Medico-legal aspects of Virginity Pregnancy and Delivery

1. VIRGINITY,
PREGNANCY
& DELIVERY
Dr Arun Pinchu Xavier
Assistant Professor
Dept: of Forensic Medicine
Sree Mookambika Institute Of Medical Sciences

2. VIRGINITY / CHASTITY
 Female who hasn’t experienced sexual intercourse
 Defloration– deprivation of virginity; rupture of hymen by
the act of coitus.

4. SIGNS OF VIRGINITY
GENITAL & EXTRAGENITAL
GENITAL
 Intact hymen – rigid & inelastic
 Apposing labia majora
 Labia minora not seen outside in normal lithotomy
position
 Fourchette and posterior commissure normal
 Vagina- narrow,tight, sensitive & rugosed

5. WHATS HYMEN THEN...?
 Thin fold of mucous membrane at the vaginal orifice
partially concealing it.
 It has an opening in it,which gives it different names
 Menstrual blood and vaginal secretions flow through it
 Normally ,it admits –tip of small finger
 Structure and consistency of hymen varies
 Bleeds when stretched via the act of coitus, masturbation,
introduction of fingers, tampons or foregin bodies

6. TYPES OF HYMEN

7. CAN THEN A
PROSTITUTE
WHO
POSSES AN
INTACT
HYMEN ,BE
CALLED A
VIRGIN..?

8. STRUCTURE AND CONSISTENCY OF
HYMEN VARIES
 Thin,fleshy ,thick or elastic
 In elastic hymen ,hymenal orifice can be stretched without
tear
 But, a women harboring an intact hymen which admits only
a tip of little finger can be considered VIRGO INTACTA- A
VIRGIN
 Women having a thick fleshy elastic hymen and who has
experienced sexual act is called FALSE VIRGIN

9.  A women is a virgin until she has sexual intercourse
 Presence of unruptured hymen is a presumption, but not an
absolute proof of virginity.
 Hymen can be present always in a virgin in someform or the
other or may be congenitally absent, rarely !
 Hymen ruptures at first coitus & is torn ,but may not be
ruptured even after repeted act of coitus if its, loose folded
elastic thick tough & fleshy which permit displacement of
shape and stretching without rupture..!

10. CHANGES IN GENITALIA DUE TO SEXUAL
ACTIVITY
 First act of coitus ruptures the hymen posteriorly at 6
o’clock Position.
 Frequent coitus ,results in multiple tears, which is then
called as “ CARUNCULAE HYMENALES ”
 After Preg & Delivery hymen will almost be absent except a
marginal attachment – “ CARUNCULAE
MYRTIFORMES”

11. 02.EXTRAGENITAL– BREASTS
 Hemispherical firm & elastic
 Pinkish areola and nipples in fair skinned ,dark brown
in brown skinned.
 It may become large saggy due to frequent handling but
not affected by single act of coitus

12. SIGNS OF VIRGINITY ARE…
 Intact hymen
 Normal condition of fourchette & post comissure
 Narrow vagina + rugosed walls
These signs taken together may be regarded as …

13. FEATURE TRUE VIRGINITY FALSE VIRGINITY
Breasts Hemispherical & firm Pendulous
GENITAL SIGNS
Labia majora Firm, lie in apposition Separated & flabby
Labia minora Pink, soft & sensitive to touch Elongated, brownish,
separate flabby, not
sensitive to touch
Fourchete,post
com
Intact Show healed tear
Vestibule Narrow Wide
Hymen Intact rigid inelastic Intact ,Loose, elastic, thick,
fleshy
Vagina Narrow, rugosity +, firm walls Wide, enlarged & roomy,
less rugousity -

14. MLI of Virginity
 Nullity of marriage– virginity proof of non
consummation
 Divorce
 Defamation of character—illegal damage to reputation
against a person who has alleged that she is not a virgin
 Criminal cases– charge of Rape

15. PREGNANCY

16. PREGNANCY
 Development of an embryo in a female ,when ovum is
fertilized by a spermatozoa.
 Fertilized ovum moves to uterine cavity, gets implanted in
the endometrium and grows into a fetus
 Divided into 3 trimesters
 Written Expressed Witnessed consent has to be obtained ..!
 Signs of pregnancy - Presumptive, Probable & Positive.

