Virginity, pregnancy and delivery

Medico-legal aspects of Virginity Pregnancy and Delivery

1. VIRGINITY , PREGNANCY & DELIVERY Dr Arun Pinchu Xavier Assistant Professor Dept: o f Forensic Medicine Sree Mookambika Institute Of Medical Sciences

2. VIRGINITY / CHASTITY Female who hasn’t experienced sexual intercourse Defloration– deprivation of virginity; rupture of hymen by the act of coitus.

3. SIGNS OF VIRGINITY GENITAL & EXTRAGENITAL GENITAL Intact hymen – rigid & inelastic Apposing labia majora Labia minora not seen outside in normal lithotomy position Fourchette and posterior commissure normal Vagina- narrow,tight , sensitive & rugosed

4. WHATS HYMEN THEN...? Thin fold of mucous membrane at the vaginal orifice partially concealing it. It has an opening in it,which gives it different names Menstrual blood and vaginal secretions flow through it Normally ,it admits –tip of small finger Structure and consistency of hymen varies Bleeds when stretched via the act of coitus, masturbation, introduction of fingers, tampons or foregin bodies

5. TYPES OF HYMEN

6. CAN THEN A PROSTITUTE WHO POSSES AN INTACT HYMEN ,BE CALLED A VIRGIN ..?

7. STRUCTURE AND CONSISTENCY OF HYMEN VARIES Thin,fleshy ,thick or elastic In elastic hymen , hymenal orifice can be stretched without tear But, a women harboring an intact hymen which admits only a tip of little finger can be considered VIRGO INTACTA- A VIRGIN Women having a thick fleshy elastic hymen and who has experienced sexual act is called FALSE VIRGIN

8. A women is a virgin until she has sexual intercourse Presence of unruptured hymen is a presumption , but not an absolute proof of virginity . Hymen can be present always in a virgin in someform or the other or may be congenitally absent, rarely ! Hymen ruptures at first coitus & is torn , but may not be ruptured even after repeted act of coitus if its, loose folded elastic thick tough & fleshy which permit displacement of shape and stretching without rupture ..!

9. CHANGES IN GENITALIA DUE TO SEXUAL ACTIVITY First act of coitus ruptures the hymen posteriorly at 6 o’clock Position. Frequent coitus ,results in multiple tears, which is then called as “ CARUNCULAE HYMENALES ” After Preg & Delivery hymen will almost be absent except a marginal attachment – “ CARUNCULAE MYRTIFORMES ”

10. 02.EXTRAGENITAL – BREASTS Hemispherical firm & elastic Pinkish areola and nipples in fair skinned ,dark brown in brown skinned. It may become large saggy due to frequent handling but not affected by single act of coitus

11. SIGNS OF VIRGINITY ARE… Intact hymen Normal condition of fourchette & post comissure Narrow vagina + rugosed walls These signs taken together may be regarded as …

12. FEATURE TRUE VIRGINITY FALSE VIRGINITY Breasts Hemispherical & firm Pendulous GENITAL SIGNS Labia majora Firm, lie in apposition Separated & flabby Labia minora Pink, soft & sensitive to touch Elongated, brownish, separate flabby, not sensitive to touch Fourchete ,post com Intact Show healed tear Vestibule Narrow Wide Hymen Intact rigid inelastic Intact ,Loose, elastic, thick, fleshy Vagina Narrow, rugosity +, firm walls Wide, enlarged & roomy, less rugousity -

13. MLI of Virginity Nullity of marriage – virginity proof of non consummation Divorce Defamation of character —illegal damage to reputation against a person who has alleged that she is not a virgin Criminal cases– charge of Rape

14. PREGNANCY

15. PREGNANCY Development of an embryo in a female ,when ovum is fertilized by a spermatozoa. Fertilized ovum moves to uterine cavity, gets implanted in the endometrium and grows into a fetus Divided into 3 trimesters Written Expressed Witnessed consent has to be obtained ..! Signs of pregnancy - Presumptive, Probable & Positive .

