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 VERGINITY

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:

Fetal movements (after 5th month,at 24 weeks )
Recognition of fetal parts (by abdominal examination)
Fetal heart sound (160 bpm at 5th month, 120bpm at term),heard between 18-20 wks for first time.
Radiograph of fetus (can be taken after 4th month)
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: