Abortion final for students in University.pptx

Very useful tool

1. Abortion Termination of Pregnancy before due date is called abortion

2. zygote Fertilized ovum Time period; fertilized ovum to 4th week ie. 28 days

3. embryo Called embryonic period Stage of organogenesis Time period; 4 th to 8 th week

4. fetus Time period; 8 th week to birth Viable fetus; >28/7mths weeks by legal statutory defn In clinical obstetric practice, a fetus >20weeks, >500g , CRL > 25cm

5. neonate Fetus becomes a neonate once the umbilical cord has been cut i.e. it is capable of independent life

6. live birth By law; one needs only see resp mvmt to record a live birth Not necessary to see; Heart rate Cord pulsations Muscle mvmt Separation from the mother

7. Still born Still born ;a viable fetus was alive in the uterus and is born but does not show any signs of life after being born. This can be found by absence of signs of live birth. The child should show the age of viability i.e. more than 28weeks/7months of intra-uterine life. This can be found by usually: Measure the C-H length of the child in centimeters. Divide this figure by 5 and that will give you the age in months. The age of viability is 7 months. This means the infant is capable of separate existence

8. Still born Put simply, the birth of a dead fetus that was viable A still birth certificate may be issued by the medical practitioner present at birth A fetus less than 28 weeks is not considered viable, thus need not be registered as a still birth in some states and the fetus be disposed as biological material or otherwise as no burial order will be issued ;

9. Dead born A dead born; a viable fetus that was already dead while still in the uterus. Clinically this will be seen as a macerated still birth

10. Duration of Pregnancy Abortion Abortion:- If terminated before placenta is formed i.e.,10weeks then it is called abortion ie zygote, embryo, very early fetus

11. Duration of Pregnancy miscarriage Miscarriage:- If terminated between 10 weeks or 3 months and 28 weeks/7months it is called miscarriage ie non viable fetus NB; this is the legal statutory defn as in clinical practice fetal viability begins at 20 weeks

12. Duration of Pregnancy premature labour Premature labour:- If terminated between 28 weeks and 40 weeks it is called Premature labour.

13. Types Spontaneous and Induced. Spontaneous: When it occurs on its own or without artificial interference. This takes place due to any disease like viral infections viz; Rubella, measles or other severe toxaemias, etc., small uterus infantile uterus, etc. Genetic defects are also a major cause

14. Induced Abortion This is done by artificial interference with the pregnancy. This can be :- Therapeutic Criminal Therapeutic abortions are done when the continued pregnancy would be dangerous to health or life of the female or the foetus. If possible you may wait till the age of viability of the foetus. This way you may save two lives. The indications for Therapeutic abortion are:- Advanced cardiac conditions/failure Advanced tuberculosis, Sepsis, Toxaemia of pregnancy, carcinoma cervix, etc. etc , hiv Rape

15. Criminal Abortions: Criminal abortions are done for illegal termination of pregnancy. Two ways of doing :- By drugs and by instrument. This can also be done by person herself of by abortionist who can be trained /untrained or by a nurse or a physician

16. Drugs: Drugs which induce contraction of uterine muscles and/or dilation of cervix can produce abortion like quinine or pituitary hormones or other suitable medicines. Please remember that there is no drug which can produce abortion when given in normal therapeutic dose will produce abortion. It will be a toxic dose with it ill effects.

17. Instruments: Self Induced: Any object that can be introduced for insertion in the uterus per vaginum will be used. The objects might be left or might break and will produce injuries either to contents or the uterus. She might bleed and then she may go to the doctor and doctor will carry out abortion. Please find out therapeutic /criminal intention by proper history and /or examination. Untrained abortionists- The same picture will develop and it will be easy to detect. Trained abortionists: will be expertly done. Please go through proper history and you will be able to find.

18. Complications: Trauma Infection Haemorrhage Pulmonary embolism Sepsis Ruptured uterus D I C D V T Embolism Death

19. Autopsy At postmortem examination: Please take a note of careful history supplied to you by relatives,Hospital notes,Police or other witnesses. Observe signs of injuries or signs of toxic effects of the chemicals/drugs Complete and thorough examination of internal injuries and its co-relations

20. Infanticide Killing of a newly born child within 12 months of its birth is called infanticide. It is necessary to establish whether it is still birth or live birth. .

21. Concealment of a birth Nobody shall dispose of the body of a child with the view to concealing the birth regardless of whether it is a live birth, still birth or dead born. In some states the concealment of a non viable fetus may not be an offence?

22. The Autopsy Perform a full Apart from identification Distinguishing between a live birth and a still birth helps to determine whether the courts will treat this as infanticide or just concealment of a birth

23. Born alive or stillborn Born alive stillborn Lungs Expanded, fill thorax, mottled light red, crepitus, round edges Atelactic, lie close to rib cage, uniform dark red purple Hydrostatic test Float in water Sink in water git Gas in stomach, milk in git No gas, no milk Umbilcal cord Inflm ring around navel After 30hrs confirm with histo , falls of in 5 to 9 days Maceration Macerated if born dead Vernix caseosa ? Can be washed of Patent pdaor foramen ovale Not proof of a still birth; can remain patent for a few days

24. Hydrostatic test Not fool proof Lungs may float due to Resusc efforts Decomposition Lungs may sink due to ; Consolidation Incomplete lung expansion in prematurity

25. Other issues at autopsy Maturity; weight, chl, crl, ossification centres by radiology Length of survival; food, umbilical cord Timing of death; difficult, quick temp fall, quick rigor mortis, sterile babies decompose longer, is it decomposed or macerated Cause; natural vs unnatural identity

26. Causes of Death This can be by: acts of commisson : acts of ommision Acts of commission: Injuries, asphyxia, poisoning etc. Acts of Omission: Failure to provide necessasities such as not properly cutting umbilical cord Shelter, food clothing etc.

27. Finding and relation with woman A woman who is brought examination should be examined for proof of her having delivered. The age of labour should be established. DNA test will relate the mother to the child as well as the blood groups.