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Virginity , Pregnancy & Delivery

Virginity , Pregnancy & Delivery. Virginity. Also known as Virgo Intacta . Definition : Virgin is a female who has not experienced sexual intercourse. Signs of virginity : 1. Extra genital signs (in breast) 2. Genital signs. GENITALS. LABIA MAJORA LABIA MINORA

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Virginity , Pregnancy & Delivery

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  1. Virginity , Pregnancy & Delivery

  2. Virginity • Also known as Virgo Intacta. • Definition:Virgin is a female who has not experienced sexual intercourse. • Signs of virginity : 1. Extra genital signs (in breast) 2. Genital signs

  3. GENITALS • LABIA MAJORA • LABIA MINORA • VAGINAL WALL • VESTIBULE • POSTERIOR COMMISURE • FORCHETTE • FOSSA NAVICULARIS • HYMEN

  4. TYPES OF HYMEN • SEMILUNAR • ANNULAR • INFANTILE • CRIBRIFORM • VERTICAL • SEPTATE • IMPERFORATE • CARUNCULAE MYRTIFORMIS

  5. Other conditions which may affect signs of virginity • Trauma or Accident • Surgical operation or Gynaecological examination • Sanitary tampons • Foreign body – sola pith (APTAE VARIS) • Scratching due to irritation from uncleaniness • Masturbation • Ulceration – d/t diphtheria , fungus, etc.

  6. False Virgins • Hymen is intact but the woman has had sexual intercourse.

  7. Medico legal importance of virginity In Civil cases: • Nullity of marriage • Divorce • Defamation of character • Rape

  8. 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: • Presumptive signs • Probable signs • Positive or conclusive signs

  9. Presumptive signs of pregnancy • Amenorrhoea • Morning sickness • Changes in breasts • Changes in the Vagina • Urinary disturbances- increased frequency of micturition • Chloasma - 24th week • Quickening - 16 – 20 weeks • Linea nigra - 20th week • Striae gravidarum • Sympathetic change -increased salivation -PICA (perverted appetite) -irritable temper.

  10. Changes in Breasts : Breasts enlarged & nodular(2nd month) Surface veins prominent Areola enlarged, pigmented with prominent Montgomery’s tubercles (2nd month). Nipples enlarged Colostrum (3rd month). Changes in Vagina : Jackquemier’s sign or Chadwick’s sign: violet or bluish discolouration of vaginal mucosa (after 4th week).

  11. PROBABLE SIGNS OF PREGNANCY • Enlargement of abdomen • Height of uterus. • Palmer’ssign- regular rhythmic contractions of uterus at 4th to 8th week.

  12. Fundal height

  13. Hegar’s sign -Bimanual examination at 6th - 8th week

  14. Goodell’s sign-softening of cervix at 4th month • Osiander’s sign– increase pulsation felt through lateral fornices at 8th week • ‘Piskacek’s sign – asymmetrical enlargement of uterus if there is lateral implantation. Goodell’s sign

  15. PROBABLE SIGNS OF PREGNANCY • Braxton-hick’ssign-After 15-16 weeks of pregnancy • Ballottement: internal and external (during 4th and 5th month) • Uterinesouffléat end of 4th month • Biologicaltests: Presence of gonadotropins in pregnant woman’s blood and their excretion in urine External ballottement Internal ballottement

  16. Immunologicaltests: • Inhibition (Indirect) Latex slide test • Direct Latex slide test • Haemagglutinationinhibition test. • RIA and ELISA

  17. POSITIVE SIGNS 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.

  18. Signs of pregnancy in Dead • Products of conception • Enlarged Uterus & other uterine change. • Corpus luteum

  19. Medicolegal importance of pregnancy • 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.

  20. 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 trust against a man. • Adultery. • In criminal abortion and to foeticide or infanticide. • Motive for suicide or murder.

  21. Pseudocyesis / False Pregnancy / Spurious Pregnancy / Phantom Pregnancy. • Superfoetation • Superfecundation • Foetus Papyraceous / Foetus Compressus

  22. QUESTIONS

  23. QUESTIONS 1. Uterine soufflé may be heard by auscultation at the end of- • 10wks • 12wks • 14wks • 16wks 2. Foetal parts can be detected by X ray usually by- • 8wks • 12wks • 14wks • 16wks

  24. 3. A pregnant woman sentenced to death cannot be hanged till- • Delivery • Delivery and attainment of 6 months of age by new born • Delivery and one year after that • None of the above 4. Pseudocyesis is found in- • Young married woman • Aged unmarried girl • Menopausal ladies • Adolescent girl

