‫بسم ال الرحمن الرحيم‬

PREGNANCY
 Learning Objectives:
 Recognize medicolegal circumstances in which a
woman is examined for pregnancy.
 List important signs to diagnose pregnancy
 Recognize medicolegal circumstances in which a
woman is examined for delivery.
 Distinguish between recent and remote signs of
delivery in the living
 Distinguish between recent and remote signs of
delivery in the dead
 Medicolegal Conditions
 Divorce more alimony
 Inheritance widow

 Disputed Paternity illegitimate preg

 Rape more compensation

 Capital sentence of death

 Attempts of suicide
 Diagnosis of
Pregnancy
Probable signs Sure signs

Skin changes Pregnancy tests

Breast Ultrasound
Fetal movements
Abdomen
Fetal heart sounds
Pelvis
 A- History
 Amenorrhea

 Morning sickness
 Frequency of micturition

 Constipation

 Breast enlargement
 B- Physical
signs
1-
 Skin changes
Pigmentation
1- Skin → Stria Gravidarum “ Streching of
skin”
Stria rubra : pink Stria albicans: white
abd. Wall / thighs / buttocks
2- Face →
Cloasma “Pregnancy mask ”
3- Abd. Wall → Linea nigra Umb → pubis
4- Nipples / Extern genitalia
Linea nigra
2- Breast changes
 2- Breast changes
2nd month (early)
Enlarged, dilated veins

2nd month (late)

Pigment. Nipples+ 1ry aerola
Enlarg. Montgomery Tubercle

3rd month Colostrum

Breast changes
3- Abdomen
Uterine enlargement

First 3 months → pelvic

organ
After 12 weeks →
abdominal
 Uterine
enlargement
 4- Pelvis
Vaginal mucosa → deep violet
(chadwik sign)
↑ vascularity
Cervix → soft
(Hegar’s sign)

8th week
 Sure signs of

pregnancy
Palpation of fetal parts 16 week
th

 Palpation of fetal movement 20th week

 Auscultation of fetal heart sound 22th week

 Detetion of fetal skeleton by X ray

after 16th week
 Ultra sound

 Pregnancy tests
Fetal heart sounds
* Stethoscope “ Doppler flowmeter”

* 120 – 140 / min, regular

 
* To differentiate between
Uterine soufle:
is synchronous with maternal
pulse
Fetal heart sound:
isn’t
Conditions in which
Fetal heart sounds are
not heard
 Fatty abdominal wall
 Excess liquor amni

 Death in utero

 Before 18th week duration

X ray after 16th
week
 Diagnose pregnancy
 Diagnose twin pregnancy

 Age of the fetus

 Congenital anomalies

 Intra uterine fetal death

 Ultra sound

*Pregnancy
Diagnose *Diseases

Estimate *Duration
*Age of fetus
 Pregnancy tests
 These depend on presence of
Human Chorionic Gonadotrophin
(HCG) in maternal serum and urine.
Human Chorionic Gonadotrophin
*Is a glycoprotein hormone secreted by
the developping placenta (blastocyst)
shortly after fertilization
*excellent marker for early detection of
pregnancy
 Pregnancy tests

Urine Pregnancy test Latex test

Serum Preg test RIA

ELISA serum urine

 Urine pregnancy tests

• Rapid
• Simple
• based on antigen- antibody
reaction
• Ex: Gravindex Latex
Agglutination test
REGNANCY TESTS

Urine + Grav antiserum +Grav antigen

No agglutination Agglutination
(positive) (negative)

Pregnant Not pregnant

 Conditions in which a ♀ is
examined for delivery
 Inheritancewhen a widow alleges that
she gave birth to an infant.

 Infanticide
when a murdered new born
is found & a woman is suspected

 Interchangeof infants when babies are

mixed in hospitals.

 Kidnapping a newly born infant

 DELIVERY
RECENT REMOTE
Within 6 weeks Later

Living Dead
uterus
 Signs of recent delivery in
living
Signs of exhaustion: pallor, weak
pulse

 Breasts: enlarged
engorged : colostrum, milk
+ preg. signs

 Abdominal wall: lax

stria gravidarum
linea nigra

 Genital signs:
 Genital signs
PERINEUM
swallen

UTERUS VAGINA
involution Lochia

CERVICAL OS
dilated
“Lochia”
“Lochia”
Vaginal
Vaginal
discharge
discharge After
After 22 weeks:
weeks:
disappears
disappears
Another
Another 55
d
d pink
pink
11stst 55 days
days pale,
pale,
bloody
bloody yellow
yellow
 “Cervical(Ext)o
“Cervical(Ext)o
s”
s”
dilated
dilated

closed
closed
22 weeks
weeks
after
after
11 finger
finger
11 week
week
22 fingers
fingers after
after
Immediately
Immediately
after
after
Involution of the
uterus
Immediately
Immediately 6
22 fing
6 weeks
weeks
fing above
above Normal
umb Normal size
size
umb PM
PM PM Wt
Wt == 100
100
PM Wt Wt =
= 1kg
1kg g
2 g
2 weeks
weeks
Pelvic
Pelvic organ
organ
PM
PM Wt
Wt == 370
370 gg
1
1 week
week
Mid
Mid way
way bet
bet Umb
Umb &
&
SP
SP
PM
PM Wt
Wt =
= 500
500 g
g
Signs of remote delivery in
living
 Breasts: soft, pendulous, dark
areola, enlarged nipples

 Abdominal wall: lax, linea albicans

 Labia: gaping

 Vagina: dilated, patulous

scars of old tears
loss of vaginal rugae
loss of hymen
Cervix: Os uteri “ext cerv
os”
Nullipara Multipara

Small More patent

Round Transverse: slit-like

Smooth edges Cicatricially-

(non lacerated) notched
 Cervix: Os uteri “ext cerv
os”

Nullipara Multipara

Small More patent

Round Transverse: slit-

like
Smooth edges Cicatricially-
(non lacerated) notched
 Signs of remote delivery in
dead
Nullipara Multipara

Shape uterus Triangular ∆ Round, O

large, heavy

Cervix Body of uterus Body of uterus

= cervix = double cervix

Internal os Not well defined

External os Enlarged
Forensic Medicine & Toxicology
Alexandria Faculty of Medicine