglandins WWW. petrol products.NET . ) 4 – Uterotonics 5 – biological extracts.drugs & chemical substances inductions 1 – Drastic Purgative 2 – Urotonics 3 – General poisons ( mineral.1.

aloe .SMSO.castor (ricin) oil .1.decoction of juniper berries  Purgatives >>> sever diarrhea >>> uterine congestion >>> placenta detachment  >>> abortion WWW. .decoction of parsley .drugs & chemical substances inductions 1     – Drastic Purgative.NET .

drugs & chemical substances inductions 2     – Urotonics (sodium nitrate) >>> congestion of kidney.SMSO.NET .1. & ureter & bladder >>> abortion WWW.

heavy metals & their salts  ( Arsine.1. Mercury.SMSO. Lead. Potassium  permanganate)  Oral or local genital administration 3  locally >>> vaginal erosions  & bleeding  Generally absorption through erosions  >>> toxic effects WWW.NET Abortion Death . Iodine.drugs & chemical substances inductions – General poisons  .

phosphate extracts .NET .salisilates WWW.SMSO.copper sulphate .drugs & chemical substances inductions 3      – General poisons There is also .1.petrol products ( penzin) .

NET . lead acidates)  Quinine >>> hemic disturbances + cyanosis +  hypothermia + vertigo + surdity +  tinnitus 4 WWW.drugs & chemical substances inductions – Uterotonics  they affect on Myometrium  >>> prolonged uterine contraction  >>> abortion >>> death  ( Quinine.1. Ergotamine.SMSO.

hypophysis ( oxytocin) .estradiol . .1.drugs & chemical substances inductions 5 – biological extracts.SMSO.prostaglandins WWW.NET .

 .SMSO.2 – general violent inductions  Sever sports like.putting heavy objects on abdomen  or on back  all of them need a special individual sensivity to irritate uterine >>> abortion WWW.running  .carrying heavy objects  .bicycling  .NET .

SMSO.NET . which used through vagina & uterine cervix mechanical procedures >>> Uterus contracts >>> expulsion uterine contents mechanical procedures cause dilation uterine cervix & uterine curettage WWW.3 – local violent inductions  Their effect depended on click of ovum & fetus by mechanical ways.

SMSO.Hegar bars series  More 3 months of pregnan  .NET .Luminaria bars (vegetarian).3 – local violent inductions  Physicians used  In first 3 months of pregnancy  . slow dilation  it is like labor WWW.

3 – local violent inductions  Dilation     uterine cervix by plastic catheters or metallic catheters needles hairs pins pencils WWW.SMSO.NET .

70 % alcohol  . there are  .3 – local violent inductions  Among foreign local objects.soapy water with iodine  .water  All of these materials introduced to uterine by using Syringes. or Rubber Balloons WWW.potassium permanganate solution  .air  .NET .SMSO.mercuric chloride solution  .

dizziness  Abortion by these inductions starts by  1 – bleeding (sever)  2 – colic pain (lumbar.SMSO.vertigo Death  .vomiting  .3 – local violent inductions  All these procedures accompanied by  .pain  .NET . lower of abdomen)  3 – fetus expulsion after (few hours – 7 days( WWW.

NET .  1 – uterine contraction pain  2 – dilation of uterus cervix  3 – flowing amniotic fluid  4 – metrorrhagia ( ~ menstruation in 2 months)  5 – fetus expulsion  – it must be connection or relation between induction & abortion WWW.Abortion symptoms & signs  They are.SMSO.

Proving of the relation between induction & abortion  We must not forget that  uterine in the first 2 months hides behind pubis (pelvic organ).  After that amniotic fluid consider as a protective object from attacks (liquid surrounded fetus) WWW.NET .SMSO.

time of occurrence.clinical examination 4 .history of disease 3 .trauma (its severity.SMSO. duration between trauma & bleeding) 2 .Proving of the relation between induction & abortion  So         we must evaluate.NET .laboratories investigations WWW. time of bleeding. 1 . site.

secondary)  3 – vaginal perforation (primary. secondary)  4 – hemorrhage WWW.NET .SMSO.)  2 – uterine perforation (primary. air emb.. – sudden death ( cardiac arrest.Abortion complications (consequences)  During 1 applying the intervention are.

