Sie sind auf Seite 1von 38

Chapter XXII

Pregnancy

Annie Grace D. Villanueva

Pregn
ancy

state of a woman who has


within her body the
growing product of
conception or a
fecundated germ.

Legal Importance of the


Study
of
Pregnancy
1.Pregnancy is
a ground
for the
suspension of the execution of
the

death

woman.

sentence

in

Art. 83, Revised Penal Code


The death sentence shall not be inflicted upon a
woman within the three years next following the
date of the sentence or while she is pregnant, nor
upon any person over seventy years of age.

Legal Importance of the


Study
of
Pregnancy
1.Pregnancy is
a ground
for the
suspension of the execution of
the

death

sentence

in

woman.
2.A conceived child is capable
of receiving donation.

Art. 742, Civil Code


Donations made to conceived and unborn children
may be accepted by those persons who would
regally represent them if they were already born.

Legal Importance of the


Study
of
Pregnancy
1.Pregnancy is
a ground
for the
suspension of the execution of
the

death

sentence

in

woman.
2.A conceived child is capable
of receiving donation.
3.A

conceived

child

exercise civil rights.

may

Art. 40, Civil Code


Birth determines personality; but the conceived
child shall be considered born for all purposes that
are favorable to it, provided it be born later with the
condition specified in the following artiocle.
Art. 41, Civil Code
For civil purposes, the fetus is considered born if it
is alive at the time it is completely delivered from
the mothers womb. However, if the foetus had an
intrauterine life of less than seven months, it is not
deemed born if it dies within twenty-four hours after
its complete delivery from the maternal womb.

Legal Importance of the


Study of Pregnancy
1. Pregnancy

is

ground

for

the

suspension of the execution of the


death sentence in a woman.
2. A

conceived

child

is

capable

of

receiving donation.
3. A conceived child may exercise civil
rights.
4. Concealment of the woman that she is
pregnant at the time of marriage is a
ground for the annulment of marriage.

Art. 85, Civil Code


A marriage may be annulled for any of the
following causes, existing at the time of the
marriage:
(4) That the consent of either party was obtained
by fraud, unless such party afterwards, with full
knowledge of the facts constituting the fraud,
freely cohabited with the other as her husband
or his wife, as the case may be.
Art. 86., Civil Code
Any of the following circumstances shall
constitute fraud referred to in Number 4 of the
preceding article:
(3) Concealment by the wife of the fact that at
the time of the marriage, she was pregnant by a
man other than her husband.
No other misrepresentation or deceit as to
character, rank, fortune or chastity shall
constitute such fraud as will give grounds for
action for the annulment of marriage.

Instances Why Some Women Claim


Pregnancy Even if None Exists

1.Pregnancy is a ground for


the suspension of the
execution of the death
sentence in a woman.
2.A lawful plea in mitigation
when charged with theft.
3.A ground for widows larger
claim.
4.Claim for the posthumous
child.
5.For black-mailing purpose.

Instances Why Some Women Deny


the Existence of Pregnancy

1.When there is no ground


for

them

to

become

pregnant.
2.Defense when accused
with

infanticide

abortion.
3.Marriage inducement.

or

Medical Evidences
of Pregnancy
Presumptive or
Probable
Signs and
Symptoms

Positive Signs
and Symptoms
of Pregnancy

Medical Evidences
of Pregnancy
Presumptive or
Probable
Signs and
Symptoms

Other causes that could cause cessation of menstruation:

Cessation of
Menstruation

Presumptive or
Probable Signs
and Symptoms

Emotional disturbance
Anemia
Systemic infection
Disturbance in the function of the ovary

Other causes that could cause morning sickness:

Morning Sickness
Cessation of
Menstruation

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Hypertonicity of the stomach


Peptic ulcer
Gastric hyperactivity

Morning Sickness
Cessation of
Menstruation

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Changes in the
Breast
Increase in size
Sensation of tightness
Pinkish brown areloae changed to dark-brown or black
Tubercles of Montgomery developed
Tissues erectile
Colostrum found in third month

Morning Sickness

Changes in the
Breast

Progressive Enlargement
of the Abdomen

Cessation of
Menstruation

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Relationship between age of fetus and the level of the fundus:


3
4
5
6
7
8
9

calendar
calendar
calendar
calendar
calendar
calendar
calendar

months
months
months
months
months
months
months

3 fingers above pubic bone


Between the symphysis and pubis
3 fingers below the umbilicus
At the level of the umbilicus
3 fingers above the umbilicus
6 fingers above the umbilicus
More than 8 fingers above the umbilicus

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Progressive Enlargement
of the Abdomen

Jacquemin-Chadiwcks Sign
There is pale violet discoloration of the anterior wall of
vaginal wall and softening of the cervix.
Hegars Sign
Bimanual examination of gravid uterus shows extreme
softening of the cervix.
MacDonalds Sign
On account of the softening of the isthmus, the fundus of
the uterus is anteflex, so by bimanual examination, there is an
easy approximation of the fundus and the cervix.

