Pregnancy Delivery Dr Ganesh Govekar Delivery v Abortion

Pregnancy & Delivery Dr. Ganesh Govekar

Delivery v. Abortion v. Infanticide v. Nullity v. Divorce-Higher maintenance v. Execution of death sentence v. Homicide/suicide v. Disputed paternity v. Legitimacy v. Property inheritance v. Higher compenhusband death v. Leave in services

Definition • Complete evacuation of fetus and other conceptional product after attaining the viability. • Full Term • Pre term • Post term

Signs and Symptoms in Recent Symptoms: Fatigue-more in prolonged labour Loss of weight Diuresis- physiological reversal Afterpains- milder after 3 days, 7 th day disappear • Post partum fever (milk fever) • Transient depression (peurperial Psychosis) • • •

signs • Breast- colostrum(2 days) later pure milk • Abdomen- linea albicans Caeserian section • Vagina-smooth walled, relaxed, wide, ironed rugae, lacerated walls, carunculae multiformis • Labia-swollen • Perineum- ruptured fourchette and posterior comm • Lochia- alkaline discharge, sour disagreeable odour • Consists of rbc, wbc, decidual sheds, epithelial cells and bacteria • Lochia rubra- upto 4 days • Lochia serosa-5 th to 10 th day • Lochia alba- 10 th day onwards upto 2 -3 weeks

• Cervix- thin collapsed and flabby • External os – laceration of outer margin, contract slowly, 2 nd day- two finger, 1 wk- one finger • Wall thickened to re-establish. • Uterus- involution • 1 -3 day-fundus midway between umblicus and pubic symphysis • 5 -6 week- normal size • Lab test- biological test- positive upto 7 -10 days after delivery.

• In dead ( Recent-Delivery signs) • As above and • Uterus-

Signs of recent Delivery in dead Uterus 0 D-20× 15 cm-1 kg 4 -5 cm thick 2 -3 D-17. 5× 10 cm-800 gm 1 wk- 5× 3× 2 inch-1/2 kg 2 wk-3× 2 -350 gm 6 wk-N(7 -8 cm) 100 -120 gm Placental sites 15 cm-shortly 3 -4 cm-2 nd wk 1 -2 cm-6 wk

Ovaries & fallopian tubes – congested for few days - large C. L. in one ovary Uterus morphology: 1. LSCS-fresh healing incision 2. -Ant & post wall- 4 -5 cm thick(soon after delivery) -myometrium-basal decidua only -placental site – palm size

-an ischemic appearance 3) 2 -3 days- decidua-2 layers 1. ) Sup-necrotic 2. ) Basal-shed in lochia 4) 2 wk – endometrium-placental site- 3 -4 cm 5) 5 -6 wk- placental site get covered by endometrium

Signs of REMOTE DELIVERY in living 1. ABDO – lax - wt scar-lat wall - linea nigra-present 2. Breast – lax, pendulus soft, wrinkled-due to feeding - linea albican - nipple-enlarged - areola-large, dark, montgomery tub. 3. Vulva- partialy open -perineum-scar

4. Vagina- rugae-absent & walls lax 5. Cervix- ext os-large, transverse In vagina-simple-dimple

Signs of Remote in dead • Uterus- large thicker, heavier • -walls- concave • - body twice the cervix. IN DEAD: Ovaries & F. T. – congested, M. E. – C. Lintact/degenerated Peritoneum- wrinkled & folded Ligaments 1) broad &2) round –lax, take long time to recover

Positive signs of pregnancy: 1. FHS 2. Fetal parts 3. Fetal movements 4. X ray - 2 -3 wk 5. USG - 6 wk IN DEAD 1. enlarged uterus 2. C. L. progre/regre 3. conception product

Superfetation: Twin preg- 2 ova fert at diff cycle Superfecundation: 2 ova discharged at a time Pseudocyesis: false/spurious preg. Pregnancy N-280 days max 320 -350 days min 210 -180 days Negeles rule: - 9 m + 7 days

FHS- definate signs - 18 -20 wks - Muffeled sound - 120 -160 - not synchronus with mother pulse X ray- 15 -16 wk - skull-crescentric - vert col- dots - ribs- curved parallel shadow/lines - limbs - linear shadow spalding collapse- V. C Gas-Heart & Vs.

Sonography - Gast ring- 6 wk Embryo -8 wk F H beat - 12 wk Head & thorax -14 wk Dx – IUGR - malformation

Prenatal diagnosis technique Act 1. Prohibit Dx for sex determination- female foeticide 2. Permit Dx for detection of genetic abnormality Central Govt. - central supervisary board to review implimentation of act. Genetic councelling centre- Get regd. By appro authority. To be done by- Qualified person Consent from female.

Test done if following condition satisfied: 1. Female >35 2. H/O ≥ 2 spont abortion 3. H/O exposure to teratogenic agent 4. H/O mental retardation. Test done for detection of. 1. Chromo. Abn. 2. Genetic/metabolic disorder 3. Hb. Pathy 4. sex linked disorder 5. cong. Abn. Act provides – Appeal - conviction – Dr -3 yr Rigourus - fine 5000 -prof death sente -perm removal for subsequent offence.