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VIRGINITY, PREGNANCY, DELIVERY AND LEGITIMACY

Definitions:

Virginity: a virgin is a woman who has never had any sexual intercourse.
Defloration: loss of virginity

SIGNS OF VIRGINITY
  • Breasts: hemispherical, firm and rounded.
  • Nipple: small, undeveloped, areola is pink.
  • Labia majora: firm, elastic, rounded & completely.
  • Labia minora: soft, smooth, small, sensitive & pink in color.
  • Fourchette & posterior commisure: intact.
  • Vaginal wall: closely approximated.
  • Vaginal mucosa: rugose, reddish, sensitive to touch.
  • Hymen: intact, deeply situated in children & superficial after puberty, soft to firm in consistency & usually annular or semilunar in shape.



Different types or shapes of hymen:

  • Annular or circular (with a central aperture)
  • Cresentic or semi lunar
  • Fimbriated or notched
  • Septate (divided into two openings by a septum)
  • Cribiform (with several openings)
  • imperforate

Difference between fimbriate & torn hymen

Fimbriate

  • Notches are symmetrical
  • Notches occur anteriorly
  • Do not extend to vaginal wall
  • Mucus membrane intact
  • No signs of inflammation

Torn Hymen

  • Irregular
  • Usually posteriorly
  • Extend to vaginal wall
  • Damaged
  • Signs of inflammation present

Signs of defloration:
  • Carunculae myrtiformes: several small, granular tags or knobs of tissues (remnants of hymen).
  • Labia majora & vagina: lose of tone and rugosity.
  • Labia minora: leathery and hard.


Conditions causing ruptured hymen before coitus
  • Accidents
  • Masturbation
  • Instrumentation by doctors
  • Artificial dilatation of vagina by foreign bodies for prostitution
  • Passage of large blood clots

True virgin

  • Hymen is intact & the woman has had no sexual intercourse.
  • It only admits tip of little finger in vagina.

False virgin

  • Hymen is intact but the woman has had sexual intercourse
  • It can easily admit two fingers in vagina.

MLI of Virginity
  • Divorce
  • Defamation (chastity)
  • Rape

Signs of prgenancy in living:

Subjective

  • Cessation of menstruation
  • Morning sickness
  • Sympathetic disturbances (salivation, altered taste, irritable temper)
  • Quickening (movement of fetus felt by mother) – after 14-18 weeks
  • Frequency of micturation

Objective

  • Breast changes
  • Skin changes
  • Vaginal changes
  • Changes in cervix
  • Hegar’s sign (softening & compressibility of lower uterine segment from 2nd to 5th month)
  • Progressive enlargement of abdomen
  • Braxton Hick’s sign: intermittent contraction & relaxation of uterus after 4th month
  • Uterine souffle (soft blowing murmur heard by 3rd or 4th month)
  • Ballottment

Breast changes:

  • 2nd month: breast becomes full & tender, increase in size, veins become prominent, nipples enlarged, areola wider & darker, Montgomery’s tubercles (ENLARGED SEBACEOUS GLANDS)appear.
  • 3rd month: colostrum can be squeezed out of the nipples.
  • 6th month: lines like linea albicantes appear on breast due to stretching.


Skin changes:
  • Pigmentation of abdomen, axillae, pubis & vulva.
  • A dark line extends from symphysis to umbilicus called linea nigra.

Vaginal changes:
  • Pressure of the gravid uterus >> increased vascularity >> mucosa becomes purple or bluish purple >> Jacqueimier’s sign.
  • 4th month- pulsation of vaginal arteries is felt by placing a finger in vagina (osiander sign)

Changes in cervix:
  • 4th month- cervix becomes soft like lips (goodell’s sign)

Location of uterine fundus:
  • 4th month- just above symphysis pubis.
  • 5th month- midway b/w symphysis pubis & umbilicus.
  • 6th month- umbilicus.
  • 7th month- midway b/w umbilicus & xiphoid.
  • 8th & early 9th month- at xiphoid process.


Classification of signs of pregnancy in living:

A.Presumptive signs
  • Suppression of menstruation
  • Morning sickness
  • Sympathetic disturbances
  • Breast changes
  • Pigmentation of skin
  • Quickening
  • Vaginal changes
  • Urinary disturbances

B.Probable signs

  • Changes in abdomen
  • Softening of lower segment and os
  • Presence of cervical mucus plug
  • Braxton Hick’s sign
  • Ballottment
  • Uterine souffle
  • Biological tests

C.Positive signs of prgnancy:
  1. Fetal movements (after 5th month,at 24 weeks )
  2. Recognition of fetal parts (by abdominal examination)
  3. Fetal heart sound (160 bpm at 5th month, 120bpm at term),heard between 18-20 wks for first time.
  4. Radiograph of fetus (can be taken after 4th month)
  5. Ultrasound-G.S seen by 6th week

Pseudocyesis
-Spurious or phantom pregnancy
-Seen in women near menopause or those who are much desiring pregnancy
-All subjective symptoms of pregnancy including increase in abdominal size by abnormal fat deposition,or ascites occur
-even lady seen to have started labour like pains

Signs of prgenancy in Dead (on PM examination)
  • Presence of an ovum or fetus
  • Uterine changes
  • Presence of corpus luteum in one of the ovaries

Uterine changes:
  • Uterus thickened and enlarged
  • Length, breadth, & weight are increased
  • Chorionic villi are seen on microscopic examination

Posthumus child
  • -born after the death of father

MLI of pregnancy:
  • To escape hard labor or punishment
  • To avoid court attendance
  • In cases of property
  • In divorce cases
  • Black mailing
  • If a woman is charged of unchastity
  • Identification

Superfecundation-fertilisation of two ova which have been discharged by two separate acts of coitus commited at short intervals.

Superfoetation –fertilisation of second ovum in a woman who is already pregnant.

DELIVERY

Signs of recent delivery in living
  • General appearance- pale, exhausted & ill looking sunken eyes, slight increase in pulse and temperature.
  • After pains – intermittent contractions of uterus for the first 4-5 days after delivery.
  • Breasts- enlarged, contain colostrums, surface veins dilated & prominent, striae & Montgomery’s tubercle present
  • Abdomen- flaccid, wrinkled, striae gravidarum present
  • Fourchette- ruptured, posterior comissure destroyed
  • Vulva- bruised, tender & gaping
  • Vagina- lax, capacious, rugae begin to reappear about the third week

Uterus- enlarged, easily felt, palpate as a cricket ball
Soon after delivery- 2.5cm below umbilicus
10th day- on level with pelvic brim
2-3 weeks- returns to pelvic cavity
6 weeks- returns to normal size and position

Cervix- soft, patulous, may be lacerated. Internal os closes in first 24 hours, external os in two weeks.

Lochia- discharge from uterus and vagina for about 2-3 weeks.
  • Has a peculiar disaggreable odor
  • 1st 4-5 days- bright red with large clots- lochia rubra
  • Next 4 days- serous and pale in color- lochia serosa
  • After 9th day- yellowish grey or turbid- lochia alba until its final disappearance
  • If the blood or urine gives positive pregnancy test, strong evidence that pregnancy has been terminated recently. (likely to disappear in a week or 10 days)


Signs of recent delivery in dead:

  • Breast when cut open, may show milk
  • Uterus flabby and enlarged
  • Ovaries and fallopian tube congested, on section may show corpus luteum