DELIVERY AFTER PREGNANCY

DELIVERY AFTER PREGNANCY

Delivery means birth of a child with or without external help.

The legal issues linked with delivery are:

1. Infanticide (unwanted birth)
2. Concealment of birth (is a criminal offence)
3. Abortion (when criminal)
4. Nullity of marriage (when delivery occurs shortly after marriage)
5. Divorce (when delivery occurs, with the wife during calculated period of conception being apart from the husband)
6. Execution of judicial death sentence may be delayed up to 6 months after delivery
7. Deferring trial of a case in a court of law as in case of pregnancy
8. Delivery after being pregnant as a result of rape, kidnapping, seduction
9. Delivery of child below 16 years of age is definitely the result of rape
10. Criminal breach of trust in case of prior promise of marriage
11. Blackmailing of a male being pointed as father
12. Other cases of disputed paternity of the child delivered
13. Legitimacy
14. Inheritance of property
15. Homicide and suicide
16. Higher maintenance allowance in divorce cases
17. Higher compensation claim in case of death of husband on duty
18. Legal provision of leave, for delivery for working women.

DELIVERY AFTER PREGNANCYIn relation to any of the above cases, a medical, man may have to examine a woman to ascertain if she has delivered recently or in the past. Some of the signs of delivery are permanent signs of pregnancy. Some remain as permanent specific signs of delivery and others pass off in course of days or weeks.

Signs of recent delivery in the living –

1. General signs – Up to 3 – 4 days or a week after delivery, the woman is sickly, indisposed, weak, and exhausted in appearance. For a day or two, there is slight rise of temperature.

2. Signs in the abdomen – The abdomen is lax with presence of linea nigra on the midline and striae gravidarum (pinkish white linear scar like marks) on the flanks. The presence of striae gravidarum indicates stretching, due to enlargement of the abdomen, due to any reason including pregnancy.

On palpation, the uterus appears like a firm tennis ball on the 1st day after delivery, at a level 4-5 cms below the umbilicus. Involution of the uterus occurs at the rate of 1.5 cm at the initial phase and by the 6th day, it is midway between umbilicus and pubis. The rate of involution then decreases and the uterus comes to its permanent parous size after about 6-8 weeks. There is intermittent contraction of the uterus for 3 – 4 days after delivery.

3. Sign in the breasts – The breasts are voluminous and pendulous with engorged surface vessels. The areola is large with prominent Montgomery’s tubercles. The nipples are large. On palpation, breasts are rather tender and are nodular in feeling. On squeezing, the nipples yield milk or colostrum.

4. The labia majora are swollen, congested and tender.

5. The labia minora is congested, swollen, tender, often bruised.

6. Fossa navicularis and posterior commissure may show tear, which may extend up to perineum.

7. The vagina is spacious with loss of rugosity, the walls of which are relaxed. The walls are congested and may show presence of abrasions and tears. The rugosity of the wall returns gradually in a few weeks.

8. The cervix is soft, swollen and congested. The os shows transverse tear. Immediately after delivery, the external os admits 2 finders. The internal os reduces much in size after a day. The external os admits 1 finger after 1 week and returns to its permanent size after 2 weeks.

9. Lochial discharge – For 2-3 weeks after delivery there is discharge of lochia from the uterus which has a sour disagreeable odour and which gradually changes its colour and consistency. For the first 4 – 5 days, there is discharge of lochia rubra which is red in colour and contains blood and blood clot. For the next 4-5 day
the discharge is thin and pale and is termed lochia serosa. After this, discharge of whitish or greyish yellow, lochia alba continues for some more days which is thick and turbid in appearance.

10. Laboratory findings – For about 2 weeks after delivery, the morning urine of the woman shows presence of H.C.G. hormone by biological or serological tests.

Signs of recent delivery in dead subjects –

The external and genital signs of recent delivery as are available in living subjects, will also be present in dead subjects. In addition to these, additional internal findings will be present in uterus and its appendages. The uterus is soft, flabby and enlarged in size which, gradually becomes firm and returns to a permanent reduced size. The site of placental attachment is raw and uneven for some days to keep later a permanent small scar like mark. Up to a few days after delivery, there will be evidence of discharge from this site. The cervix and the os will be as discussed in cases of living subjects. The delivery fallopian tube, the ovaries, urinary bladder and lower part of (pelvic) intestine are congested for a day or more. A regressed corpus luteum will still be detectable in one ovary.

Signs of past (remote) delivery in the living –

Some of these signs are permanent signs of pregnancy and others are permanent signs of delivery.

1. Signs on abdomen – Wall is lax, the extent of laxity depends on number of pregnancy. Linea nigra and striae gravidarum will be present on the midline and flanks and lower aspects of abdomen respectively.

2. Signs on breasts – Breasts are lax and pendulous with dark big areola with montgomery’s tubercles. The nipples are larger, dark and raised. In some multipara there may be stria present on the surface of the breasts; on palpation, breasts, give nodular feeling.

3. External genitalia – Labia majora is dark and the two sides are not in close apposition. Labia minoras are pigmented dark and protrude out through the gap in between the majora of two sides.

4. Hymen – Hymen is absent and is represented by carunculae myritiformis (thick, uneven knob like circular marginal line at the vaginal outlet).

5. Perineum including posterior commissure may show old healed scar representing tear during past delivery.

6. Vagina is comparatively capacious with some degree loss of rugosity.

7. External os — It is represented by transverse slit like opening.

Signs of past (remote) delivery in dead –

In a dead subject, in addition to the signs available in living subjects for remote delivery, there will also be some findings in the uterus.

