Download MBBS Criminal Abortion Lecture PPT

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Criminal Abortion
Dr. Vinod Kumar,
Prof. & HOD,
Forensic Medicine,

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TMMC&RC
2020

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Criminal Abortion

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n Any abortion induced in defiance of one or more of the provisions wil
amount to criminal abortion
n In simple words it can be defined as:-
n Abortion which is not as per Termination Law
Motive for Criminal Abortion

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1. To get rid of child fol owing il icit intercourse with a view to avoid the shame
and disgrace in cases of:-
Widows
Unmarried girls
Married woman conceiving during long absence of her husband

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2. To prevent inconvenient addition to the family

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Methods adopted in inducing Criminal Abortion
Up to the end of 1st month
Mechanical violence used by several means

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Extrauterine means:-
Lifting of heavy weight, horse riding, cycling, jolting
Kicks and blows over abdomen, fal ing or jumping from a height
Kneading or firmly massaging the ant. Abdominal wal
Tight compression of lower abdomen, alternate hot and cold

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bath, use of purgative
By the end of 2nd month
( Suspicion becomes a surety now:- more drastic measures are adopted )
Use of Abortifacient drugs

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Abortifacient drugs
A) ECBOLICS -- these drugs contracts the pregnant uterus.
a) Ergot preparations, b) Quinine, c) Strychnine, d) Synthetic estrogen,

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e) Pituitary extract
But not always successful in low doses, in higher doses- may cause danger
B) EMENAGOGUES ?these durgs initiates and increases menstrual blood flow.
a) Oestrogen, b)Borax, c) Savin, d) Sanguinarine
C) Drugs irritating genito urinary tract? these are

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a) Cantherides, b) Oil of pennyroyal, c) oil of tancy, terpentine
D) Drugs which irritates the GI Tract? these reflexly initiates uterine contraction
Emetics- Tartar emetic
Saline cathartics? Magnesium sulphate
Strong purgatives? Castor oil, Croton oil, Aloes, Colocynth, Phenolphthalein

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Abortifacient Drugs ? cont.

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E) Drugs which are primarily toxic to other systems
Inorganic irritants? salts of lead, arsenic, phosphorus, copper, mercury, antimony.
Organic irritants? unripe fruit of papaya, pineamethi, Rati ( abrus precatorious)
Calotropis, plumbago:- (juice is used in abortion stick)
F) Patent preparations:- abortion pil s made of lead, diphenylethylene

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Organic irritants

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Rati ( Abrus Precatorious )
Plant with pods
Seeds

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Organic irritants
Unripe fruit of Pappaya
Unripe Pineapple

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Organic irritants
Methi ( Fenugreek)

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Methi Leaves
Methi Seeds

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Organic irritants
Calotropis Gigantea
Calotropis Fruit

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Organic irritants
n Plumbago

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General Violence

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n G) General Violence-
n Beside the method already discussed under the heading Extra uterine means
n Cupping?
n A flaming light is placed on abdominal wal . It is covered by a bowl--
air expands? on cooling air contracts? bowl sticks to the abdominal wal ?

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bowl is pul ed suddenly? causes separation of placenta

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Cupping

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H) Introduction of Utus Paste --

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(containing mercury, thymol, iodine and some other
agents) inside the
uterus leads to abortion.
I) Pushing laminaria tent and abortion stick inside uterus
J) Rupture of membrane by - hair-pin, nail

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K) Syringing --Higginson's syringe? Abortifacient fluid
like soap water,
KMNO4 sol., cresol,
Lysol or tincture iodine pushed inside uterus.

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Local violence
n Syringing

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n Rupture of membrane
n Abortion stick
n Syringe and aspiration
n Vacuum aspiration
n Dilatation of cervix

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n Air insufflation
n Electric current
n Utus paste

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Higginson syringe

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Higginson syringe

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n Soap water
n Dettol water
n Alum
n KMNO4
n Formalin sol.

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n Lysol

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Abortion Stick

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See Weed ( Laminaria)

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Laminaria tent
Irritant Plant Twig

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Materials used for local violence

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Causes of death and dangers of criminal abortion
1) Causes of rapid death:-
Haemorrhage- common in incomplete abortion

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Perforation
Vagal shock
Fat embolism- when fat containing solution is used
Air embolism

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Causes of death and dangers of criminal abortion
Delayed death :- ( within some days)
Peritonitis ( in case of perforation)

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Local infection
Tetanus
Septicaemia, pyemia
Remote causes:- (Death occurs due to complications of abortion)
Renal failure

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Meningitis
Endocarditis
Hepatitis
Toxic effect of abortifacient drugs :- may cause death during any period

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Evidences of criminal abortion
n In living lady
n Signs are akin to those found in recent delivery (modified by certain factors)

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n Breast changes (in primipara)
n Enlargement of uterus
n Haemorrhage
n Offensive vaginal discharge
n Vaginal speculum examination:-

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n Vaginal erosion/ laceration
n Cervix- Softening / lacerations
n Signs of peritonitis

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Evidences of criminal abortion

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n In Dead lady
n Always sent for post mortem examination
n Sudden death of a woman of child bearing age
n Dead woman is pregnant and deeply cyanosed
n Pale if death was due to excessive hemorrhage

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n Disturbed underclothing
n Evidence of abortifacient drugs/ instruments used
n Soapy fluid/ blood stained fluid coming out of vagina
n Vaginal discharge may have offensive smel / smel of soap/ Dettol/ Lysol
Genital examination often reveals congestion of labia, injury to posterior

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commissure

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Evidences of criminal abortion in a dead lady
Continued
n Abdominal cavity may contain clotted blood

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n Perforation of pelvic organs may be present
n Uterus findings:- Enlarged size, cavity may contain chemicals/ abortion stick
n Part of product of conception, blood clot
n Findings in the ovaries, lungs, heart, kidneys and others
n Material Preserved

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n Uterus, ovaries and vagina:- in formol saline for histopathology
n Part of uterus, part of vagina in S. S. of common salt for chemical analysis
n Other usual viscera as per indication
n Blood and urine also preserved
n Examination of product/ part of product of conception

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Medicolegal aspects of abortion
n Abortion induced without proper indication:- Amounts to crime
n Doctor violating the MTP Act 1971:- liable to be punished
n Pregnant or even non pregnant lady may malinger abortion ?
n due to assault- false charge against enemy.

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n Abortion may be feigned:- for blackmailing
n for compensation by a working woman
n A woman may be falsely charged for inducing criminal abortion
n A woman who has aborted:- falsely charged of infanticide
n A woman who has aborted:- may bring charge of negligence against

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the treating doctor

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Role of doctor in dealing a case of criminal abortion
n 1. Consult a professional col eague

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n 2. Render proper treatment, preserve suspected material, keep detailed record
n 3. Maintain professional secrecy
n 4. If police inquires, must give ful information
n 5. In case of impending death- request for recording of dying declaration
n 6. In case of death of woman- police informed

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n - dead body handed to police
n - death certificate not issuied

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