Virginity, Pregnancy & Delivery-FMT Dr.Krishna Kant Singh.pdf

virginity

1. VIRGINITY, PREGNANCY
&
DELIVERY
By
Dr.KrishnaKant Singh
M.D.(Hom.)
Asst. Professor, Dept. of OBG
Shaheed Raja Hari Prasad Mall State Homoeopathic Medical College
&
Hospital, Barhalganj-Gorakhpur
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2. VIRGINITY??
Also known as “Virgo Intacta”
Definition:Virginisafemalewhohasnot
experiencedanysexualintercourse
atall.
Defloration means loss of virginity.
Signs of virginity :
1. Extra genital signs (in breast)
2. Genital signs
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3. GENITALS
•LABIA MAJORA
•LABIA MINORA
•VAGINAL WALL
•VESTIBULE
•POSTERIOR COMMISURE
•FORCHETTE
•FOSSA NAVICULARIS
•HYMEN
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4. TYPES OF HYMEN
The hymen is a fold of mucous membrane about 1mm thick,
situated at the vaginal outlet.
1)SEMILUNAR
2)ANNULAR
3)INFANTILE
4)CRIBRIFORM
5)VERTICAL
6)SEPTATE
7)IMPERFORATE
8)CARUNCULAE MYRTIFORMIS
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5. FimbriatedLabialSeptate
DenticularCribriformCrescentricAnnular
Semilunar/Crescentric –10-11 o’clock
Annular –Oval at middle
Infantile –small liner opening
Cribriform –several opening
Septate –2 lateral openings
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6. FeaturesVirginityDefloration
1.Basic differenceNo experience of sexualintercourseHave experience of sexual intercourse
2.HymenIntactTorn except in false virgin
3.IntroitusDoes not admit more thantip of little finger,
it is painful
May admit 2 fingers , it is painless
4.Vagina.Marked rugosityon wall
Full length of a finger cannot be admitted
Rugositydiminishes
Full length of finger can be admitted
5.Fossa navicularisLess conspicuousMore conspicuous after sexual intercourse
6.FourchetteIntactHealed tear
7.Labia minoraSmaller pinkish, covered with majoraenlarged, pigmented, notcovered
8.Labia majoraThick, fleshy, both majoraare inclose
apposition
Less fleshy, not in full apposition
9.BreastsSmaller, firm, pinkish smaller areola, and
small nipple
Larger, flabby, pendulous, widerareola,
large and raised nippleHomeobook.com

7. vTrauma or Accident
vSurgical operation or Gynaecological examination
vSanitary tampons
vForeign body –sola pith (APTAE VARIS)
vScratching due to irritation from uncleaniness
vMasturbation
vUlceration –d/t diphtheria , fungus, etc.
Other conditions which may affect signs
of virginity
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8. False Virgins
Hymen is intact but the woman has had sexual intercourse.
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9. Pointof differenceTrue virginFalse virgin
1.Basic differenceThe woman has no experience of sexual
intercourse
Has experience of sexual intercourse
2.HymenNot ruptured. It is thin flap of tissue of
regular shape and appearance
Not ruptured. It is thick , fleshy or fibrouselastic
with folds
3.IntroitusDoes not admit more than the tip of little
finger, it is painful
Mayadmit 2 fingers, it is not painful
4.Vagina.Marked rugosityon wall
Full length of a finger cannot be admitted
Rugositydiminishes
Full length of finger can be admitted
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10. 5.Fossa navicularisLess conspicuousMore conspicuous after sexual
intercourse
6.FourchetteIntactHealed tear
7.Labia minoraSmaller pinkish, covered with majoraenlarged, pigmented, notcovered
8.Labia majoraThick, fleshy, both majoraare inclose
apposition
Less fleshy, not in full apposition
9.BreastsSmaller, firm, pinkish smaller areola and small
nipple
Larger, flabby, pendulous, wider
areola, large and raised nipple
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11. Medico Legal Importance of Virginity
In Civil cases:
1.Nullity of Marriage (Sec. 12, Hindu Marriage Act)i.e. marriage never to have existed in
Law.
A marriage can be nullified:
(1) When either party was under the age of marriage contract.
(2) When one party was of unsound mind or a mental defective at the time of marriage.
(3) When one party was already validly married.
(4) Where the marriage has not been consummated due to impotence or willful refusal.
(5) Where the woman was pregnant by another man at the time of marriage.
1.Divorce (Sec. 13, Hindu Marriage Act)
3.Defamation of character
4.Rape
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12. PREGNANCY
•It is a physiological condition develops in a female with in her
child bearing age due to fertilisation of ova by spermatozoa
results in developing embryo or foetus in the uterus till its birth.
•Signs of pregnancy in living:
1.Presumptive signs
2.Probable signs
3.Positive or conclusive signs
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13. Presumptivesigns of pregnancy
•Amenorrhoea
•Morning sickness
•Changes in breasts
•Changes in the Vagina
•Urinary disturbances-increased frequency of micturition
•Chloasma -24thweek
•Quickening -16 –20 weeks
•Linea nigra -20thweek (Also known as Pregnancy Line)
•Striae gravidarum
•Sympathetic change -increased salivation
-PICA (perverted appetite)
-irritable temper.Homeobook.com

14. Changes in Breasts:
•Breasts enlarged & nodular(2nd
month)
•Surface veins prominent
•Areola enlarged, pigmented with prominent Montgomery’s Tubercles (2nd month).
•Nipples enlarged
•Colostrum (3rdmonth)
Changes in Vagina:
•Jackquemier’sSign or Chadwick’s Sign:violet or bluish discolouration of vaginal mucosa (after 4thweek).
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15. PROBABLESIGNS OF PREGNANCY
•Enlargement of abdomen
•Height of uterus.
•Palmer’sSign-Regular rhythmic
contractions of uterus at 4thto 8th
week.
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16. FundalHeight
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17. •Hegar’sSign:
-Bimanual examination demonstrates
softening in the consistency of the uterus,
and the uterus and cervix seem to be two
separate regions at 6th -8thweek
•Goodell’s Sign:
-It is a significant softening of
thevaginalportion of thecervixfrom
increased vascularization by 4thmonth
of pregnancy.
Goodell’s sign
Hegar’s Sign
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18. •Osiander’sSign–Increase pulsation felt through lateral
fornicesat 8thweek
•Piskacek’sSign –Asymmetrical enlargement of uterus if there
is lateral implantation.
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19. PROBABLESIGNS OF PREGNANCY
•Braxton-hick’ssign-After 15-16
weeks of pregnancy
•Ballottement: internal and external
(during 4thand 5thmonth)
•Uterinesouffléat end of 4thmonth
•Biologicaltests: Presence of
gonadotropinsin pregnant woman’s
blood and their excretion in urine
External Ballottement
Internal BallottementHomeobook.com