16. MLI of Pregnancy Women may plead pregnancy to avoid attendance in the court of law as a witness Execution of death sentence Fegin preg in maintenance cases In an allegation of seduction / blackmailing In cases of divorce ,the women may claim to be pregnant to get more alimony Preg due to illicit sexual intimacy - Suicide / Murder Maternity leave

17. SIGNS OF PREGNANCY IN THE LIVING ARE USUALLY CLASSIFIED INTO 3 GROUPS : PRESUMPTIVE SIGNS PRESUME PROBABLE SIGNS PROBABLE-Uterus POSITIVE / CONCLUSIVE SIGNS

18. PRESUMPTIVE SIGNS OF PREGNANCY- PRESUME P ERIODS ABSENT– AMENORRHEA, P IGMENTAION R EALLY TIRED - MORNING SICKNESS E NLARGED & S ORE BREAST U RINARY DISTURBANCES M OVEMENT OF FOETUS - QUICKENING E MESIS ,N AUSEA - MORNING SICKNESS

19. PRESUMPTIVE SIGNS OF PREGNANCY PRESUME P ERIODS ABSENT - AMENORRHEA Earliest & most important symptom Menstrual flow stops after conception and doesn’t commence again ,until 3 months or more after delivery – Lactational Amenorrhea P IGMENTAION OF SKIN Vulva abdomen armpits becomes dark and dark line extends from pubis to umbilicus – Linea nigra Silver-colored lines on abdomen – Striae gravidarum

20. PRESUMPTIVE SIGNS OF PREGNANCY… R EALLY TIRED - MORNING SICKNESS Easy fatiguability, hypersalivation, unusual appetite, increased irritability

21. PRESUMPTIVE SIGNS OF PREGNANCY… E NLARGED & S ORE BREAST Progressive enlargement & tenderness Easily visible superficial veins 2 nd month– hyper pigmentation and small round tubercles are seen around the areola - Montgomery’s Tubercles 3 rd month– Colostrum - Yellowish fluid rich in fat globules and phagocytic cells.

22. PRESUMPTIVE SIGNS OF PREGNANCY… U RINARY DISTURBANCES Enlarging uterus exerts pressure on bladder Disturbances in micturition: increased frequency M OVEMENT OF FOETUS - QUICKENING Feel the movement of fetus & the movements increase with intensity. Seen by 18-20 weeks

23. PRESUMPTIVE SIGNS OF PREGNANCY… E MESIS ,N AUSEA - MORNING SICKNESS Nausea,Vomiting , palpitation,dizziness ,perverted appetite seen in first month of pregnancy,which disappears by 2-3 months

24. LINEA NIGRA STRIAE GRAVIDARUM

25. PROBABLE SIGNS OF PREGNANCY PROBABLE- Utreus PR EGNANCY TEST- Positive G OO DELL’S SIGN- B RAXTON HICK’S SIGN B A LLOTMENT OF FOETUS B LUISH DISCOLOURATION L OWER UTERINE SEGMENT E NLARGEMENT OF UTERUS UTERINE SOUFFLE

26. PROBABLE SIGNS OF PREGNANCY PROBABLE P OSITIVE PREGNANCY TEST Bioassay Immunoassay Haemagglutination inhibition test ( Pregnosticon ) or flocculation inhibition of hCG -coated particles ( Gravindex test) Radioimmunoassay (RIA) ELISA test

27. PROBABLE SIGNS OF PREGNANCY G OO DELL’S SIGN- S oftening of cervix due to increased vascularity seen at 6-8 weeks, cervix become patulous as pregnancy advances B RAXTON HICK’S Sign : appreciation of intermittent painless contractions of uterus felt per abdomen from 16 weeks, 5-20 min interval, lasts for 1-5 mins.