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Goodells Sign
When the cervix feels as hard as the tip of the nose,
pregnancy does not exist, but when it is as soft as the lips,
the uterus is gravid.

Changes in color of
the vagina and
softening of the
cervix

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle

The whistling sound synchronous with the fetal


heart beat.

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Changes in color of
the vagina and
softening of the
cervix

Morning Sickness
Cessation of
Menstruation

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle

This is the feeling perceptible to the fingers


placed on the abdomen on giving sudden impulse to
the child through the neck of the uterus.

Changes in color of
the vagina and
softening of the
cervix

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle
Braxton-Hicks
Sign

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

This is the rhythmical contraction and relaxation of


the uterus perceptible to the hand when resting on the
abdomen.
Interval of contraction is 5-20 min and lasting from
2-5 min.

Changes in color of
the vagina and
softening of the
cervix

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle

Noticeable at the second month of pregnancy. However,


Braxton-Hicks
no diagnostic value because even a non-pregnant woman
Sign
may manifest the same symptom.

Bladder Irritability

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Changes in color of
the vagina and
softening of the
cervix

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle
Braxton-Hicks
Sign
Bladder Irritability

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Capricious
Appetite
Changes in color of
The desire for a particular class or kind of
vagina
food may show in the
women
duringand
the early
stage of pregnancy
or
even
thereafter.
softening of the
However, its presence is not conclusive of
cervix
pregnancy.

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle
Braxton-Hicks
Sign
Bladder Irritability

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

Pregnant women usually


manifest pigmentation in
Capricious
some parts of the body especially in the
Appetite
abdomen and perineum.
Changes in color of
However, pigmentation may also present in some
the vagina and
diseases, like Addisons disease.

Abnormality in
Pigmentation

softening of the
cervix

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle

Easy Fatigability
Braxton-Hicks

Presumptive or
Presumptive or
Probable Signs
Probable Signs
and Symptoms
and Symptoms

This may be due to the weight of the gravid


Sign
uterus and insufficiency of nutrient and oxygen
supply to the tissues if the body due to the
deviation of a portion to the growing fetus.
Bladder Irritability
However, may also present in cardiac and
pulmonary diseases.

Capricious
Appetite
Changes in color of
the vagina and
Abnormality in
softening of the
Pigmentation
cervix

Morning Sickness
Cessation of
Menstruation

Changes in the
Breast

Ballottement

Progressive Enlargement
of the Abdomen
Funic Souffle or
Umbilical Souffle

Easy Fatigability
Braxton-Hicks
Sign
Bladder Irritability

Presumptive or
Probable Signs
and Symptoms

Capricious
Appetite
Changes in color of
the vagina and
Abnormality in
softening of the
Pigmentation
cervix

Medical Evidences
of Pregnancy
Positive Signs
and Symptoms
of Pregnancy

Hearing of the Fetal Heart


Sounds (Mayors Sign)
The fetal heart sound is compared to that of the
ticking of the watch under the pillow.
Location is at the anterior abdominal wall and
is dependent upon the presentation and position
of the fetus.

Presumptive or
Positive Signs
Probable Signs
and Symptoms
and Symptoms
of Pregnancy

Outlining of the
Fetal Parts
By palpation, we can determine the
head, neck, arm, back and buttocks. If
these parts could be outlined, the
pregnancy is sure.
However, it may be confused with
irregular ovarian cyst.

Hearing of the Fetal Heart


Sounds (Mayors Sign)

Presumptive or
Positive Signs
Probable Signs
and Symptoms
and Symptoms
of Pregnancy

Outlining of the
Fetal Parts

Hearing of the Fetal Heart


Sounds (Mayors Sign)

Movement of the
Fetus (Quickening)
Observed
at
the
fifth
month
of
pregnancy, this can be felt if the
pregnant woman and may be visible to
other observers.

Presumptive or
Positive Signs
Probable Signs
and Symptoms
and Symptoms
of Pregnancy

Outlining of the
Fetal Parts

Hearing of the Fetal Heart


Sounds (Mayors Sign)

Movement of the
Fetus (Quickening)

Fetal skull and vertebra are visible with


ray examination at the fifth month
pregnancy.
Also valuable to determine the presence
plural pregnancy, malformation and death
the fetus.