  25. 5. Impregnation of an ovum discharged from a previous ovulation has been developed is called- • Fecundation • Superfecundation • Super foetation • None of the above 6. Which of the following statements is true for virgointacta- • Breasts are large and nodular • Labia majora not apposed with each other • Fossa navicularis is disappeared • Labia minora completely covered by labia majora

  26. DELIVERY • Definition: Expulsion of products of conception from within the uterus at term.

  27. Signs of Recent delivery in Living : General appearances of indisposition : Woman looks pale, exhausted and ill. Breasts: • Enlarged, full, firm, tense. • Darkeningof areola. • Prominent Montgomery tubercles . • Surface veins are prominent . • Striae are seen. • Colostrum can be squeezed out for 2-3 days after delivery.

  28. Abdomen: • Striae gravidarum (pink) • Lineaealbicantes (silvery white) • Linea nigra (black) 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 -lochia serosa (pale or serous) After 9th day -lochia alba (yellowish grey or turbid)

  29. Signs ofRecent delivery in Living: • Extent of signs depends upon whether the woman is primiparous or multiparous • Breast: pendulous • Hyperpigmentation present • Montgomery's tubercles are prominent • Stria are present • Abdomen: abdominal wall is lax • Linea albicantes • Linea nigra

  30. Signs of Remote delivery in Living: • External genitalia: labia are lax • Vaginal rugae are lost • Fourchette is lost • Hymen: carunculaemyrtiformis • Os in Nulliparous:- Internal os is well defined - External os is rounded and orifice closed • Os in Multiparous:-Internal os is not well defined External os is transverse irregular and may admit a tip of finger

  31. Sign ofRecent delivery in the Dead: • Same as are found in living • Additional findings are found in uterus and its appendages • Uterus is firm and returns to a permanent reduced size • Placental site can be identified by its dark colour and coarse granular appearance and covered with blood clots, lymph and decidua. • Ovaries and fallopian tubes are congested • Histopathological examination: - trophoblastic cells and chorionic villi are present in endometrium - one large corpus luteum is present in one ovary

  32. Signs of Remote delivery in Dead : • Same as are found in remote delivery in living • Additional findings are present in uterus and its appendages • Uterus is concave inwards. • Fundus is above the line of fallopian tube • Length of body is twice the length of cervix in multiparous and it is equal in nulliparous. • External os is enlarged, irregular and patulous and admits tip of finger • Internal os is not well defined • Arbor vitae: lost in parous woman

  33. Abortion • Definition: “Termination of pregnancy due to premature expulsion of product of conception at any time from the uterus.”

  34. TYPES OF ABORTION SPONTANEOUS NATURAL ACCIDENTAL 2.INDUCED LEGAL CRIMINAL

  35. Medical termination of pregnancy (MTP)act 1971 • Came into force in 1972 • Amendments in 1975, 2002 and 2003 • 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

  36. Duration of pregnancy for MTP • Below 12 weeks :only one medical officer alone can take decision for MTP • Between 12 to 20 weeks: decision is taken by two medical 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.)

  37. Places for MTP • Any government or semi-government hospital • Any non-government hospital approved by government or CMO or district health officer

  38. 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 surgency 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.

  39. Consent • Only consent of pregnant woman is 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 guardian is required

  40. Common methods of MTP • Medical : mifepristone and misoprostol • Dilatation and curettage (D&C) • Vacuum aspiration technique or surgical abortion • Intra-embryonic instillation of PG • Extra-embryonic instillation of hypertonic saline • Surgical

  41. Complications Immediate: • Haemorrhagic shock • Perforation of uterus, perineum or intestine • Laceration of cervix or vagina • Incomplete abortion • Embolism • Thrombophlebitis

  42. Delayed: • PID • Menstrual irregularities • Sterility • Endometritis • Cervicitis • Vaginitis

  43. Criminal Abortion : • Abortion done against the provision of MTP act.

  44. Legal aspects of criminal abortion: • Sec.312 IPC: Criminal abortion with the consent of patient • Punishment to both for upto 3 year,and +/- fine • If the woman is quick with child then may extend upto 7years • Sec 313 IPC: if abortion done without her consent • Punishment upto 10 years and fine • Sec 314IPC:if woman dies by this act • Punishment upto 10 years and fine

  45. Sec 315 IPC : Any act with the intent to prevent the child being born alive or cause its death before birth • Punishment : upto 10 years and/or fine. • Sec 316 IPC : any act which cause death of quick unborn child amount to culpable homicide • Imprisionmentupto 10 years and fine

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