PREGNANCY & DELIVERY

PREGNANCY DELIVERY
medicolegal
importance
CIVIL CIRCUMSTANCES:
1. Inheritance:
- A widow may feign pregnancy so that the child would heir his estate.
2. Divorce:
- A woman may allege pregnancy to get more alimony
3. A woman is accused of being pregnant while her husband is away

CRIMINAL CIRCUMSTANCES
1. Rape:
- The accusation will be greater for more compensation.
2. To delay the time of execution
3. As the motive for suicide, in cases of suicidal attempts, pregnancy is
expected

1. When a widow alleges that she delivered an infant to inherit.
2. In cases of infanticide, when a woman is accused of killing her newly born infant.
3. In cases of disputed maternity.
4. In cases of kidnapping of a newly born infant
Signs I. Presumptive signs & symptoms of pregnancy

1. Amenorrhea
2. Nausea and Vomiting (Morning Sickness)
3. Frequent Urination
4. Breast Changes (2-3m):
- Increased firmness & tenderness
- More prominent and visible veins
- Darkening of the areola
- Enlargement of Montgomery glands
- Presence of colostrum
5. Skin Changes(3m):
- Striae gravidarum (stretch marks):
- Linea nigra
- Chloasmam (mask of pregnancy)

6. Abdominal enlargement.
- In the first three months the uterus is a pelvic organ.
- After the third month it becomes abdominal
Fundus level:
3
rd
month above the symphysis pubis
4
th
month at the junction of the lower 1/3 + the upper 2/3 of the line
joining the symphysis pubis to the umbilicus
5
th
month the junction of the lower 2/3 + the upper 1/3 of this line
6
th
month reaches the level of the umbilicus
7
th
month reaches the junction of the lower 1/3 + the upper 2/3 of the
line joining the umbilicus to the xiphi-sternum .
8
th
month reaches the junction of the lower 2/3 + the upper 1/3 of this
line
9
th
month it is as high as the xiphoid



Signs of recent delivery in the living (6 w) SIGNS OF RECENT DELIVERY IN THE DEAD
General signs:
Pallor, exhaustion and rapid pulse.
Enlarged breasts and contain colostrum.
Lax abdomen with striae gravidara and linea nigra.

Local signs:
perineum = may show tears or bruising
vulva = congested and swollen.
vaginal discharge lochia:
- bloody for the first 4 - 5 d
- pinkish for another 5 days
- then gradually looses all color
- white & turbid until its final disappearance in 14d
cervix=
- int. os closes within 24 hours.
- ext. os is soft + patent & may show recent tear.
- admits 2 fingers for 3-4 days, one finger by the
end of the 1
st
w
- close by 2 weeks * becomes button-hole shaped.
uterus: ( involution)
- Just after delivery it is 2-3 fingers above the
umbilicus.
- After 1 week it becomes midway between the
umbilicus and the symphysis pubis.
- In 2 weeks it becomes a pelvic organ to
- In 6 weeks reach its normal size

1. The involution of the uterus
Soon after delivery 1kg
one week 500 g
2 weeks 370 g
6 weeks 100 g

2. The site of the placenta in the uterus appears as
a bruised and lacerated area
3. The vagina is dilated, bruised and may be
lacerated.
4. There may be signs of episiotomy or perineal
tear.
5. Ovary shows a large corpus luteum

7. Palpable uterine contractions at 20 weeks

8. Genital changes :
- The vulva is more pigmented.
- The vaginal mucosa is violet (Chadwick's sign) 2
nd
m
- The vagina shows mucous secretion.
- The cervix is softened (Hegars sign) 2
nd
m
9. Quickening:
- At the end of the 5th m.

II. Sure signs of pregnancy

1. Palpation of fetal parts at 16 weeks.
2. Palpation of fetal movements at 20 weeks.
3. Auscultation of fetal heart sounds.
- using fetal stethoscope at 22 weeks, with a Doppler at 12 -14 weeks.
- fetal heart sounds is 120-140 beats/min and is regular rhythm.
- the fetal heart sounds may not heard

4. Pregnancy tests:
Based on the presence of human chorionic gonadotropin (HCG) in the urine
or blood of pregnant females.
A. Urinary Immunological Tests:
These tests detect HCG 2 weeks after the first missed period.
Agglutination inhibition test (Gravindex test)
B. Blood Radioimmunoassay

5. Ultrasound scanning of the fetus


SIGNS OF REMOTE DELIVERY IN THE LIVING SIGNS OF REMOTE DELIVERY IN THE DEAD
Breast = lax + enlarged nipple + dark areola.
Abdomen = lax + striae gravidara + linea nigra.
Labia = do not completely close the vaginal orifice with
scars of old tears in the perineum.
Hymen = completely ruptured.
Vaginal mucosa = smooth (loss of vaginal rugae
arbora vitae).
The external os =
- in multipara : transverse (slit-like), fissured and may
show old scar.
-in nullipara : small round opening with smooth edges.

- shape of the uterus of a multipara =round or
globular
*iIn virgin it is triangular)

- uterus = enlarged with its body about double
the length of the cervix
*In virgin the body of the uterus equals that of
the cervix

- placental site may show endarteritis
obliterans

DURATION OF PREGNANCY
- normal duration of pregnancy = 280 days
- calculated from the 1
st
day of last menstrual period , or 40 weeks 2 weeks.
- duration includes 2 w before ovulation
- fertilization delivery period is most difficult to determine as one can never
know the exact date of fertilization.
- child born outside these limits can be disputed by the husband.


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