The uterus will be comparatively enlarged in size (10 cm x 6 cm x 2.5 cm) with convexity for the outer surface of the fundus and concavity of the inner surfaces of the walls. Weight is about 80gm. The body is about twice the length of the cervix and the internal os may show marginal wrinklings.

Concealment of birth – Intentional concealment of birth is a punishable criminal offence in India. Sec. 318 of the Indian Penal Code States that, “Whoever, by secretly burying or otherwise disposing of the dead body of a child, whether such a child die before or after or during its birth, intentionally conceals or endeavours to conceal the birth of such child, shall be punished with imprisonment of either description for a term, which may extend to two years or with fine or with both”.

Possthumous child – It is a child who is born after the death of its father. Legal issues involved are:

1. Legitimacy
2. Inheritance of property
3.Increased compensation from the father’s employer
4. Compensation cases against slanders against the mother.

Suppositious child – It is a child presented by a women to have been delivered by her, though she has not delivered the child. Sometimes child of one sex, delivered by a woman, is substituted by the child of another sex. Legal issues involved are:

1. Inheritance of property
2. Blackmailing a male
3. When a widow claims higher compensation from the husband s employer
4. Bringing a charge of breach of promise of marriage, against a man who, allegedly is the father of the child.

Legitimacy and Disputed Paternity-

Legitimacy It means positive legal status of a child who is born out of lawful wedlock. Any child born within 280 days after legal separation or divorce or death of the husband is presumed to be a legitimate child, unless the contrary is proved.

Question of legitimacy of a child arises in connection with:
1. Inheritance of property
2. Use of title of the husband of the mother by the child
3. In nullity of marriage and divorce cases
4. In posthumous child cases and in
5. Affiliation or adoption cases.

A child is presumed to be illegitimate when:

1. It is not born out of lawful wedlock as described in the first para, or
2. When the husband is sterile
3. When the wife had no access to her husband during her probable period of conception.

Paternity of a child is disputed in all these cases and also in posthumous child cases or alleged suppositious child cases or when the alleged father is sterile by virtue of being under-aged or even for a married woman, other conditions remaining satisfactory, the child bears some biological properties different from the husband of the mother and also on the basis of some doubtful circumstantial reasons.

Fixation of paternity in disputed cases – In these cases, paternity may be fixed basing on the following factors:

1. Accessibility of the mother, with the alleged (putative) father during the probable time of conception

2. Morphological akinness of the child with the father, in respect of complexion and other features

3. Atavism – Sometimes the child may not have morphological similarity with the father but, may have the same with the grand-parents or, great grand-parents in the paternal side. This is Atavism.

4. Matching of blood group and type factors – A blood group genotype factor absent in mother and father, cannot be present in the child. That way fathership of a person can be excluded in over 80% cases of false allegations of paternity, by testing the blood of the child, mother and the putative father, for different group factors. Where there is no disparity in the blood group test of the three, the paternity is only suggestive and not confirmatory because, many persons have similar group factors. On the other hand, exclusion is without ambiguity, if we ignore the chance of mutation of blood group factors in the child, which is presumed to occur in 1 in 50,000 cases.

Giving due consideration to all the factors discussed above and carrying out exhaustive blood group tests, reasonably satisfactory opinion can be given in this regard.

5. D.N.A. test may be confirmative.

Disputed Maternity Cases –

Maternity may be disputed in :

1. Hospital birth cases, where many newborn children are kept side by side, which may cause mixing up of children,
2. In alleged suppositious child.

Disputed maternity cases are settled in the line of settlement of disputed paternity cases with addition of one more factor, i.e. matching the age of the child with the findings of the disputed mother’s body related to her time of delivery, if at all there was any delivery. Here also D.N.A. test will be confirmative.

Cloning –

In laboratory, in lower animals experimentally it has been possible by in-vitro fertilization to produce offsprings bearing one or more specific features of either or both parents. So far human species is concerned there is no support or recommendation yet to practise cloning, from any comer due to the apprehension that this may disturb the social balance and affect the natural progress of civilization. This is done by a technique producing identical D.N.A. sequence.

Different measurements of Uterus after delivery
Different
measurements
Immediately after delivery After 3 days of delivery After a week of delivery After 2 weeks of delivery After 6 weeks of delivery
 Outer length  20 cm  17 cm  14 cm  12 cm  10 cm
 Outer breadth  13 -14 cm  10 cm  8 cm  7 cm  6 cm
 Thickness  5 cm  4-5 cm  4 cm  3 cm  2.5 cm
 Inner length  15 cm  12 cm  10 cm  8 cm  7 cm
 Weight of uterus  1 kg  700 gm  500 gm  300 gm  80-100 gm
 Diameter of site of placental attachment  10 cm  7 cm  4 cm  2.5 cm  1.5 cm

 

Differences between Nulliparous and Parous uterus
Points of differences Nulliparous uterus Parous uterus
 1. Size  Smaller (7 cm x 5 cm x 2 cm)  Larger (ID cm x 6 cm x 2.5 cm).
 2. Weight  40 gm approx  80 -100 gm.
 3. Ratio between body and
cervix
 Lengths of body and cervix almost equal  Body length is almost twice the length of cervix.
 4. Upper surface of fundus  Less convex and is in the same line of broad ligament  More convex and is at a higher level than the line of broad ligament.
 5. Uterine cavity  The inner walls are convex and that makes a triangular cavity with less space  The inner walls are concave and that makes a comparatively large and spacious cavity.
 6. Scar for placental attachment  No such thing  It is present. May be very faint and not prominent in very old pregnancies.
 7. External os  Small roundish dimple like depressed opening  Transverse slit like opening.
 8. Internal os  Circular, well defined  Ill defined, margin wrinkled.