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03
October, 2017
BIRTH, ABORTION, INFANTICIDE
Atty. Malaya Capulong, MD, DFM, LLB 4
Department of Bioethics and Legal Medicine

TOPIC OUTLINE o Easy Fatigability

I. Medico-legal Importance of Determining Pregnancy Positive Signs
a. Signs of Pregnancy o Fetal heart sounds
b. Proof of Previous Pregnancy o Outline of fetal parts
II. Abortion o Movement of fetus
a. Clinical Types of Abortion o Radiologic Examination
b. Articles of Revised Penal Code on Abortion Xray
c. Three Stages of a Crime
Ultrasound
III. Methods of Abortion
a. General Violence
b. Local Violence Proof of Previous Pregnancy
c. Use of Drugs Presence of pink-to-pale scars or abdominal striae = striae
d. Surgical Intervention gravidarum
IV. Therapeutic Abortion Fourchette is markedly retracted
V. Proof of Live Birth
VI. Infanticide There may be an episiotomy scar
a. Post-mortem Findings Vaginal examination may show laceration scars of the cervix
VII. Infa Darkened nipple areola
*Text in boxes are notes from Doc
Linea nigra
MEDICO-LEGAL IMPORTANCE OF DETERMINING
Hymen either vanishes or small remnants remain
PREGNANCY (carunculae multiformes)
In cases of abortion, it is important to confirm whether the
woman had been recently pregnant ABORTION
In civil controversies concerning the estate of the dead The termination of pregnancy, before full term or before the
spouse, the pregnancy of the wife affects the disposition of age of viability by the removal or expulsion from the uterus,
property and succession. resulting in or caused by its death (embryo/fetus)
Under the Rules of Court, the advanced pregnancy of a
An abortion can occur spontaneously due to complications
woman can excuse her attendance in court. The execution of during pregnancy
the death sentence of a pregnant woman can be postponed
It can be induced
until she delivers and until the infant is weaned.
Refer to willful killing of the fetus in the uterus
In the crime of infanticide, it must be shown that the woman
Violent expulsion of the fetus from the uterus resulting in its
previously gave birth to a live infant.
death
To support the claim of adultery against the wife, pregnancy
All abortions in our country are illegal
can be made material evidence.
Clinical Types of Abortion
Signs of Pregnancy Missed Abortion
o Usually occurs before the 4th month of gestation when
Pregnancy state of a woman who has within her body the
the fertilized ovum/embryo is destroyed by
growing product of conception.
hemorrhage into the choriospace
o commences from fertilization and terminates upon
o The embryo is either macerated or absorbed
delivery.
o 270 to 280 days from 1st day of LMP. Threatened Abortion
o Hemorrhage without dilatation of the internal cervical
Presumptive of Probable Signs
os
o Cessation of menses
o Morning sickness Inevitable Abortion
o Hemorrhage with dilatation of the internal os
o Changes in her breast
o Progressive enlargement of the abdomen accompanied by rhythmical abdominal pain
o Changes in vagina and the cervix Incomplete Abortion
Jacquemin-Chadwicks sign violet discoloration of o Abortion where not all products of conception were
ant. wall of vagina expelled from the uterus
Hegars sign o Usually necessitates completion curettage to remove
Goodells sign the retained fetal elements
o Funic or umbilical souffl Complete Abortion
o Ballotement o Products of conception are completely expelled
o Braxton-Hicks Sign Spontaneous Abortion
o Bladder irritability o Aka miscarriage
o Capricious Appetite o Expulsion of embryo or fetus due to accidental trauma
o Abnormality in pigmentation linea nigra or natural causes before approx. 22nd week of gestation

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 BIRTH, ABORTION, AND INFANTICIDE

