12 Maternal Death, Infanticide, Abortion Flashcards
Causes of maternal death (in situation biasa)
- sepsis
- pre eclampsia and eclampsia
- thrombosis and thromboembolism
- early pregnancy death/ ectopic pregnancy
- haemorrhage
- anaesthesia
- amniotic fluid embolism
Death from legal termination of pregnancy
- pulmonary emboism from dvt
- mishaps associated with anaesthesia
- divc and cerebral damage dt saline or glucose injection
- air embolism following vacuum aspiration
- bleeding or infection
Dangers of method from illegal abortion
- instrumental interference (surgical dilators/bicycle spoke): bleeding, infection in vagina/cervix, sepsis, cervical shock (when dilating the cervix)
- insufflation of air: insert rubber pump - put fluid under pressure into cavity of uterus - if has sufficient detachment, abortion will occur. Use of phenol, formalin, alcohol, turpentin to the fluid introduce toxic element. In some cases, fluid enter peritoneal cavity tru interine tube causing chemical peritonitis
- dilatation of cervix: put a strip of substance that absorbs water and became enlarged such as Laminaria digitale or slippery elm
- physical violence: punching, kicking most common. Death from visceral rupture such as liver, spleen, intestine
- syringe aspiration: large syringe attach to catheter to suction uterine content, leads to rupture of chorionic sac and abortion. If evacuation incomplete, produce nidus for infection
- intrauterine infection: retained placenta or poc. Organisms involved streptococci and clostridium perfringens. Uterus become swollen, spongy and discoloured. Endometrium ragged, foul smelling. Signs of septicemia: enlarged soft spleen, prominent lymph nodes, hepatorenal failure. Kidney bl cortical necrosis. Bronze discolouration of skin (clostridium septicemia)
- use of drugs and chemicals: cause systemic effect and local corrosion in vagina
Potassium permanganate: profuse vaginal bleeding dt necrosis of vagina
Utus paste and interruptin: induce abortion when fetus dead
Ecbolics & emmenagogues: taken by mouth of injection
Pennyroyal, tansy, savin, castor oil: purging, git irritation
Quinine: cause cinchonism (excessive use of cinchona & cause temporary deafness, ringing in ears, headache, dizziness, rash
Ergometrine: peripheral vascular spasm, gangrene
Heavy metals: lead
Aminopterin, steroid, cytotoxic drugs: abortifacient
Amniotic fluid embolism (fluid content and how it occurs)
Fluid content: fetal squames, lanugo, lipoid, meconium, cells from chorion and amnion
Entry of amniotic fluid into maternal circulation. Solid elements impacted in lung capillaries. Cause ‘allergic responses’, profound collapse and sudden death
Definition of infanticide and what is Infanticide Act in 1938
- deliberate killing of a newborn infant by the mother (mak b7nuh anak)
Infanticide Act 1938: mother kill her own child under <12m with disturbed mind sbb kan oleh effect of lactation or giving birth. If mind dia balance, she is categorised as committed manslaughter
Definition of Stillbirth
Death of baby after 24w of gestation
Frequent in <19y and > 35y
Fx of pathologist in infanticide
- to assist in identifying the mother
- estimate maturity of child
- determine stillbirth or separate existence (survive): criteria of survival (well expand lungs, food in stomach, vital rx in the stump of umbilical cord)
- determine death was due to natural cause or any act of omissions (lack of care) /comissions (lethal injury)
Definition of live birth and separate existence
Livebirth: survive at 24w gestational age
separate existence: showed signs of life after completely expelled from mother even if its still attached to placenta within mother
What to check in autopsy on infant
- ID mother
- scene: head injury or drowning
- external: decomposed/intrauterine maceration
- measure estimation of maturity: weight, CRL, head circumference
- abnormalities: spina bifida, anencephaly
- act of commission: strangulation, smothering, drowning
Proof of separate existence
- food in stomach
- well expanded lungs (hydrostatic test/floatation test): only suggestive pointer not definitive
Estimation of maturity
Full term singleton at 40w gestation
- body weight (2.5-3.3)
- crown heel length (48-52cm)
- CRL (28-32cm)
- head circumference: 33-38cm
- head hair (2-3cm) long
Testes palpable in scrotum, vulva labia closes vaginal opening, umbilicus between xiphi and pubis, dark meconium in large intestine
Old Haase rule of thumb
What is old haase rule of thumb
Up to 20th week, length of fetus in cm is square of age in months (length= 3^2)
Beyond 20w, length of fetus in cm divided by five represents the age in months (age in months = length divide 5)
