FMT project how to prevent litigation by RMP.pptx

This ppt describes ways a doctor can protect themselves from alleged case of litigation.

1. Case Scenario Presentation Presented by: 872, 880, 881, 972 Guided by: Dr. Swapnil Akhade

2. Suzimo, a 16-year-old girl was brought by police for postmortem examination with alleged history of illegal abortion and she died immediately after the expulsion of products of conception.

3. Types of abortion and methods of criminal abortion

4. What does abortion mean? Medically, abortion is expulsion or extraction from its mother of an embryo or fetus weighing 500 g or less, when it is not capable of independent survival(WHO). This 500 g of fetal development is attained at about 22 weeks of gestation. Legally, abortion is defined as expulsion of products of conception from the uterus at any period before full term There are mainly two types of abortion. 1. Natural - spontaneous termination 2. Artificial – induced termination

5. Causes of Natural Abortion Though roughly 40% of abortions don’t have a cause, there are 6 major causes: Genetic (Most common) : Commonest cause is autosomal trisomy of which trisomy 16 is most common. Anatomic : Cervical incompetence, uterine fibroid and septate uterus Endocrine: Diabetes Mellitus, Hypo and Hyperthyroidism Infections: Toxoplasmosis, rubella, Chlamydia, Malaria, HSV Immunological: Both autoimmune and alloimmune factors cause miscarriage. Others: Rh incompatibility, PROM, maternal illnesses etc.

6. What are the different types of abortion?

7. Types of Spontaneous Abortion Threatened abortion : Bleeding is present in the uterus, but it's too early to tell if the fetus is alive or if the cervix is open and spotting P/V is present .  Inevitable abortion : The cervix is dilated, and there may be significant bleeding .  Incomplete abortion : Some products of conception have been expelled, but some remain in the uterus.  Complete abortion : All products of conception have been expelled, and the cervix is closed.  Missed abortion : The fetus or embryo has died, but there's no bleeding or cervical dilation , and the products of conception haven't been expelled. It is USG based Diagnosis Septic spontaneous abortion : An incomplete abortion with an associated infection. 

8. Artificial or Induced Abortion It means willful termination of pregnancy before viability. It can be: Legal or justifiable : When it is done in good faith to save the life of the woman, and performed within the legal provisions of the MTP Act (Right person, Right place, Right method). Criminal or illegal : Induced destruction and expulsion of fetus from womb unlawfully. It is usually induced before the 3rd month, and causes infection and inflammation of the endometrium. (BNS 88,89,90)

9. METHODS OF CRIMINAL ABORTION

10. Abortifacient Drugs` General Violence Local Violence Ecbolics (Ergot preparations and strychnine) Severe pressure on abdomen like kicking, blowing, tight bandage. Syringing Emmenagogues (Estrogen and Borax) Violent Exercise like horse riding, cycling, and jumping from height Syringe aspiration GIT Irritants (Purgatives, Croton) Cupping Vacuum aspiration Genito-Urinary Irritants (Cantharides, Oil of Turpentine) Very hot and cold hip bath alternately Rupture of membranes Drugs having Systemic toxicity (Metallic irritants, Calotropis, Abrus precatorius) Abortion stick Abortion pills made of lead of diphenyl ethylene Dilation of cervix Air insufflation Electric current

11. Cupping A mug is turned upside down over a lighted wick and placed on the hypogastria. Air escapes due to heat and the mug sets tightly on the abdomen. The mug is then pulled which may result in partial separation of placenta.

12. Cantharides Strychnos nuxvomica Misoprostol and Mifepristone tablets

13. Abortion by Local Violence Syringing : Ordinary enema syringe with a hand bulb is commonly used to inject fluid into uterus. Higginson’s syringe is also used with the most common injection material being soap water. Syringe aspiration : Large syringe with a plastic cannula is inserted into cervix; develops suction which ruptures early gestational sac, and leads to aspiration and expulsion of contents. Vacuum aspiration : The cervix is dilated and a tube attached to a suction pump extracts the fetus.

14. Vacuum Aspiration of fetus Higginson’s enema syringe

15. Abortion by Local Violence Rupturing of membranes : The membranes are ruptured by introduction of an instrument, like probe, stick, uterine sound, umbrella ribs, catheter, pencil, pen holder, knitting needle or hairpin. Abortion stick : It is a wooden or bamboo stick,12–18 cm long, wrapped at one end with cotton, wool or piece of cloth and soaked with juice of marking nut, Calotropis or paste made of arsenious oxide or lead. It is introduced into the vagina or os by dais and retain there, till contraction starts. Instead of this stick, a twig of some irritant plant, like Plumbago rosea, Calotropis or Nerium odorum may be used. Abortion Stick

16. Various instruments commonly used to cause rupture of membranes

17. Abortion by Local Violence Dilation of cervix : Foreign bodies are introduced and left in cervical canal, like pessaries, laminaria (a dried seaweed) or sea tangle tent which dilate the cervix, irritate uterine mucosa and produce marked congestion and uterine contractions with expulsion of fetus. Cervical canal may be dilated by introducing a compressed sponge into the cervix and leaving it there. Sponge swells from moisture in the uterine segment with expulsion of fetus. Slippery elm bark (Ulmus fulva) obtained from a tree in Central America, is inserted into cervical canal in portions of 1–3 inches long. It absorbs moisture, and on each side of the bark, a jelly like layer is produced that is as thick as the bark itself, due to which the cervical canal is dilated Laminaria stick

18. Abortion by Local Violence Air insufflations : Air is introduced into vagina and uterus by various means, like pumps or syringes leading to abortion. Electric current : An electric current of 110 V with negative pole applied to posterior vaginal cul-de-sac and positive pole to lumbosacral region, leads to contraction of uterus and expulsion of contents. Pastes: Utus paste (semi-solid soap mixed with potassium iodide, thymol and mercury) or Fetex paste is introduced in the extra-ovular space for abortion.

19. Different methods of interference in local violence

20. Other case studies on illegal abortion

21. THANK YOU!