Pregnancy

Def: it is a state in which a woman carries a fertilised

ovum in to the uterus.
Or
Pregnancy in woman is due to embedding of a
fertilised ovum or zygote deep in endometrium of the
uterus.
• Ovum is fertilised in isthmus of fallopian tube within
12-24 hrs of ovulation and it came down to uterine
cavity by 4th day and gets implanted on uterine wall
after about 7th day of fertilisation.
• The fertilised ovum is known as zygote and after
implantation it is called as embryo.
• Pregnancy continues normally for 10 lunar months
or 40 weeks or counting from date of last period to
9 calendar months & ± 7 days.
• Medicolegal aspects of pregnancy:
A. Criminal aspect:
1. Execution of death sentence:
When a pregnant woman is declared a capital
punishment after a crime, the execution of
punishment may be is delayed until 6months pass
after the birth of child so that she can feed the
child till that period. In some cases the punishment
is commuted to imprisonment.
2. When a woman due to advanced stage of
pregnancy expresses her inability to present in trial
of a criminal court, the trial of the case is
postponed to next date.
3. When a pregnancy is claimed as a result of rape,
kidnapping & seduction.
4. Pregnancy in unmarried girl of 16 yrs or in married
girl of 15 yrs is considered as offence.
5. A pregnant woman may bring charge of criminal
breach of trust against man who promised to marry
her.
6. When a woman claiming to be pregnant by a man
tries to blackmail her.
7. Pregnancy of a woman who had no contact with
her husband for reasonable time and had
pregnancy, can charge of adultery against man who
make her pregnant.
8. Pregnancy may be cause of homicide of an unmarried
woman or widow.
9. In case of suicide of pregnant unmarried woman or
widow.
10. When a question of pregnancy is related with
abortion or concealment of birth.

B. Civil aspect:
1. Nullity of marriage: if at a time of marriage, a woman
is pregnant then the marriage may be declared as
null.
2. If a woman has no contact with her husband for a
reasonable period matching with her pregnancy, then
3. Inheritance of property: when a pregnancy is
followed by death of husband, a widow may claim
for greater share of ancestral property of husband.
4. In divorce case pregnant woman is allowed for
higher maintenance.
5. Compensation case: death of a husband of a
pregnant woman may allow her for higher
maintenance.
6. Pregnancy beyond the scope of lawful marriage
makes the baby illegitimate.
7. Working pregnant woman are allowed additional
leave facility.
8. A civil compensation case can be allowed for
slanderous allegation of pregnancy against an
unmarried woman or widow.

• Diagnosis of pregnancy:
- Diagnosis of pregnancy is not difficult but it is
required full proof in medicolegal field.
- Forensic medicine prefers to categorise different
signs as presumptive, probable & positive signs of
pregnancy, so that he knows and can present in
court with due weightage about changes of
pregnancy in a woman.
A. Presumptive signs of pregnancy:
- Certain changes appear in woman during pregnancy
due to hormonal changes and mechanical causes:
1. Amenorrhoea: This is the earliest and one of the
most important symptoms of pregnancy. After
implantation of zygote the corpus luteum becomes
active and releases hormones which results in
amenorrhoea. However amenorrhoea is not only
result of pregnancy, there are many other causes to
be ruled out.
2. Changes in breast: breasts are enlarged and
pendulous. Tingling & tense feeling evident by 6th -
8th week.
on palpation, the hypertrophied alveolar ducts gives
a nodular feeling. Surface veins become prominent.
Areola is enlarged, dark pigmented. Enlargement of
Montegomery’s tubercle(sebaceous glands).
Nipples are enlarged and secretion of
colostrum(pale yellow fluid) starts by 3rd month.
After 6th month, silvery lines/striae are seen.
3. Morning sickness: It usually appears about the end
of the 1st month & disappears by end of 3rd month.
Nausea and vomiting are usually present in the
morning and pass off in a few hours. It more
prominent in primigravidas.
4. Pigmentation of the skin: The vulva, abdomen and
axillae become darker due to the deposition of
Pigment.
5. linea nigra (appear by 20th week): a vertical
pigmented line appears over the midline of
abdomen from umbilicus to symphysis pubis.
6. Quickening: Near about 18th week (16th week in
multipara), the pregnant woman feels slight fetal
movements in her abdomen.
7. Striae gravidarum: multiple transverse or oblique
stripes appears over abdomen due to fibrous
changes in tissue due to over stretching of
abdominal wall.
8. Chloasma: Pigmentation over forehead and cheek
may appear at about 24th week.
9. Urinary disturbances: During 1st trimester, the
enlarging uterus exerts pressure on the bladder and
produces frequent micturition. This gradually
disappears after 12th week as the uterus
straightens up into the abdomen and reappears few
weeks before term when the head descends into
the pelvis.
10. Jacquemier's or Chadwick's sign: The mucous
membrane of the vagina changes from pink to violet,
deepening to blue as a result of venous obstruction
at about 8th week of pregnancy.
11. Easy fatigue: easy fatigue and mood changes.
12. Perverted desire for spicy food.

