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MISCARRIAGE OR ABORTION

Definition:

Expulsion of product of conception at any time before full term.
After a pregnancy is apparent, the loss of the fetus up to 24 weeks is usually called a ‘spontaneous abortion’ or ‘miscarriage’; from 24 weeks to full term, it may be called a ‘premature birth’.
The punishment- 3 years imprisonment to transportation for life.

Classification:
1. Natural:

Spontaneous
Accidental

2. Artificial:

Justifiable
Criminal

Criminal abortion

  • A criminal abortion is the deliberate ending of a pregnancy outside any legal provisions that have been made by the state for this act. A criminal abortion is a serious criminal offence

Methods of performing illegal abortion:

  • Drugs and toxins have been used for millennia to try to remove unwanted pregnancies, but most of them are quite ineffective.
  • In South-East Asia, unripe pineapple is alleged to produce miscarriage. However, none of these substances is known to have any predictable or significant effect on the uterus
  • Other substances that have a contractile effect on smooth muscle have a better theoretical chance of success and these include ergot, pituitary extracts and quinine.

  • Other substances normally used in obstetrics, particularly prostaglandins, are also used to induce abortions and are potentially more potent .
  • Another group of chemicals is the strong purgatives such as colocynth, croton oil or jalap, which simply cause general debility to the woman, but they are highly unlikely to cause an abortion.
  • Instrumentation is commonly practised, involving a wide variety of devices from surgical probes and bougies to the crudest implements made of metal or wood, as well as bicycle spokes, metal coat-hangers or even twigs from trees.
  • The dangers of instrumentation are perforation and infection.

  • The fundus may be perforated and the instrument pushed up into the intestines or even the liver.
  • General violence in an attempt to induce a ‘spontaneous’ abortion may still be encountered on rare occasions.
  • Other methods that are thought to be capable of inducing a ‘spontaneous’ abortion include the taking of very hot baths, ingestion of large quantities of alcohol, vaginal douches with many substances, and violent exercise such as skipping, jumping and even riding horses or bicycles over rough ground.
  • Syringe aspiration is a method used by both legal and criminal abortionists.

Drugs for abortion

Mechanical Violence for Abortion
General:
  1. Violent exercise like jumping, cycling, horse riding, heavy weight lifting, driving on rough roads.
  2. Severe pressure on abdomen- blow, kick, jumping over abdomen.
  3. Cupping on hypogastrium
  4. Hot and cold bath alternatively

Local:
  1. Dilatation of cervix- instrumentation, abortion stick, curettage, electricity.
  2. Local irritation by abortifacient

Legal termination of pregnancy

Many countries now have legal provisions for the medical termination of pregnancy. This is often called ‘therapeutic abortion’,

RULES
  • The termination must be performed by a registered medical practitioner.
  • It must be carried out in a Health Service hospital or a place specifically registered for the purpose.
  • Two registered medical practitioners must examine the woman (not necessarily together) and certify that grounds for termination exist.
  • Neither of these doctors needs to be the doctor who actually performs the operation.
  • The termination must be notified to medical officers of the appropriate government department.

Consent to termination of pregnancy

  • The only consent that is required for termination of pregnancy is from the woman herself, provided she is competent to make that decision.
  • The consent of a husband or permanent partner (if he accompanies the woman) may be obtained as good clinical practice; however, the woman’s wishes are paramount and a husband’s or partner’s objections are not relevant in English law.
  • Any competent young girl may seek medial advice and may consent on her own to an abortion, although for girls under 16 the doctor should seek to encourage them to discuss the matter with their parents or carers

A photograph of only historic interest in the UK. This
woman had died of air embolism after attempting to induce an
abortion with a Higginson syringe, which can be seen below her
right foot.


Autopsy appearance of a septic uterus following an
illegal abortion.

Differences b/w criminal & natural abortion
Natural
  • Cause- natural
  • Genital tract- not injured
  • Foreign body in genital tract- not present
  • Sepsis- not usually
  • Signs of violence- nil
  • Toxic drug effect- nil
  • Fetal injury- nil

Criminal

  • May be injured
  • May be present
  • Frequent
  • Usually present
  • May be present
  • May be present

Complications of criminal abortion

  1. Shock
  2. Haemorrhage
  3. Air or fat embolism
  4. Perforation of uterus
  5. Sepsis
  6. Poisoning by drugs
  7. Sub-involution of uterus
  8. Death