17. MLI of Pregnancy
 Women may plead pregnancy to avoid attendance in
the court of law as a witness
 Execution of death sentence
 Fegin preg in maintenance cases
 In an allegation of seduction / blackmailing
 In cases of divorce ,the women may claim to be
pregnant to get more alimony
 Preg due to illicit sexual intimacy - Suicide / Murder
 Maternity leave

18. SIGNS OF PREGNANCY IN THE LIVING ARE
USUALLY
CLASSIFIED INTO 3 GROUPS:
• PRESUMPTIVE SIGNS
PRESUME
• PROBABLE SIGNS
PROBABLE-Uterus
• POSITIVE / CONCLUSIVE SIGNS

19. PRESUMPTIVE SIGNS OF PREGNANCY- PRESUME
PERIODS ABSENT–AMENORRHEA, PIGMENTAION
REALLY TIRED -MORNING SICKNESS
ENLARGED & SORE BREAST
URINARY DISTURBANCES
MOVEMENT OF FOETUS - QUICKENING
EMESIS,NAUSEA - MORNING SICKNESS

20. PRESUMPTIVE SIGNS OF PREGNANCY
PRESUME
PERIODS ABSENT - AMENORRHEA
 Earliest & most important symptom
 Menstrual flow stops after conception and doesn’t
commence again ,until 3 months or more after delivery –
Lactational Amenorrhea
PIGMENTAION OF SKIN
Vulva abdomen armpits becomes dark and dark line extends
from pubis to umbilicus – Linea nigra
Silver-colored lines on abdomen – Striae gravidarum

21. PRESUMPTIVE SIGNS OF PREGNANCY…
REALLY TIRED -MORNING SICKNESS
 Easy fatiguability, hypersalivation, unusual appetite,
increased irritability

22. PRESUMPTIVE SIGNS OF PREGNANCY…
ENLARGED & SORE BREAST
 Progressive enlargement & tenderness
Easily visible superficial veins
 2nd month– hyper pigmentation and small round tubercles
are seen around the areola - Montgomery’s Tubercles
 3rd month– Colostrum - Yellowish fluid rich in fat globules
and phagocytic cells.

23. PRESUMPTIVE SIGNS OF PREGNANCY…
URINARY DISTURBANCES
 Enlarging uterus exerts pressure on bladder
 Disturbances in micturition: increased frequency
MOVEMENT OF FOETUS - QUICKENING
 Feel the movement of fetus
& the movements
increase with intensity.
 Seen by 18-20 weeks

24. PRESUMPTIVE SIGNS OF PREGNANCY…
EMESIS,NAUSEA - MORNING SICKNESS
 Nausea,Vomiting, palpitation,dizziness ,perverted
appetite seen in first month of pregnancy,which disappears
by 2-3 months

25. LINEA NIGRA STRIAE GRAVIDARUM

26. PROBABLE SIGNS OF PREGNANCY
PROBABLE-Utreus
PREGNANCY TEST- Positive
GOODELL’S SIGN-
BRAXTON HICK’S SIGN
BALLOTMENT OF FOETUS
BLUISH DISCOLOURATION
LOWER UTERINE SEGMENT
ENLARGEMENT OF UTERUS
UTERINE SOUFFLE

27. PROBABLE SIGNS OF PREGNANCY
PROBABLE
 POSITIVE PREGNANCY TEST
Bioassay
 Immunoassay
o Haemagglutination inhibition test (Pregnosticon) or
flocculation inhibition of hCG-coated particles
(Gravindex test)
o Radioimmunoassay (RIA)
 ELISA test

28. PROBABLE SIGNS OF PREGNANCY
 GOODELL’S SIGN- Softening of cervix due to
increased vascularity seen at 6-8 weeks, cervix
become patulous as pregnancy advances
 BRAXTON HICK’S Sign: appreciation of
intermittent painless contractions of uterus felt per
abdomen from 16 weeks, 5-20 min interval, lasts for
1-5 mins.

29. PROBABLE SIGNS OF PREGNANCY
 BALLOTMENT OF FOETUS
Bouncing of the foetus in the amniotic fluid which can be
demonstrated fourth to seventh month .
When palpated per abdomen or per vagina
This may not be demonstrable in conditions associated with
a deficiency of the liquor amnii, where the foetus is not
presenting by the cephalic pole.