Induced Abortion Yields higher penalty since these people are supposed to
o Therapeutic abortion rpeserve life
Abortion induced to preserve the health of the All of the ff. elements should be present to consider abortion
gravida as a crime:
o Criminal abortion o Pregnant woman
o Defined under the Revised Penal Code o Intent is to abort the fetus
o A physician or midwife induced or assisted in causing
Articles of Revised Penal Code on Abortion the abortion
Article 256: Intentional Abortion A physician or midwife who practices abortion is meted a
Article 257: Unintentional Abortion higher penalty because they make use of their special
Article 258: Abortion practiced by the woman of her knowledge and training for the destruction of human life
parents rather than it preservation, which is contrary to the oath
Article 259: Abortion practiced by physician or midwife or they took. It speaks if greater perversity of evil design.
dispensing of abortives
Three Stages of a Crime
Article 256: Intentional Abortion Consummated
Pregnant woman o End point is realized/achieved
Application of violence or the administration of drug, o Example: Napatay mo yung tao.
especially an abortifacient (Misoprostol) Attempted
The fetus dies as a result o Plan was executed but the end-point was not met
Intent is to abort the fetus intent is proved by the o Example: Papatayin mo sana pero hindi mo napatay
surrounding circumstances (proof of intent) Frustrated
Known in Med Ethics as direct abortion o There was planning and preparation but the plan was
MUST HAVE A MOTIVE/PROOF OF INTENT not executed
o Example: You were planting a bomb, but you were
Article 257: Unintentional Abortion caught by the police
Pregnant woman
METHODS OF ABORTION
Application of violence General violence
Fetus is aborted as a result Local violence
No intent to abort the fetus Use of drugs
Example: You punched a pregnant not knowing she is Surgical intervention
pregnant. The fetus is aborted as a result. You can be
charged with unintentional abortion. Under the criminal law, General Violence
it is not your intended crime that is punished but rather, the Pressure
end of your intended act. o Exerted on the abdomen, usually through kneading,
blows, kicks, tight lacing
Article 258: Abortion Practiced by The Woman or her Exercise
Parents o Riding on horseback, hiking, lifting heavy weights,
Pregnant woman cycling
Intent is to abort the fetus Cupping
Committed by the woman or her parents, never the o Placing a lighted wick over the hypogastrium and
man/husband turning a big glass, mouth downward over the wick
Penalty is lower that the intentional abortion of Article 256 o This probably causes separation of the placenta
because it is on the presumption that it is an unwanted Application of leeches
pregnancy o To the pudenda, perineum
There is built-in mitigating circumstance; the law recognizes Local Violence
that the woman and her parents may not be acting out of evil Douches
intentions but rather a desire to protect their family from Injection of fluid into uterine cavity
shame o Saline used in abortions performed during the 2nd
trimester
Article 259: Abortion Praticed by a Physician or Midwife or Laminaria tent
Dispensing of Abortives o Sticks of seaweed which absorbs fluid swell
A physician or midwife who, taking advantage of their promote dilatation of the cervix
scientific knowledge or skill, shall cause an abortion. o Induces dilatation of cervix leading to abortion
Any pharmacist who, without proper prescription from a Instrumentation
physician, shall dispense any abortiveeven if the abortion o Insertion of foley catheter, hangers or other
is just a secondary effect; especially if the effect is imminent instruments into the cervix and uterus
(e.g. antineoplastic agent)
There is a built-in aggravating circumstance which can never Use of Drugs
be cancelled out by a mitigating circumstance; higher Acting directly on the uterus
penalty than RA 258 o Emmenagogues

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 BIRTH, ABORTION, AND INFANTICIDE

o Ecbolics Misoprostol
Acting through the GUT o A prostaglandin initially developed and marketed as a
o Hyoscine N-butylbromide drug to prevent the development of NSAID-induced
o Oil of tamsy gastric ulcers
o Turpentine o Acts by promoting uterine contractions and ripening
Acting through the GIT (effacement or thinning) of the cervix
o Castor oil o Available in oral preparations and suppositories
o Magnesium sulfate o Very effective. One tables is enough.
With poisonous effect on the body o DOC for abortion according to Doc.
o RU 486 or mifepristone Methotrexate
o Misoprostol o Stops embryonic cells from dividing and multiplying
o Methotrexate and is a non-surgical method of ending pregnancy in its
o Prostaglandins early stages
Prostaglandins
Drugs Acting Directly on the Uterus o Within a few days or weeks of receiving an injection of
Emmenagogues: increases menstrual flow Methotrexate, the pregnancy ends through an
o Direct experience similar to an early miscarriage.
Ergot
Cantharides Surgical Intervention
Potassium permanganate Suction
Bora
o Indirect
Iron
Arsenic
Strychnine
Liver extracts
Castor oil
Ecbolics: stimulates uterine contraction

Drugs Acting through the Geniturinary Tract

Drugs which produce irritation of the GUT and reflexively
incite uterine contractions
o Oil of Tamsy
o Turpentine
o Hyoscine N-Butylbromide
Relaxes the smooth muscle of the gastrointestinal,
biliary, and urinary tracts.

Inhibits cholinergic transmission in the abdominal
and pelvic parasympathetic ganglia
Spasm relief
Cervical dilatation
Drugs Acting through the Gastrointestinal Tract
Causes uterine contractions reflexively
o Castor oil
o Magnesium sulfate
Drugs with Poisonous Effect to the Body
RU 486/Mifepristone
o Synthetic steroid compound used as an abortifacient in
the first two months of pregnancy
o Blocks progesterone receptors that directly cause:
Endometrial decidual degeneration
Cervical softening and dilatation
Release of endogenous prostaglandins
Increase in the sensitivity of the myometrium to
the contractile effects of prostaglandins
Aka morning-after pill
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o In the first 12 weeks, suction-aspiration or vacuum
abortion is the most common method
o Manual vacuum aspiration (MVA)
Consists of removing the fetus or embryo, placenta
and membranes by suction using a manual syringe
o Electric vacuum aspiration (EVA)
Uses an electric pump
Dilation and curettage (D&C)
o A standard gynecological procedure performed for:
Examination of the uterine lining for possible
malignancy
Investigation of abnormal bleeding
Abortion (usually in the 1st trimester)
Dilation and evacuation (D&E)
o Used from the 15th week until approx.. 26th week AOG
o Consists of opening the cervix of the uterus and
emptying it using surgical instruments and suction
STUDY BREAK GAME!
Name that thing:
A. Pleat
B. Front
C. Yoke
D. Placket
 BIRTH, ABORTION, AND INFANTICIDE

