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