20. •ImmunologicalTests:
a)Inhibition (Indirect) Latex slide test
b)DirectLatex slide test
•Haemagglutinationinhibitiontest.
•RIAand ELISA
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21. POSITIVESIGNS OF PREGNANCY
•Auscultation of foetal heart sounds-positive after 18-20 wks
•Palpation of foetal part
•Feeling foetal movements
•Radiograph of foetus -after 3 months
•USG: 6 wks -Gestational sac
7 wks-Embryo
10 wks-Heart beat
14 wks-Head and Thorax
•Presence of foetal cells in mother’s blood.
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22. Signs of Pregnancy in Dead
•Products of conception
•Enlarged Uterus & other uterine change.
•Corpus luteum
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23. Medicolegal Importance of Pregnancy
(A). In Civil cases:
•Nullity of marriage
•Inheritance of property
•Higher maintenance allowance in case of divorce
•Compensation cases
•Illegitimate baby
•Maternity leave
•Compensation case if allegation of pregnancy against
unmarried woman or widow.
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24. (B). In Criminal cases:
•Execution of death sentence.
•Advantage during trial in court.
•It is positive proof in a trial of rape.
•An unmarried pregnant woman bring a
charge of criminal breach of trustagainst a man.
•Adultery.
•In criminal abortion and to foeticide or infanticide.
•Motive for suicide or murder.
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25. •Pseudocyesis/ False Pregnancy / Spurious Pregnancy /
Phantom Pregnancy.
•Superfoetation
•Superfecundation
•Foetus Papyraceous / Foetus Compressus
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26. QUESTIONS
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27. 1. Uterine soufflé may be heard by auscultation at the end of-
a)10wks
b)12wks
c)14wks
d)16wks
2. Foetal parts can be detected by X ray usually by-
a)8wks
b)12wks
c)14wks
d)16wks
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28. 3. A pregnant woman sentenced to death cannot be hanged till-
a)Delivery
b)Delivery and attainment of 6 months of age by new born
c)Delivery and one year after that
d)None of the above
4. Pseudocyesisis found in-
a)Young married woman
b)Aged unmarried girl
c)Menopausal ladies
d)Adolescent girl
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29. 5. Impregnation of an ovum discharged from a previous ovulation
has been developed is called-
a)Fecundation
b)Superfecundation
c)Super foetation
d)None of the above
6. Which of the following statements is true for virgointacta-
a)Breasts are large and nodular
b)Labia majoranot apposed with each other
c)Fossa navicularisis disappeared
d)Labia minoracompletely covered by labia majora
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30. DELIVERY
Definition:
Expulsionof products of conception from within
the uterus at term.
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31. Signs of RecentDelivery in Living
General appearances of indisposition :
Woman looks pale, exhausted and ill.
(A). Breasts:
•Enlarged, full, firm, tense.
•Darkeningof areola.
•Prominent Montgomery tubercles .
•Surface veins are prominent .
•Striaeare seen.
•Colostrumcan be squeezed out for 2-3 days after delivery.
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32. (B). Abdomen:
•Striaegravidarum (pink)
•Lineaealbicantes(silvery white)
•Linea nigra(black)
(C). External genitalia :
•Labia are tender, swollen and lacerated.
•Fourchette is ruptured.
•Perineum is lacerated.
•Internal os begins to close within 24 hrs
•External os is patent admitting two fingers initially and later one finger with
difficulty at the end of a week.
•Vaginal discharge known as Lochia( for 2-3 weeks) :
During first 4-5 days -lochiarubra(red)
During the next 4 days -lochiaserosa (pale or serous)
After 9th day -lochiaalba (yellowish grey or turbid)Homeobook.com

33. Signs of Recentdelivery in Living
•Extent of signs depends upon whether the woman is
primiparousor multiparous
•Breast: Pendulous
•Hyperpigmentationpresent
•Montgomery'stubercles are prominent
•Striaare present
•Abdomen: abdominal wall is lax
•Linea albicantes
•Linea nigra
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34. Signs of Remotedelivery in Living
•External genitalia: labia are lax
•Vaginal rugaeare lost
•Fourchetteis lost
•Hymen: carunculaemyrtiformis
•Os in Nulliparous:-Internal osis well defined
-External osis rounded and orifice closed
•Os in Multiparous:-Internal osis notwell defined
-External osis transverse irregular and may
admit a tip of finger
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35. Sign of Recentdelivery in the Dead
•Sameas are found in living
•Additional findings are found in uterus and its appendages
•Uterus is firmand returns to a permanent reducedsize
•Placental site can be identified by its darkcolour and
coarse granular appearance and covered with blood clots,
lymph and decidua.
•Ovaries and fallopian tubes are congested
•Histopathologicalexamination:
-trophoblastic cells and chorionic villi are present in endometrium
-one large corpus luteum is present in one ovary
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36. Signs of Remotedelivery in Dead
•Sameas are found in remote delivery in living
•Additional findings are present in uterus and its appendages
•Uterus is concaveinwards.
•Fundus is abovethe line of fallopian tube
•Length of body is twicethe length of cervix in multiparous and it is equal in nulliparous.
•External os is enlarged, irregular and patulous and admits tipof finger
•Internal os is notwell defined
•Arborvitae: lostin parouswoman
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37. Different
measures
ImmediatelyAfter 3 daysAfter 1 week After 2 weeksAfter 3 weeks
Outer length20cm17cm14cm12cm10cm
Outer breadth13-14cm10cm8cm7cm6cm
Thickness5cm5cm4cm3cm2.5cm
Inner length15cm12cm10cm8cm7cm
Weight1kg7oogm500gm300gm80-100gm
Diameter ofthe
site of placental
attachment
10cm7cm4cm2.5cm1.5cm
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38. Point of differencesNulliparousParous
Size7cm x 5cm x 2 cm10cm x 6cm x 2.5cm
Weight40 gm80-100 gm
Ratio b/w Body/CervixEqual2:1
Uppersurface of fundusLess convexMore convex
Uterine cavityconvexconcave
Scar for placental attachmentabsentpresent
External os roundtransverse
Internal osCircular, well definedIlldefined, margin wrinkledHomeobook.com

39. ABORTION
Definition:
Termination of pregnancy due to premature
expulsion of product of conception at any time from
the uterus.”
Types of Abortion:
(A). SPONTANEOUS
(i) Natural
(Ii) Accidental
(B). INDUCED
(i) Legal
(ii) CriminalHomeobook.com

40. Medical Termination of Pregnancy (MTP) Act, 1971
•Came into force in 1972
•Amendments in 1975, 2002,
2003 and 2014.
•It has been implemented by the
latest amendment in MTP Act
in 2020.
•Inroduced in Lok Sabha on
02ndMarch, 2020, Passed by
Lok Sabha on 20thMarch,
2020and by Rajya Sabha on
21stMarch, 2021.
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41. MTP (amendment) Bill, 2014
•MTP (amendment) Bill, 2014 allows any HOMOEOPATHICand
AYURVEDICpractitioner to conduct the medical termination of
pregnancy.
•CMO (Chief Medical Officer) of the district is empowered to
certify that a doctor has the necessary training to do abortions.
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42. 4 weeks8 weeks12 weeks16 weeks20 weeks24 weeks28 weeks32 weeks36 weeks
1 Medical Practitioner needs
to advice for the termination
of pregnancy
2 Medical Practitioner needs
to advice for the termination
of pregnancy
As Per MTP Act, 2020
(Amendment)
Provisions of the act also
extended for Un-Married
Women.
Government to notify the
special categories.
As Per MTP Act, 1971
Beyond 24 weeks
Medical Board will took
decisionsetup in each
state and Uts.
The board will decide
whether any substantial
abnormality to terminate
the pregnancy.
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43. Grounds for MTP
•Therapeutic: risk to pregnant woman
•Eugenic: risk to the child to be born
•Humanitarian : pregnancy caused by rape
•Socioeconomic: pregnancy due to failure of
contraceptive, Unwanted pregnancy with low SE status
•Environemental: no one to help from society
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44. Duration of Pregnancy for MTP
Below 12 weeks :only onemedical officer alone can take
decision for MTP
Between 12 to 20 weeks: decision is taken by twomedical
officers for MTP
After 20 weeks: MTP can not be done, except in emergency
conditions.
(In emergency conditions decision can be taken by only a single
doctor.)
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45. Changes proposed in conditions for terminating a pregnancy
at different gestational periods
Time since conceptionRequirement for Termination of Pregnancy
MTP Act , 1971MTP (Amendment) Bill, 2020
Up to 12 weeksAdvice of one doctorAdvice of one doctor
12 to 20 weeksAdvice of two doctorsAdvice of one doctor
20 to 24 weeksNot allowedTwo doctors for some categories of
pregnant women
More than 24 weeksNot allowedMedical Board in case of substantial
foetalabnormality
Any time during the pregnancyOne doctor, if immediately necessary to save pregnant woman's life
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46. Places for MTP
•Any governmentor semi-government hospital
•Any non-governmenthospital approvedby government or CMO or
district health officer
Qualification and Experience of Doctors for MTP
•Up to 12 weeks:By any RMP who has performed at least 25 cases of MTP
and out of which 5 have been performed independently in an approved place.
By doctor with any of the following:
-PG degree or diploma in OBG
-6 month of house surgery in OBG
-Experience of one year or more in OBG at any hospital
•In emergency cases:By any RMP , at any place , irrespective of duration of
pregnancy.
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47. •Termination due to failure of contraceptive method or device:Under the Act
a pregnancy may be terminated up to 20 weeks by a married woman in the
case of failure of contraceptive method or device. The Bill allows unmarried
women to also terminate a pregnancy for this reason.
•Medical Boards: All state and union territory governments will constitute a
Medical Board. The Board will decide if a pregnancy may be terminated after
24 weeks due to substantial foetal abnormalities. Each Board will have a
gynaecologist, paediatrician, radiologist/sonologist, and other members notified
by the state government.
•Privacy:A registered medical practitioner may only reveal the details of a
woman whose pregnancy has been terminated to a person authorised by law. Violation is punishable with imprisonment up to a year, a fine, or both.
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48. Consent
•Only consent of pregnant womanis necessary
•No need to obtain consent from her husband
•In case of minor (less than 18 year of age),and mentally ill
woman, consent from guardianis required
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49. Common methods of MTP
•Medical: Mifepristone and Misoprostol
•Dilatation and curettage (D&C)
•Vacuum aspirationtechnique or surgicalabortion
•Intra-embryonic instillation of PG
•Extra-embryonic instillation of hypertonic saline
•Surgical
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50. Complications
(A). Immediate:
•Haemorrhagic shock
•Perforation of uterus,
perineum or intestine
•Laceration of cervix or
vagina
•Incomplete abortion
•Embolism
•Thrombophlebitis
(B). Delayed:
•PID
•Menstrual irregularities
•Sterility
•Endometritis
•Cervicitis
•Vaginitis
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51. Criminal Abortion
•Abortion done against the provision of MTP act.
Legal aspects of criminal abortion:
ØSec.312IPC: Criminal abortion with the consent of patient
•Punishment to both for upto3 year,and+/-fine
•If the woman is quick with child then may extend upto7years
ØSec 313IPC: if abortion done without her consent
•Punishment upto10 years and fine
ØSec 314IPC:ifwoman dies by this act
•Punishment upto10 years and fine
ØSec 315IPC : Any act with the intent to prevent the child being born alive or cause its
death before birth
•Punishment : upto10 years and/or fine.
ØSec 316 IPC : any act which cause death of quick unborn child amount to culpable
homicide
•Imprisionmentupto10 years and fineHomeobook.com