X-ray Examination

xof
of
of

Presumptive or
Positive Signs
Probable Signs
and Symptoms
and Symptoms
of Pregnancy

Outlining of the
Fetal Parts

Hearing of the Fetal Heart


Sounds (Mayors Sign)

Movement of the
Fetus (Quickening)

X-ray Examination

Presumptive or
Positive Signs
Probable Signs
and Symptoms
and Symptoms
of Pregnancy

Laboratory Test
for Pregnancy
1.Pregnancy Slide Test

a) Principle An agglutination-inhibition reaction is used to


demonstrate the hormone HCG which is excreted into the
urine during pregnancy.
b) Reagents (1) Pregnancy Slide Test antiserum (2)
Pregnancy Slide Test antigen
c) Procedure Place 1 drop of urine, then 1 drop of PST
antiserum in one of the circles on the test slide and mix
thoroughly with a stirring rod. Add 1 drop of PST antigen 2 .
Mix well with a stirring rod. Carefully agitate the slide with
a circular motion ensuring that the fluid revolves all over
the circle. Read the result after 2min.
d) Interpretation of result No agglutination means positive
e) Sensitivity HCG concentration of 1.5-2.4 IU/ml urine
f) Remarks Fresh urine preferably in the morning.

2.Gravindex HCG Slide Test


- principle and procedure involved same with the
Pregnancy Slide Test

Signs of Pregnancy in
the Dead
Presence of Ovum
or Fetus
Examination will reveal
product of conception
together with the
placenta, amniotic fluid,
and membrane.

Findings on the
Uterus Itself
Examination will reveal
thickening, increase in
size and capacity of the
uterus. The mark of
placental
attachment
may be seen.

Corpus Luteum

Examination may reve


a well-developed corpu
luteum with a certa
size, however, it ma
gradually retrogress.

Duration of Pregnancy
Average duration is 270 280 days from the onset of last menstruation.
It is hard to ascertain the exact date of fertilization.

Abnormally Prolonged Gestation


In all cases where the gestation much over 300 days is alleged, confirmatory
evidence should be expected in the exceptional weight and size of the child.

Minimum Period of Gestation Compatible with Viability of


the Child
A child born at 180 days of gestation may live.
Before that period, may exhibit signs of life but cannot continue to live, owing
the want of development of the breathing muscles and breathing center.

Methods of Estimating the


Date of Expected Delivery
o

From the date of the first day of the last menstruation, add
seven days and count three months backwards.

Count forward nine calendar months from the date of the first
day of the last menstruation and add one week.

Count forty weeks or ten lunar months from the date of the first
day of the last menstruation.
Measure the distance of the symphysis pubis up to
the fundus of the uterus in centimeters divided by
Determination
of the
level of
fundus(MacDonald
of the uterus.
3.5 gives the age
in month
ofthe
gestation
Method).
Count ahead 24 weeks in multigravidas and 22 weeks in
primagravidas from the date of the quickening.

o
o
o

Proofs of Previous
Pregnancy
Laxity of the abdominal
wall.

Vestige only of the


hymen is present
(caruncula
myrtiformis).

Presence of striae of
pregnancy on the
abdominal wall.

Perineum is lax with a


scar if there was a
previous laceration.
Fourchette is markedly
retracted.

Breast is lax with enlarged nipples. Vaginal examination


shows previous
laceration of the
cervix.

Superfecu
ndation
Fertilization made by
separate intercourses of
two ova which have
escaped at the same act
of ovulation.

Superfoet
ation

Fertilization of two ova


which have escaped at
different

acts

of

Possible

before

the

decidua

vera

has

ovulation.

united

with

decidua

Pseudocyesi
s
or Spurious
Pregnancy

Imaginary pregnancy usually observed in


women nearing menopause or in
younger women who are very desirous of
having children.
Patients will present:
All the subjective symptoms.
Increase in abdominal size due to abnormal fat
deposition or tympanism.
Abnormalities with the menses.
Fetal movements which are in reality muscle

Diagnosis of Fetal
Death

1. Repeated examinations of the uterus show that the size remains stationary even after
a lapse of a number of weeks or months.
2. Endocrine test for pregnancy is negative on more than one occasion.
3. Cessation of fetal movements after they have been felt.
4. Absence of fetal heart sounds after a repeated and prolonged examination.

Later months
of pregnancy

5. Positive signs of fetal death as shown by the palpation of softened macerated

fetal head, with bones freely moveable on each other and the scalp hanging
over a loose sac.
6. The breast cease to enlarge and become soft and flabby.

Is It Possible of a Child
to be Born Without
Human Form?
Present
civil
code
eliminated
human
form as a requisite for
the personality of a
new-born
child.
Monstrosities and other
forms of abnormalities
does not divorce from
the child the human
form. Who
May a Woman
is
Pregnant
Be
Unconscious of Her
Condition?

Can Impregnation
Occur When The
Woman
Is
Unconscious?

May happen in rare


circumstances
in
women who have
already
dismissed
the possibility of
being pregnant.

A woman may be
under the influence
of
narcotics,
anesthesia, alcohol
or other knock-out
drugs.

When
Menstruation
Commence?

When
Does
Menstruation
Cease?

Does

In the Philippines, it
commences at the
age of 12-14.

What Is The Earliest


Age When Pregnancy Is
Possible?
As long as the woman is
menstruation, she has
the potential capability
of being pregnant.

Also
called
as
climacterium
or
menopause. The
average
age
when
menstruation
ceases is 45.