B. Probable signs of pregnancy:

1. Enlargement of abdomen(fundal height): During
pregnancy, abdomen gradually enlarges in size
after the 12th week. During the last two months,
the uterus sinks into the pelvis and tends to fall
forward due to its weight.
Uterus feels soft and elastic and becomes ovoid in
shape which changes to spherical shape beyond 36th
week.
2. Hegar's sign: It is positive between 6-10th week.
• Demonstration: If one hand is placed on the abdomen
and two fingers of other hand in the vagina, the firm
hard cervix is felt and above it the elastic body of the
uterus, while between the two, isthmus is felt as a
soft compressible area. This is the most valuable
physical sign of early pregnancy.
3. Anteroversion of uterus: uterus is normally in
anteroverted position. This anteroversion is increases
during first few month of pregnancy.
4. Goodell's sign: As early as 6th week, the cervix
progressively softens from below upward. Pregnant
woman's cervix feels like lips and non-pregnant
The cervical orifice, during last months of pregnancy,
becomes circular instead of being transverse and
admits the point of finger to a greater depth.
5. Uterine souffle: due to increase in size of uterus
and foetus, the blood supply is increased through
uterine vessels. So during auscultation of lateral
wall of fundus, murmur is heard which is
synchronises with mother’s pulse. It becomes more
prominent from the end of 4th month.
6. Ballottement (toss up like a ball): This is positive
during the 4th-5th month of pregnancy as the fetus
is small in relation to the amount of amniotic fluid
present.
Demonstration
• Vaginal/internal ballottement: Two fingers are
inserted into the anterior fornix and a sudden
upward motion given. This causes the fetus to move
up in the liquor amnii and after a moment, the fetus
drops down on the fingers, like a ball bouncing
back.
• External ballottement: A sudden motion is given to
the abdominal wall covering the uterus, in a few
seconds the rebound of the fetus can be felt.
7. Braxton – Hick’s sign: they are seen after 15-16
weeks of pregnancy.
They are intermittent,spasmodic, painless uterine
contractions & relaxations are observed rarely
before the 3rd month, but are easily felt after the
4th month. Each contraction lasts for about a
minute and relaxation for about 2-3 min. They are
present even when the fetus is dead.
8. Biological test: test for human chorionic
gonadotrophin in urine. HCG is secreted by placenta
and is detected in woman’s blood and urine by 2nd
week of pregnancy.

c. Positive/conclusive signs of pregnancy:

1. Foetal heart sounds: Definite sign of pregnancy.
They are heard between 18-20th week with an
ordinary stethoscope. The sounds are like the
ticking of a watch placed under a pillow. The rate is
usually about 160/min at 5th month and 140/min
at 9th month, and is not synchronous with the
mother's pulse.
Even with foetus inside the FHS are absent before 18
weeks, dead foetus, obese woman & hydramnios.
2. Foetal movements and parts: Foetal movements
and foetal parts can be identified distinctly by 20th
week on abdominal palpation.
3. Radiographic imaging: x ray after 3rd month shows
crescentic skull shadow, Series of small dots of
vertebral column, ladder like arrangement of ribs. X
ray examination can be done in USG of woman.
4. Ultrasonography : Intra-decidual gestational sac is
identified as early as 29-35 days of gestation. Fetal pole
and embryonic movements by 7th week. Transvaginal
sonography (TVS) can detect cardiac activity by 5th
week and transabdominal sonography by 6th week.
Detection of sex is possible but is against law.
5. Fetal cells in mother’s blood: It can be detected by
5th week of pregnancy. Even the sex of the fetus
can be determined by karyotyping these cells.
• Diagnosis of Pregnancy in the Dead:
External physical changes should be noted. In the
internal examination, following should be looke for:
i. Presence of embryo, fetus, placental tissue or
membranes—positive proof of pregnancy
ii. Enlarged and thickened uterus
iii. Corpus luteum in ovary.

• Pseudocyesis (Spurious/False/Phantom Pregnancy)

Definition: It is a psychological disorder where a
woman has the false but firm belief that she is
pregnant, although no pregnancy exists.
- It is generally observed in infertile females /women
nearing menopause, who desire a child intensely.
- Most of these women suffer from some form of
psychic or hormonal disorder.
- Such patients may present with all the subjective
symptoms of pregnancy including cessation of
menstruation and associated with a considerable
increase in the size of the abdomen which may be due
to abnormal deposition of fat or due to pathological
conditions, like ovarian tumor or ascites.
- The woman may have imaginary or false feeling of
movement of foetus inside.
- If not diagnosed earlier, the condition may continue for about full
period of pregnancy and the woman may even have false labor
pain.
- Obstetrical examination along with ultrasonography
and/or immunological tests for pregnancy will clear
the patient of her imagination.

• Superfoetation:
Definition: Fertilization of two ova discharged from ovary at
different periods of ovulation.
• It is fertilization of second ovum in a pregnant woman.
• In this, one fetus always remains more developed than the other
and may be born either at the same time showing different
maturation or may born at different periods, varying from 1-3
months.
• Superfecundation:
Definition: Fertilization of two ova discharged from
ovary at the same period of ovulation by two different
acts of coitus committed at short intervals.
- The term is also used to refer to instances of two
different males fathering fraternal twins, though this
is more accurately known as heteropaternal
superfecundation. This leads to the possibility of
twins also being half-siblings, classic example being
one baby is white and the other black.
- There are two placentas, circulation through one
may be better than other.
• Medicolegal aspect of superfoetation &
superfecundation:
- These conditions are essentially twin pregnancy and
being the product of two separate sexual contacts.
- Gross variation between the complexion and other
features of the two babies after birth give rise to
doubt of adultery and infidelity.
- Disputed paternity of either or both the babies.
- Blood group and DNA test are required in such
cases.