28. PROBABLE SIGNS OF PREGNANCY B ALLOTMENT OF FOETUS Bouncing of the foetus in the amniotic fluid which can be demonstrated fourth to seventh month . When palpated per abdomen or per vagina This may not be demonstrable in conditions associated with a deficiency of the liquor amnii , where the foetus is not presenting by the cephalic pole.

29. PROBABLE SIGNS OF PREGNANCY B luish Discolouration of the Vagina - detected between the fourth and 8th weeks of pregnancy. The discolouration increases in intensity up to the 16th weeks L ower Uterine Segment - S oftening & easy compressibility seen at 6-8 weeks - Hegar’s sign

30. PROBABLE SIGNS OF PREGNANCY E NLARGEMENT OF UTERUS By the end of 3 RD month ,uterus fills the pelvis At 5 th month ,its midway between symphysis and umbilicus By the end of 6 th month at umbilicus 7 th month midway between umbilicus and xiphisternum

31. PROBABLE SIGNS OF PREGNANCY UTERINE SOUFFLE A soft blowing murmur, which synchronizes with the mother’s pulse ,when the lateral aspects of fundus is been auscultated. Its due to passage of blood through the uterine vessels Seen towards the end of 4 th month .With increase in the size of uterus and the fetus inside, the circulation of blood in uterus is also increased.

32. POSITIVE SIGNS OF PREGNANCY Foetal parts & foetal movements appreciated by18 to 20 wks Foetal heart sounds– 120-160bpm , Fetoscope, usg doppler- 6 wks , pulse echo & real time sonography- 8 weeks, echocardiography- 7 week Radiological demonstration of foetal skeleton – 20 wks, c/ i in 1 st trimester USG - 4-5 th week. gestational ring 4-5weeks,

33. DIFFERENTIAL DIAGNOSIS OF PREGNANCY

34. PSEUDOCYESIS / SPURIOUS/PHANTOM-PREGNANCY Women nearing menopause or in younger women anxious to have kids Most frequently, it is observed in a woman who is approaching the menopause, when her menstrual flow has become scanty or has ceased for a time. A deposit of fat takes place in the anterior abdominal wall and omentum or the intestines become distended with flatus Changes in breast may be present, women imagine fetal movements Secretions from the breast & intestinal movements . Presumed to be fetal movements ..! Preg test / X-ray examination / USG will solve ..!

35. SUPERFOETATION Fertilization of a second ovum in a women already pregnant and the consequence is the birth of two children at the same time, one of whom may be mature and the other immature Occurs commonly in septate or bifid uterus Different periods– 1- 3months

36. SUPERFECUNDATION Two or more ova discharged during same ovulatory period are fertilized by separate acts of coitus committed at short intervals , with the same person or two different persons MLI- Gross variation in the complexion of two babies may give rise to doubt of adultery and infidelity..!

37. PEROID OF GESTATION & VIABILITY Period of gestation is usually 280 days VIABILITY Ability of a new born child to have an independent life apart from the mother. Children born at or after 180 days may be viable,but usually 210 days is accepted ,for all legal purposes.

38. DELIVERY

39. DELIVERY Process by which fetus is expelled from the uterus Normal duration 40 weeks / 280 days from the LMP Normally ,delivers near full term. She undergoes a process of LABOR, where rhythmic contractions expel the baby through the vagina. Labor is divided into 3 stages: Dilatation of cervix Delivery of baby Expulsion of placenta

40. SIGNS OF RECENT DELIVERY IN LIVING General disposition : Languished looks, fatigue Slight rise in pulse temp,loss of weight Intermittent contractions - after pains for 4-5 days Breasts: Enlarged ,nipples and areola will be dark Montgomery's tubercle present Colostrum will be replaced by milk Abdomen: Lax, pendulous – striae gravidarum and linea albicantes Fundus at the level of umbilicus just after delivery

41. SIGNS OF RECENT DELIVERY IN LIVING… Vagina & Cervix: Perineum shows tears Labia will be swollen Walls congested, tears excoriations External os,will remain patulous for 10-14days, close by 2 weeks, internal os will close by 24 hours Pregnancy tests : Positive test indicates recent delivery/abortion HCG will disappear within 10 days

