Abortion final forensic pathology is vital

forensic

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
I.Resusc efforts
II.Decomposition
•Lungs may sink due to ;
I.Consolidation
II.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.