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ABORTION

The

abortion is define as the expulsion of


the products of conception at any period
of gestation before full term that is 280
days.
The
distinction
between
abortion,
miscarriage and premature delivery are
not recognized in law.

Abortion may be
Natural
Induced
1. Legal
2. Criminal

Legal abortion : Is done in conditions

where the continuance of pregnancy would


involved risk:
To the life of mother both Physical and
mentally like.
Organic disease: like: CCF: active T.B. &
sever Diabetes Hypertension complicated
with heart or renal failure.

Renal

disease like Nephrotic syndrome.


Pulmonary Hypertension.
Hepatitis T.B.
P.E.T.
Hydatidfom mole.
Some malignant disease.
Insanity.
If the female expose to German measles
chicken pox. other serious viral infections
in 1st trimester.

Prerequisite for Therapeutic

1.
2.
3.

4.

5.

abortion.
It is essential that operation must be
performed in good faith.
It should be done by trained gynecologist.
Pregnancy can only be terminated by
opinion from two registered medical
specialist.
The termination of pregnancy must be
carried out in government Hospital or at a
place approved by Government.
The written consent of the woman is
essential or from the guardian if she is
lunatic.

Criminal Abortion
It is preformed with criminal intention to get
rid of the fetus.
Method use for Criminal Abortion.
1. The administration of drugs.
2. The application of mechanical violence.

The Administrations of Drugs:


The drugs commonly used as abortifacient may be
classified as

Drugs act directly on the uterus.

Acting indirectly on the uterus.

DRUGS ACTING DIRECTLY ON UTERUS

Ecbolics

These are that increase the contraction of the


uterus: like Ergot, quinine, cotton root bark is
resemble ergot.
Emmenagougues: These are the drug
increased the menstrual blood flow.
Synthetic drugs like Estrogens
Oil of savin.
Borax
The drugs have no effect in pregnancy except
in vary large doses which are sufficient to
produce toxic effect even dangerous to cause
death.

DRUGS ACTING INDIRECTLY ON UTERUS


The drugs commonly used are
1.
Drastic purgative
2.
Emetic
3.

Heavy metals.
Emetics and purgatives are taken on the basis that any
violent stimulation of the gastrointestinal tract may
result in abortion by reflex promoting uterine
contraction.
Purgative like caster oil they cause stimulation of the
gastro intestine tract along with the uterine contraction.
But their action is not constant.

In large doses they cause extensive damage to


the renal glomerulus's and Tubular epithelium &
death.
HEAVY METALS
Mostly lead in the form of Diachylon pills. It is
lethal to the fetus and Mother. It is not only
cause tonic contractions of the uterus but also
toxic effect on trophoblastic epithelium so it
cause abortion of dead fetus.

Application of Mechanical Violence

Mechanical violence may be


General
Local

GENERAL VIOLENCE:
It acts directly on the uterus or indirectly by
promoting congestion of the pelvic organs or
hemorrhage between uterus and membranes.
Such violence includes severe exercise, cycling,
jumping from heights.

LOCAL VIOLENCE
Local VIOLENCE acts by
1.
2.

Causing local irritation followed by septic abortion


Dilatation of cervix with or without rupture of the
membrane.
The method employed depends largely upon the skills
and upon the knowledge of the anatomy of the pelvic
parts and accordingly the interference may be
classified as
Unskilled
Skilled
Semi-skilled

By pregnant female itself use.


1. Self instrumentation by Abortion
stick and Dai & LHV by causing
dilatation of CX and rupturing the
membrane
even
they
cause
curratage under septic condition.
2. Syringing the utrine cavity with
pressure like soap or other chemical
like carbolic acid, such irritant leads
shock, air ambulism and toxicity .

Skilled Abortificient
In 1st 12 week, DxC
After that either use synticnon
drip in D / W in High dose or
prostaglandin or Both,
passaries Vaginally and the
synto. drip followed by DxC.

In 2nd trimester,expulsion by synto.


infusion along with prostaglandien
followed by curratage. Hystrotomy
can be done.

Precautions
Taken by a doctor who deals the patient of
criminal abortion:
1. The
usual: Preliminary History and
examination should be done.
2. The
information regarding a woman
having under gone abortion should be
treated as professionally secret.
3. One should gather as much information as
possible regarding the manner in which
abortion
was
attempted
and
circumstances.

4.

5.
6.

7.

He or she should not attempt any


surgery which could label to criminal
charges if he or she is not trained.
If the patient is seriously ill the
police should be informed.
If death is Imminent he should
arrange for a dying declaration or
dying deposition by informing the
nearest Magistrate.
He should refuse to issue a death
certificate if she dies. But should
report the matter to police.

Cause of Death
i.
ii.
iii.
iv.
v.
vi.

Rapid death due to hemorrhage, toxicity of the


drug use.
Neurogenic shock by dilatation of the cervix.
Air , fat or Amniotic Embolism.
Hemorrhagic shock : By doing the DXC from
utrine cavity or due to perforation of the uterus.
Delayed death due to Septicemia, tetanus
Remote causes, renal failure, meningitis
endocarditic and hepatitis.

Medico Legal Aspect


1.
2.
3.
4.

Law for abortion


When alleged abortion in due to
blow in quarrel.
when female wish to conceal the
pregnancy.
Compensation purpose when
abortion accure due to accident or
quarrel.

Examination of female:1. History: Taking drug, or Method use.


2. Fabricated abortion: she may
exagurrated the offence by simmulating
an abortion in menstrual period.
On examination she looks like:1. Exhausted, running temp. , anemic.
2. There will be injury to the cervix.
3. Foul smelling vaginal discharge. She
may be septic.
4. The uterus will be enlarge with OS
open.

In the Dead.
There will be signs of pregnancy
2. Genital organ; we should look for any injury
or instrumentation in the valve, vagina,
& CX.
3. On opening the Abdomen;
uterus may be perforated, Enlarge.
In septicemic death there will be foci of small
abscesses in all the organs specially in
kidneys
& adenexa .
1.

Histological examination
Specimen should be taken like uterus.
If there is no Injury to the
genital organ specimen should be
taken for toxicological examination.

Classification of criminal
miscarriage

338

A: Isquat i Haml, whoever causes a


woman with child whose organ have not
formed to miscarry, if such misarrange is
not cause in good faith (for the purpose of
saving the life of the women or providing
necessary treatment to her said to cause
Isquat i Haml.
A women who causes herself to miscarry is
within the meaning of this section.

The

statue law of miscarriage in


pakistan takes into consideration
stages of gestation making the
offence more serious if it is done at a
later stage of pregnancy. distinguish
ISQAT-E-HAML from ISQAT-E-JANIN.

1.

2.

Punishment for Isquat i


ImprisonmentHaml
which may extent to
three years if Isquat i- Haml is
caused with the consent of the
woman.
Imprisonment which may extent to
10 year if Isquat i- Haml is caused
with out the consent of the woman.
Provided that as of I.H. may hurt to
the female or dies.

338B. Isquat, Janin


causing a woman with child
whose limbs or organs are
formed to miscarry, if such
miscarry is not caused in a good
faith for the purpose of saving
the life of woman, is said to
cause Isquat i-Janin. A woman
herself to miscarry come with
the meaning of this section.

1.
2.

3.

Punishment of Isquat i
Janin
1 /20 of the Diyat if the child

born dead.
Full Diyat if the child is born
alive but Dies as a result of any
act of the offender.
Punishment
as
Tazir
with
imprisoement
of
either
description for a term will may
extend to 7 years if child born
alive but die, otherwise with
result of any act of t offance. .