42. Lochia : Discharge from the uterus which lasts for 2-3 weeks Disagreeable odour First few days –RED, lochia rubra 5-10 days— WATERY & PALE, lochia serosa 10 th day onwards– thicker, scantier, white or YELLOWISH white, lochia alba SIGNS OF RECENT DELIVERY IN LIVING …

43. SIGNS OF RECENT DELIVERY IN DEAD Duration after delivery Weight in gms Dimensions in cm Just after 900 20 * 15 * 5 End of first week 500 14 * 8 * 4 5-6 weeks after 80-100 10 * 6 * 2.5 All genital and breast signs will be present as in living Uterus soft flabby enlarged & later reduces in size . C/s - shows dark coloured ,irregular areas of placental attachment covered with blood clots. Fallopian tubes & Ovaries are congested and one of the ovaries shows large corpus luteum This table shows the approximate weight & dimensions of involuting uterus

44. SIGNS OF REMOTE DELIVERY IN LIVING Breasts- flabby, pigmented enlarged prominent nipples Abdomen -lax with linea nigra & albicantes Vagina- lax capacious ,absent rugosity labia do not close the vaginal orifice completely Fourchette and perineum reveal old scars Hymen – lost and represented carunculae mytriformis

45. SIGNS OF REMOTE DELIVERY IN DEAD Uterus usually does not involute as in a nulliparous womb Fundus tends to be higher than the line of fallopian tubes Cervix and body are about the same length in virgin , while in parous women cervix, is twice the length In virgin there is several mucosal folds in cervical canal – ARBOR VITAE . It will be lost during delivery Histology of the placental site shows blood pigments upto 6 months after delivery.

46. MLI OF DELIVERY In cases where there is a dispute over legitimacy / mathernity Feigns delivery for some duration and then produce a child, alleging that it is hers - Fictitious / Suppositous child- with a motive to extract more money Abortion & infanticide – alleged to have aborted/delivered / killed the child Cases of suspected concealment of birth – a child born to a unmarried / Widow / out of lawful wedlock- she conceals !

47. LEGITIMACY Legal state of a person born in lawful marriage A child born during continuance of legal marriage,between his mother and any man or within 280 days after the dissolution,the mother being unmarried. ILLEGITIMATE / BASTARD CHILD ,is .. One who is born out of lawful wedlock Within a wedlock or within competent period after cessation of relationship of man and wife Born within wedlock when procreation by husband is not possible bcz of congenital or acquired malformations.

48. PATERNITY Q arises in legitimacy, posthumous births, supposititious children, determined by Parental likeness– resemble father in feature, figure, gesture, personal peculiarities, atavism corroborative evidence only Developmental defects Blood gp tests or paternity tests DNA fingerprinting

49. DISPUTED PATERNITY

50. DISPUTED PATERNITY Arises, when a mother of a child, names a person to be father of child, whereas man denies the accusation Question of disputed paternity : CIVIL CASES: Divorce/ nullity of marriage: husband file divorce suit Maintenance of claim: Share of property: pretend to be preg and delivers a child so as to obtain a greater share of husbands property CRIMINAL CASES : Adultery: husband may deny a child born in lawful marriage Blackmail :for personal gains

51. ATAVISM

52. ATAVISM When a child doesn’t resembles its parents but resembles its grand parents ,such child is atavistic child and the process is called atavism It is due to chance recombination of genes, which failed to express in the father but not in the child Any mental / physical / tendency / a disease peculiar to remote ancestor may be inherited .

53. RESTORING YOUR INNOCENCE ..!   A surgical procedure that involves restoring to normal, a torn hymen for cultural, religious or social reasons

54. MAY THE GRACIOUS GOD BLESS US ALL ALWAYS WISHING YOU ALL SUCCESS FOR YOUR UPCOMING EXAMS Your valuable suggestions are entertained - [email protected]