– infections ( septicemia)  2 -intoxication 1 WWW.Abortion complications (consequences)  After applying intervention  ( few minutes – few days) are .NET .SMSO.

SMSO.NET .sudden death  1- cardiac arrest  applying intrauterine induction >>>  vagus reflex >>> shock parasympathic >>> death ( within seconds) WWW.

occurs >>> C.sudden death – air embolism  applying intrauterine >>>  veins >>> R. heart >>> pulmonary artery  >>> pulmonary infarction  arteries >>> L.. and convulsions >>> death (after 12 – 24 hours) 2 WWW.NET .SMSO. heart >>> cerebral circulation >>> Cerebral infarction >>> death (few minutes)  sometimes air E. Infarct >>> paralysis.

 directly injury on uterine cervix.uterine perforation  1- primary. or its body.NET . or its fundus >>> perforation >>>  hemorrhage >>> sudden death  or infection >>> late death  2 – secondary.  It follows injection of erosive liquids into uterine  >>> burns >>> necrosis >>> perforation >>> death WWW.SMSO.

SMSO.NET . stiff  histopathological:  thrombosis in viens  + Myometrium necrosis  Soapy WWW.uterine perforation water ( after 2 – 3 days) >>> uterine infarction >>> acute abdominal pain >>>shock  uterus is enlarged.

Vaginal perforation 1 –primary. >>> vaginal infarction WWW.SMSO.NET . like uterine >>> hemorrhage & infection 2  –secondary .

placenta detachment partially or totally .vaginal perforation .decidua detachment >>> hypovolmic shock WWW.hemorrhage  It      is due to .SMSO.NET  Hemorrhage .uterine perforation .

E.infections  It starts from endometrium to surrounding areas >>> several regions  Bacteria are : . welshii. coli  .NET .SMSO.streptococcus  .staphlococcus  .)  Septicemia >>> death after 24 hours  because of endotoxin – induced shock WWW. tetanus.anaerobic are most dangerous  (clostridium.

Abortion diagnosis  In life women  In corpse WWW.NET .SMSO.

metrarrhagia (~ menstruation)  2 . and vellus)  5 – uterine cervix secretion ( hemic.Diagnosis of abortion in life women  It’s difficult pre 2nd month of pregnancy.fetus tissues.  (chorionic trophoplast.small enlargement of uterus  3 .SMSO.fetus ( ovum) length is ~  8mm >>> 3rd week pregnancy  25 -30 mm >>> 4th week pregnancy  4 . serousWWW. after that is easier. signs are.NET .  1 .

NET  2 .Criminal Abortion diagnosis – scene examination  2 – women examination  a.sure signs WWW.considerable signs 1 .  1.  3 – confession b – corpse.SMSO.uterine cervical inj.life .  1.  2 – intoxication symp.

uterus. uterine cervix. vaginal diverticulums.NET .Criminal Abortion diagnosis  Sure signs in corpse.  3 – air embolism  4 – uterine necrosis WWW.  1 – existence of abortion instrument in uterine  2 – perforation.SMSO.

 2 -ovaries distortion.injected soapy liquid in uterine)  4 – genital necrotic areas.NET .SMSO.  3 . & necrotic bruise in uterine & uterine cervix due to erosive substances WWW.  1 – local genital injuries  2 –intoxication symptoms & signs  3 –Myometrium infarction  ( D.pregnant intoxication.Criminal Abortion diagnosis  Considerable signs in corpse.D is 1.

WWW.bruises  .SMSO.NET .vital inj.Criminal Abortion diagnosis  Fetus examination  .

Physician behavior  He    must not indicate. nor suggest. nor recommend the abortion if there isn’t indication  If women arrive to clinic.NET .SMSO. physician must recommend her or her relatives to transfer to hospital WWW.

Estimation fetus age age (month) 1 Length ( cm) 1*1 = 1 Weight ( gram) 2 3 4 5 6 7 8 9 2*2 = 4 3*3 = 9 4 *4=16 5 * 5= 25 6* 5 = 30 7 * 5 = 35 8 * 5 = 40 45 .3500 .SMSO.50 WWW.NET Nails at finger tip 400 1000 1500 2500 3000 .

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