ABORTION

ABORTION
Definition:
It is the expulsion of the contents of a gravid uterus at any time before full term.
Medicolegal conditions in which a female is examined for abortion:

1- A woman alleges that she has been aborted after a blow or a kick in a
quarrel to inflect more penalties on the assailant. Also, to take a
compensation after a transportation accident.
2- A woman may notify that a physician brought her into abortion by giving
her some abortifacient drugs.
3- A woman may try to conceal abortion after being charged with it.
4- A dead woman after abortion to investigate the case.
Types of abortion
Spontaneous Abortion (10-25% of all pregnancies)
The pregnancy may terminate spontaneously and independently of any known
external factors. The following are common causes:
1- Diseases of the mother:
General: Diabetes mellitus, hypertension, malaria, chronic
nephritis.
Local: uterine hypoplasia, fibroids, uterine displacement.
2- Diseases of the fetus, membranes or placenta
e.g. vesicular mole, acute polyhydramnios or fetal anomalies.
Induced Abortion
It could be self induced or by another person. It is either therapeutic or criminal.
a- Therapeutic (Lawful) Abortion:
Definition: Induction of abortion to save the life of the mother as in:
Decompensated cardiac conditions.
Chronic rheumatic fever.
Active pulmonary tuberculosis.
Uncontrolled diabetes mellitus.
Cancer breast.
Hyperemesis gravidarum.
Eclampsia.
The obstetrician who carries out a therapeutic abortion has to:

1- Consult a specialist to give his agreement.
2- Have a written consent of the woman and, her husband.
3- Choose a hospital with all precautions and adequate records. (abortion
must be done in a hospital).
b- Criminal (illegal) Abortion:
Definition: Induction of abortion due to any reasons other than saving the mother’s life.
Methods of Induction of Abortion:
I- General Violence:
II- Local Violence:
A- Nonprofessional persons:
Introduction of foreign body e.g., knitting needle, stick (piece of wood), elm
bark (slippery and flexible) to cause rupture of the membranes & uterine
contractions.
Insertion of a double nozzle or a Higginson syringe and flushing the uterus
with antiseptic solution (glycerin, iodine), the fluid separates the sac from
the interior of the uterus.
B- In medically trained people:
During First 12 Weeks
I-Surgical evacuation:
Suction evacuation.
Dilatation &curettage (D&C).
II-Antiprogesterone used within 20 days after first missed period e.g →
mifepristone single oral dose 600mg followed 48 hrs. later by administration
of vaginal tables of 1 mg gemeprost (prostaglandin analogue).
Substances Used in induction of abortion (Abortifacient):

Ecbolics: have specific action on the uterus leading to its contraction e.g.:
Ergot (ergometrine). → vascular spasm and gangrene.
Prostaglandins: PGE2 and F2 Pituitary extract (posterior lobe)
Oxytocin
lOMoARcPSD|36984692
Purgatives: They lead to reflex contraction of the uterus, e.g. Croton oil, castor oil,
Jalap , colocynth.
Dangers (Complications) of Abortion

I- Neurogenic shock:
Parasympathetic: Reflex cardiac inhibition due to mere touching of the cervix
with an instrument, sudden dilatation of the cervix or
sudden hot or cold douches.
II- Hemorrhage:
a- Primary:
b- Secondary:
It occurs due to sepsis which causes dislodgment of thrombi from the opened
uterine vessels.
III- Venous air embolism:
Air is introduced into the uterine veins, to Rt. Heart during douching or
flushing the uterus.
IV- Amniotic embolism: Amniotic fluid, containing vernix and fat can pass through
opened veins to the lungs and cardiac vessels.
V - Acute poisoning: due to rapid absorption of poison from vaginal mucosa.
VI- DIC (disseminated intravascular coagulopathy) in cases with severe bleeding.
VII- Sepsis: (septicemia).
a- In instrumental abortion: occurs early in the first three days.
b- In non-instrumental abortion: delayed and occurs after a week or more.
Diagnosis of Abortion
I- In the living:
1- Patient’s consent: for examination.
2- History is taken.
3- Signs of pregnancy:
a- Breast and abdominal changes.
b- Biological tests of pregnancy remain positive for 2 weeks
after abortion.
4- Signs of general violence: The abdomen and back may show
contusions.
5- Signs of local violence :
Cervix
Vagina:
6- Laboratory investigations:
Syphilis and diabetes.
Blood, urine and stools are examined for abortifacient drugs.
7- Products of abortion:
Precipitin test for products of abortion.
Age of the fetus is estimated and compared with the history.
Fetus macerated: intrauterine fetal death.
II- In the dead:
There will be signs of abortion in the living, in addition to the following:
lOMoARcPSD|369846
1- Peritoneum: shows evidences of peritonitis and perforated or

ruptured uterus.
2- G.I.T shows irritation due to purgatives.

3- Vagina must be examined
4- Cervix must be examined
5- Uterus: must be examined for:
Size.
Contents & Inflammation.

ABORTION

Uploaded by

Copyright:

Available Formats

ABORTION

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ABORTION

Uploaded by

Copyright:

Available Formats

ABORTION

Medicolegal conditions in which a female is examined for abortion:

The obstetrician who carries out a therapeutic abortion has to:

Substances Used in induction of abortion (Abortifacient):

Dangers (Complications) of Abortion

1- Peritoneum: shows evidences of peritonitis and perforated or

2- G.I.T shows irritation due to purgatives.

You might also like