52. Methods adopted for criminal abortion
1. Abortifacient drugs
•Drugs acting directly on the Uterus
•Irritants of Genito-Urinary tract
•Irritants of GI tract
•Drugs having poisonous effect on Body
2. General violence
3. Local violence
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53. 1.Abortifacient Drugs
1. Drugs acting directly on the Uterus :
A.ECBOLICS: (Increase Uterine Contraction)
Eg. Ergot
Hydrastiscanadensis
Quinine
Lead ( lead oleateor lead plaster)
Decoction of cotton root bark
Nitrobenzol
Picrotoxinand strychnine
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54. B. EMMENAGOGUES : (Increase Menstrual Flow)
Eg. :-savin
borex
apiol
rue
laburum
oestrogen
sanguinarin
caulophyllin
hallebore
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55. 2. Irritants of Genito-Urinary tract:
•Oil of pennyroyal
•Oil of tansy
•Oil of turpentine
•Cantharides
•KMnO4
3. Irritants of GI tract :
•Saline cathartics eg.-MgSO4
•Purgatives eg.-aloes
calomel
castor oil
croton oil
•Emetic eg.-tartarHomeobook.com

56. 4.Drugs having poisonous effect on Body:
•Inorganic: Pb , Cu , Fe ,Hg , Sb
•Organic: cantharides , unripe fruits of papaya and pine apple,
juice of calotropis , bark of plumbago rosea , methi ,saffron
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57. 2.General Violence
Intensional-
1.Severe pressure on abdomen: by blow, kick, jumping or
kneeling
2.Violent exercise: horse riding, cycling, jumping from height,
severe jolting, carrying or lifting heavy weights
3.Cupping
4. Very hot and cold bath alternately
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58. 3.Local Violence
•Syringing: by Higginson’s syringe
•Syringe aspiration
•Vacuum aspiration
•Rupture of membrane
•Use of laminaria tent /slippery elm
•Abortion sticks
•Utus paste (thymol, iodine, salt of mercury)
•Electric current
•Air insufflations
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59. CAUSE OF DEATH AND DANGERS OF
CRIMINAL ABORTION
A. Cause of Rapid death:
•Haemorrhage
•Perforation
•Vagalshock
•Fat embolism
•Air embolism
B. Cause of delayed death:
•Peritonitis
•Local infection getting complicated
•Tetanus
•Septicaemia
•PyaemiaHomeobook.com