30. PROBABLE SIGNS OF PREGNANCY
 Bluish Discolouration of the Vagina - detected
between the fourth and 8th weeks of pregnancy.
The discolouration increases in intensity up to
the 16th weeks
 Lower Uterine Segment - Softening & easy
compressibility seen at 6-8 weeks - Hegar’s sign

31. PROBABLE SIGNS OF PREGNANCY
 ENLARGEMENT OF UTERUS
• By the end of 3RD month
,uterus fills the pelvis
• At 5th month ,its midway
between symphysis and
umbilicus
• By the end of 6th month at
umbilicus
• 7th month midway between
umbilicus and xiphisternum

32. PROBABLE SIGNS OF PREGNANCY
UTERINE SOUFFLE
 A soft blowing murmur, which synchronizes with the
mother’s pulse,when the lateral aspects of fundus is
been auscultated.
 Its due to passage of blood through the uterine vessels
 Seen towards the end of 4th month .With increase in the
size of uterus and the fetus inside, the circulation of
blood in uterus is also increased.

33. POSITIVE SIGNS OF PREGNANCY
 Foetal parts & foetal movements
appreciated by18 to 20 wks
 Foetal heart sounds– 120-160bpm,
Fetoscope, usg doppler- 6 wks, pulse echo & real time
sonography- 8 weeks, echocardiography- 7 week
 Radiological demonstration of foetal skeleton– 20 wks,
c/i in 1st trimester
 USG- 4-5th week. gestational ring 4-5weeks,

34. DIFFERENTIAL DIAGNOSIS
OF PREGNANCY

35. PSEUDOCYESIS / SPURIOUS/PHANTOM-PREGNANCY
 Women nearing menopause or in younger women anxious
to have kids
 Most frequently, it is observed in a woman who is
approaching the menopause, when her menstrual flow has
become scanty or has ceased for a time.
 A deposit of fat takes place in the anterior abdominal wall
and omentum or the intestines become distended with flatus
 Changes in breast may be present, women imagine fetal
movements
 Secretions from the breast & intestinal movements.
Presumed to be fetal movements ..!
 Preg test / X-ray examination / USG will solve ..!

36. SUPERFOETATION
 Fertilization of a second ovum in a women already
pregnant and the consequence is the birth of two children
at the same time, one of whom may be mature and the
other immature
 Occurs commonly in septate or bifid uterus
 Different periods– 1- 3months

37. SUPERFECUNDATION
 Two or more ova discharged during same ovulatory period
are fertilized by separate acts of coitus committed at short
intervals ,with the same person or two different persons
MLI-
 Gross variation in the complexion of two
babies may give rise to doubt
of adultery and infidelity..!

38. PEROID OF GESTATION & VIABILITY
Period of gestation is usually 280 days
VIABILITY
Ability of a new born child to have an independent life
apart from the mother.
Children born at or after 180
days may be viable,but usually
210 days is accepted ,for all
legal purposes.

39. DELIVERY

40. DELIVERY
 Process by which fetus is expelled from the uterus
 Normal duration 40 weeks / 280 days from the LMP
 Normally ,delivers near full term.
 She undergoes a process of LABOR, where rhythmic
contractions expel the baby through the vagina.
Labor is divided into 3 stages:
 Dilatation of cervix
 Delivery of baby
 Expulsion of placenta

41. SIGNS OF RECENT DELIVERY IN LIVING
General disposition:
 Languished looks, fatigue
 Slight rise in pulse temp,loss of weight
 Intermittent contractions - after pains for 4-5 days
Breasts:
 Enlarged ,nipples and areola will be dark
 Montgomery's tubercle present
 Colostrum will be replaced by milk
Abdomen:
 Lax, pendulous – striae gravidarum and linea albicantes
 Fundus at the level of umbilicus just after delivery

42. SIGNS OF RECENT DELIVERY IN LIVING…
Vagina & Cervix:
 Perineum shows tears
 Labia will be swollen
 Walls congested, tears excoriations
 External os,will remain patulous for 10-14days, close by
2 weeks, internal os will close by 24 hours
Pregnancy tests:
 Positive test indicates recent delivery/abortion
 HCG will disappear within 10 days

