Abortion - Forensic

Criminal Abortion in Forensic Medicine

1. Definition of Abortion

2. Definition: Abortion means spontaneous or induced expulsion of products of conception before viability (28 weeks) whereas premature labor is delivery of fetus after 28 weeks of pregnancy up to 40th week. In medical practice, the abortion occurs in1st trimester, miscarriage in the 2nd trimester premature labor in the 3rd trimester. Legally all the above terms are synonymous.

3. Types of Abortion

4. Type Definition Early Abortion before 12 wk gestation Late Abortion between 12 and 20 wk gestation Spontaneous Noninduced abortion Induced Termination of pregnancy for medical or elective reasons Therapeutic Termination of pregnancy because the woman’s life or health is endangered or because the fetus is dead or has malformations incompatible with life Threatened Vaginal bleeding occurring before 20 wk gestation without cervical dilation and indicating that spontaneous abortion may occur Inevitable Vaginal bleeding or rupture of the membranes accompanied by dilation of the cervix Incomplete Expulsion of some products of conception Complete Expulsion of all products of conception Recurrent or habitual ≥ 2 to 3 consecutive spontaneous abortions Missed Undetected death of an embryo or a fetus that is not expelled and that causes no bleeding (also called blighted ovum, anembryonic pregnancy, or intrauterine embryonic demise) Septic Serious infection of the uterine contents during or shortly before or after an abortion http://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/spontaneous-abortion#v1074677

5. Definition of Criminal Abortion

6. Criminal Abortion Criminal abortion is the induced destruction or expulsion of the foetus from the womb of the mother unlawfully that is where there is no therauptic indication for operation. Criminal abortion is usually undertaken by the Widows for remarriage. Unmarried girls. Married woman of educated middle class to avoid addition to the family. Nowadays it is less due to widespread knowledge of contraceptives. The abortion may be undertaken solely for the purpose of sex determination to avoid female child.

7. Methods to induce Criminal Abortion Mechanical violence ( general and local). Abortifacient drugs. Instruments.

8. Mechanical violence General Mechanical Violence These methods may act directly on the uterus or act indirectly by promoting congestion of pelvic organs and causing haemorrhage between uterus and pelvic membranes. These methods are: 1. Severe pressure over the abdomen as caused by the (blows, kicks, tight lacing and jumping) 2. Violent exercise such as (riding, cycling, jumping from height, jolting and lifting heavy weights. 3. Cupping: Cupping is placing a lighted wick over the hypogastric area and turning a brass mug over the wick. The traction is applied over the mug that results in separation of placenta. The method is usually employed in advanced months of pregnancy. 4. Very hot and cold baths alternatively. 5. Massaging the uterus through abdominal wall. Local Mechanical Violence While correcting the retroverted uterus bimanually

9. Abortifacient Drugs The abortifacient drugs are: Ecbolics: They act directly on the uterus and increase the uterine contraction that causes abortion. Emmenogogues: They produce an increase menstrual blood flow and act as abortifacient when given in large doses. Irritants of genitourinary tract: these agents produce inflammation of genitourinary tract and irritates the uterus and induce uterine contractions Irritants of the Gastrointestinal tract: They will excite uterus to contract “in sympathy” with the violent contractions of stomach and colon. Drugs having poisonous effect on the body: i . Inorganic irritants such as copper, mercury. ii. Organic irritants such as unripe fruits of Papaya and Pineapple. iii. Abortion Pill F-6103. It concentrates in the corpus luteum and acts by stimulating a woman's natural inclination to menstruate even after presence of fertilized ovum and causes incomplete abortion.

10. Instruments The instruments are used for the purpose of: 1. Rupture of membranes by introduction of penetrating instrument such as uterine sound, catheter, pencil, knitting needle, hairpin, stick and even fingers. 2. Abortion stick : Abortion stick is a thin wood or bamboo stick, 12 to 18 cm (5-8 in) long and its one end is wrapped with cotton wool or a piece of rag whose greater part is soaked with juice of Marking nut, or a paste made of Arsenic oxide, sulphide etc. Instead of stick, a twig of irritant plant such as calotropis . 3. Air insufflation : The air is instilled into vagina by means of syringes or pumps.

11. 4. Electricity: Negative pole is applied over the cervix and positive pole over sacrum or lumber vessels and then the current is passed that results in uterine contractions and subsequent abortion. 5. Paste: The paste containing iodine, thymol or mercury into the uterus 6. Syringing: Enema syringe with a hard bulb is commonly used to inject fluid in to the uterus. A mixture of air and fluid is forced into uterine cavity at a higher pressure than uterine veins. The fluid detaches parts of amniotic sac and placenta from the uterine walls. The uterus contracts causing haemorrhage and thus abortion.

12. Uterine Sound

13. Complications of Criminal Abortion

14. Immediate: Hemorrhage  Perforation of uterus  Air embolism  Amniotic fluid embolism  Incomplete abortion  Local injury  Shock due to vagal inhibition resulting from instrumentation 

15. Delayed: Septicemia  Tetanus  Endometritis  Peritonitis  Sterility  Recurrent abortion