60. C. Remote causes :
•Renal failure
•Meningitis
•Endocarditis
•Pneumonitis
•Hepatitis
D. Toxic effects of Abortifacientdrugs:
-causing early or delayed deaths
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61. Duties of doctor in suspected criminal abortion
•Doctor must ask the patient to make a statementabout the criminal
abortion.
•If she refuses, he should not pursue the matter, but inform the
police.
•He should keep all the information secret to maintain professional
secrecy.
•He must arrange to record the dying declaration in case woman’s
condition is serious.
•If woman dies, he must not issue the death certificate, but should
inform police for post-mortem examination.
•Any foreign materials collected from genitals should be kept
preserved.
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62. Examination of Living individual
•Requisition from the concerned authority
•Identification of female
•Written informed consent
•A female must be present
•Brief history
•Clothing must be examined
•Clinical examination: sign of ill health, GIT disturbances, exhaustion
•Local examination
•Laboratory investigations
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63. Examination of Dead body
Sudden death of a woman of child bearing age should give
rise the suspicion of criminal abortion if:
1.The deceased was pregnantand deeply cyanosed.
2.Instrumentto procure the abortion or abortifacient drugs
are found at scene of death.
3.Underclothingappears to be disturbed after death.
4.Fluid ,soapy material or blood coming out of vagina.
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64. Following points should be proved to convict the
abortionist:
1.The dead woman was pregnant
2.The accused was responsible for the act which resulted in
the interruption of pregnancy
3.The accused acted for purpose of procuring illegal abortion
4.Death occurred as a result of attempt to interrupt the
pregnancy
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65. Medical evidence of Abortion
In a Living victim:
•Breasts-pigmented
•Colostrum
•Linea nigra and albicans may present
•Congestion of labia majora and minora
•Tags of membrane may be present in uterus
•Swab taken from cervical canal may show chemical used
•HCG in urine up to 7 days
•Aborted material, if available ,should be subjected to visual or
histological examination.
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66. In a dead victim (autopsy findings):
•Face may appear pale.
•Undergarment may show blood clots and fragments of
product of conception.
•Congestion of labia and post. commissure
•Signs of peritonitis.
•Vaginal fluid for chemical analysis.
•In case of suspected air embolism X-ray & CT-Scan.
•Uterus and ovary may also be sent for chemical
analysis to detect abortifacients.
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67. Factor suggestive of Spontaneous / Natural Abortion
•Blighted embryo
•Degenerative change of chorionic villi
•Hydatidiform mole
•Attenuated trophoblastic layer and myxomatous avascular
stroma
•Macerated foetus and placenta
•Foetal abnormalities
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68. QUESTIONS
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69. 1.In India MTP act was first introduced in
a. 1947
B.1966
C.1971
D.1975
2.MTP act extends all over India ,except, the city/state
a.Delhi
b.Mumbai
c.Chennai
d.Jammu and kashmir
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70. 3.under MTP act one doctor can terminate the pregnancy upto-
•A. six weeks
•B. twelve weeks
•C. Twenty weeks
•D. Twenty weeks
4.if criminal abortion is performed with the consent of the woman, the
doctor will be charged under section
•A.310IPC
•B.312IPC
•C.313IPC
•D.320IPC
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71. 5. Age of pregnant woman to give consent in MTP act is
•A.12years
•B.16years
•C.18years
•D.21years
6.Injection of soap water into vagina during criminal abortion can
cause
•A.Air embolism
•B.fat embolism
•C.neurogenic shock
•D.peritonitis
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72. 7.Intra-amniotic injection of prostaglandins is successful in causing
abortion in the
•A. First trimester
•B. Second trimester
•C. Third trimester
•D. After viability of fetus
8. If criminal abortion is performed without the consent of woman , the
doctor will be charged under section
•A.310IPC
•B.312IPC
•C.313IPC
•D.320IPCHomeobook.com

73. •9. Under MTP act pregnancy can be terminated at any stage on the
ground of
•A. Eugenic
•B. Therapeutic
•C. Social
•D. Humanitarian
•10 Consent required for termination of pregnancy ,in an adult woman
is
•A. Husband and herself
•B. mother
•C. Mother
•D. Herself onlyHomeobook.com