A crime is committed but the perpetrator is absolved of

liability, provided the following concur:
o Evil sought to be avoided actually exists
o Injury feared is greater than that done
o No other practical or less harmful way of avoiding
injury
This is not exempting; you are still found guilty of a crime
but your criminal liability is not penalized
Magrereflect sa NBI clearance. You are still considered a
criminal

MEDICO-LEGAL IMPORTANCE OF DETERMINING

PREGNANCY
BIRTH DETERMINES PERSONALITY
o Article 40, civil code
Birth determines personality.
The conceived child shall be considered born for all
purposes that are favorable to it, provided it be
Partial birth abortion (3rd trimester abortion) born later with the conditions specified in the
o Performed during a later stage of pregnancy following article.
o Late-term abortion is more controversial than abortion o Article 41, civil code
in general because the fetus is more developed and For civil purposes, the fetus is considered born if it
sometimes viable (usually done during the second half is alive at the time it is completely delivered from
of 3rd trimester) the mothers womb.
o Induced abortion procedure that occurs after 20th week However, if the fetus had an intrauterine life of less
AOG than 7 months, it is not deemed born if it dies
o Intact dilation and extraction, intact dilation and within 24 hours after its complete delivery from
evacuation, intrauterine cranial decompression the maternal womb.
o You are delivering the baby to kill it. SCENARIO IMPLICATION
If born full term, and Issuance of a birth
survives at least within 24 certificate is a must
hours All beneficial things given
Regarded as having to him before birth shall
been born be granted
The state recognizes his
estate; his legal heirs will
be his parents
If born <7 mos., <500 The law does not
grams and dies in <24 hrs recognize his birth
Regarded as not He will not get the
having been born benefits given to him
(abortus) before he was born
Example: a child was born at 27 weeks AOG. He was born on
January 31, 2016 and died on February 2, 2016.
The state recognizes his birth

Example: a child was born on January 31, 2016, 27 weeks AOG.

Twelve hrs. later, he died. Furthermore, his grandfather died on
December 2015 and left his future grandchildren with millions of
money.
The child will not be entitled with the inheritance.
Ang pwedeng makakuha ay yung parents.
Guided by ultrasound, the baby's leg is grasped with forceps. The
BIRTH OF A CHILD IS A CAUSE TO REVOKE DONATION
baby's leg is pulled out into the birth canal. The baby's entire
o Article 760, civil code
body, except for the head, is delivered. A scissor is jammed into
the baby's skull. The scissors are removed and a suction catheter
PROOF OF LIVE BIRTH BEFORE PROSECUTION FOR
is inserted. The child's brains are sucked out, causing the skull to
INFANTICIDE
collapse. The dead baby is then removed.
o All full-term babies must have a birth certificate and
THERAPEUTIC ABORTION death certificate (unlike premature babies)
Article 11, No. 4, Revised Penal Code Justifying
Circumstances

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 BIRTH, ABORTION, AND INFANTICIDE

PROOF OF LIVE BIRTH

Presence of cardiac action and circulation
Movement and crying
Respiration
Stomach contents (besides amniotic fluid)
Changes in middle ear
Condition of the skin
Marks of violence
Changes in the umbilical cord
Condition of the heart and blood vessels

INFANTICIDE
Article 255(Revised Penal Code)- Infanticide
The killing of a child less than 3 days old
If committed by the mother or the maternal grandparent,
penalty is less
If committed by anyone else, the penalty is that for murder
(including father of the child and paternal grandparents)
May be a crime of omission or commission

Post-mortem Findings
1. Signs of physical violence (shaken-baby syndrome)
2. Mouth and upper GIT may have signs of irritation
3. Laceration or other injury of respiratory tract
4. Lungs have petechial hemorrhages
5. Fractures

Legal Importance of Pregnancy

Pregnancy is a ground for suspension of the execution of the
death sentence
Concealment of pregnancy is a ground for annulment of
marriage
Conceived child can receive donations
Conceived child may exercise civil rights

Personality and Capacity

Civil personality: external manifestation of juridicial capacity
to act. The aptitude of being the subject of right and
obligations.
Capacity to act: the power to do acts with legal effects. It may
be modified by:
o Age
o Insanity
o Imbecility
Juridicial personality: fitness to be the subject of legal
relations. Inherent in every natural person.
TRANSERS MESSAGE
MORE NAME THAT THING QUESTIONS:

Answers: Study Break: Placket. 1. Carnation, 2. Winglet, 3.

Persimmon, 4. Foil, 5. Radicchio

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