43. Lochia : Discharge from the uterus which lasts for 2-3 weeks
Disagreeable odour
 First few days–RED, lochia rubra
 5-10 days—WATERY & PALE,
lochia serosa
 10th day onwards– thicker, scantier,
white or YELLOWISH white, lochia alba
SIGNS OF RECENT DELIVERY IN LIVING …

44. SIGNS OF RECENT DELIVERY IN DEAD
Duration after delivery Weight in gms Dimensions in cm
Just after 900 20 * 15 * 5
End of first week 500 14 * 8 * 4
5-6 weeks after 80-100 10 * 6 * 2.5
All genital and breast signs will be present as in living
Uterus soft flabby enlarged & later reduces in size .
C/s - shows dark coloured ,irregular areas of placental
attachment covered with blood clots.
Fallopian tubes & Ovaries are congested and one of the
ovaries shows large corpus luteum
This table shows the approximate weight & dimensions of involuting uterus

45. SIGNS OF REMOTE DELIVERY IN LIVING
 Breasts- flabby, pigmented enlarged prominent nipples
 Abdomen -lax with linea nigra & albicantes
 Vagina- lax capacious ,absent rugosity
labia do not close the vaginal orifice completely
Fourchette and perineum reveal old scars
 Hymen – lost and represented carunculae mytriformis

46. SIGNS OF REMOTE DELIVERY IN DEAD
 Uterus usually does not involute as in a nulliparous womb
 Fundus tends to be higher than the line of fallopian tubes
 Cervix and body are about the same length in virgin, while
in parous women cervix, is twice the length
 In virgin there is several mucosal folds in cervical canal –
ARBOR VITAE. It will be lost during delivery
 Histology of the placental site
shows blood pigments
upto 6 months after
delivery.

47. MLI OF DELIVERY
 In cases where there is a dispute over legitimacy/mathernity
 Feigns delivery for some duration and then produce a child,
alleging that it is hers - Fictitious / Suppositous child- with a
motive to extract more money
 Abortion & infanticide – alleged to have aborted/delivered /
killed the child
 Cases of suspected concealment of birth – a child born to a
unmarried / Widow / out of lawful wedlock- she conceals !

48. LEGITIMACY
 Legal state of a person born in lawful marriage
 A child born during continuance of legal marriage,between
his mother and any man or within 280 days after the
dissolution,the mother being unmarried.
ILLEGITIMATE / BASTARD CHILD ,is ..
 One who is born out of lawful wedlock
 Within a wedlock or within competent period after
cessation of relationship of man and wife
 Born within wedlock when procreation by husband is not
possible bcz of congenital or acquired malformations.

49. PATERNITY
 Q arises in legitimacy, posthumous births, supposititious
children, determined by
1. Parental likeness– resemble father in feature, figure,
gesture, personal peculiarities, atavism corroborative
evidence only
2. Developmental defects
3. Blood gp tests or paternity tests
4. DNA fingerprinting

50. DISPUTED PATERNITY

51. DISPUTED PATERNITY
Arises, when a mother of a child, names a person to be father
of child, whereas man denies the accusation
Question of disputed paternity :
CIVIL CASES:
Divorce/ nullity of marriage: husband file divorce suit
Maintenance of claim:
Share of property: pretend to be preg and delivers a child so as
to obtain a greater share of husbands property
CRIMINAL CASES:
Adultery: husband may deny a child born in lawful marriage
Blackmail :for personal gains

52. ATAVISM

53. ATAVISM
 When a child doesn’t resembles its parents but
resembles its grand parents ,such child is atavistic
child and the process is called atavism
 It is due to chance recombination of genes, which
failed to express in the father but not in the child
 Any mental / physical / tendency / a disease peculiar
to remote ancestor may be inherited.

54. RESTORING YOUR INNOCENCE ..!
A surgical procedure that involves restoring to normal,
a torn hymen for cultural, religious or social reasons

55. MAY THE GRACIOUS GOD
BLESS US ALL ALWAYS
WISHING YOU ALL SUCCESS
FOR YOUR UPCOMING
EXAMS
Your valuable suggestions are
entertained -
drpinchu89@gmail.com