Medical Jurisprudence Midterm Expanded Outline Sam Tirthdas

PREGNANCY AND ABORTION MODULE

PREGNANCY
Related Laws
Civil Code Article 40. Birth determines personality; but the conceived child
shall be considered born for all purposes that are favorable to it, provided it be
born later with the conditions specified in the following article. (29a)
Civil Code Article 41. For civil purposes, the foetus is considered born if it is alive
at the time it is completely delivered from the mother's womb. However, if the
foetus had an intra-uterine life of less than seven months, it is not deemed born if it
dies within twenty-four hours after its complete delivery from the maternal womb.
(30a)
Article 85. A marriage may be annulled for any of the following causes, existing at
the time of the marriage:
(1) That the party in whose behalf it is sought to have the marriage annulled was
between the ages of sixteen and twenty years, if male, or between the ages of
fourteen and eighteen years, if female, and the marriage was solemnized without
the consent of the parent, guardian or person having authority over the party,
unless after attaining the ages of twenty or eighteen years, as the case may be,
such party freely cohabited with the other and both lived together as husband and
wife;
(2) In a subsequent marriage under article 83, number 2, that the former husband
or wife believed to be dead was in fact living and the marriage with such former
husband or wife was then in force;
(3) That either party was of unsound mind, unless such party, after coming to
reason, freely cohabited with the other as husband or wife;
(4) That the consent of either party was obtained by fraud, unless such party
afterwards, with full knowledge of the facts constituting the fraud, freely cohabited
with the other as her husband or his wife, as the case may be;
(5) That the consent of either party was obtained by force or intimidation, unless
the violence or threat having disappeared, such party afterwards freely cohabited
with the other as her husband or his wife, as the case may be;
(6) That either party was, at the time of marriage, physically incapable of entering
into the married state, and such incapacity continues, and appears to be incurable.
(30a)
Article 86. Any of the following circumstances shall constitute fraud referred to in
number 4 of the preceding article:
(1) Misrepresentation as to the identity of one of the contracting parties;
(2) Non-disclosure of the previous conviction of the other party of a crime involving
moral turpitude, and the penalty imposed was imprisonment for two years or more;
(3) Concealment by the wife of the fact that at the time of the marriage, she was
pregnant by a man other than her husband.
No other misrepresentation or deceit as to character, rank, fortune or chastity shall
constitute such fraud as will give grounds for action for the annulment of marriage.
(n)

Medical Jurisprudence Midterm Expanded Outline Sam Tirthdas

SIGNS OF PREGNANCY
Presumptive Signs of Pregnancy
a. Amenorrhea (Cessation of Menstruation)

b. Nausea and Vomiting (Morning Sickness)

c. Frequent Urination

d. Breast Changes
In early pregnancy, changes start with a slight, temporary enlargement of the
breasts, causing a sensation of weight, fullness, and mild tingling.

Darkening of the areola--the brown part around the nipple.

Enlargement of Montgomery glands--the tiny nodules or sebaceous glands

within the areola.

Increased firmness or tenderness of the breasts.

More prominent and visible veins due to the increased blood supply.

Presence of colostrum (thin yellowish fluid that is the precursor of breast

milk). This can be expressed during the second trimester and may even leak
outin the latter part of the pregnancy.

e. Vaginal Changes.

Chadwick's sign. The vaginal walls have taken on a deeper color caused by
the increased vascularity because of increased hormones. It is noted at the

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sixth week when associated with pregnancy. It may also be noted with a
rapidly growing uterine tumor or any cause of pelvic congestion.

Leukorrhea. This is an increase in the white or slightly gray mucoid discharge

that has a faint musty odor. It is due to hyperplasia of vaginal epithelial cells
of the cervix because of increased hormone level from the pregnancy.
Leukorrhea is also present in vaginal infections.

f. Quickening (Feeling of Life).

This is the first perception of fetal movement within the uterus. It usually occurs
toward the end of the fifth month because of spasmodic flutter.

g. Skin Changes.

Striae gravidarum (stretch marks). These are marks noted on the abdomen
and/or buttocks.

Linea nigra - This is a black line in the midline of the abdomen that may run
from the sternum or umbilicus to the symphysis pubis.

Chloasma. This is called the "Mask of Pregnancy." It is a bronze type of facial

coloration seen more on dark-haired women. It is seen after the sixteenth
week of pregnancy.

Fingernails. Some patients note marked thinning and softening by the sixth
week.

h. Fatigue. This is a common complaint by most patients during the first trimester.
Fatigue may also be a result of anemia, infection, emotional stress, or malignant
disease.

Conclusive Signs
a. Fetal Heart Sounds. The fetal heart begins beating by the 24th day following
conception. It is audible with a doppler by 10 weeks of pregnancy and with a
fetoscope after the 16th week .

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b. Ultrasound Scanning of the Fetus. The gestation sac can be seen and
photographed. An embryo as early as the 4th week after conception can be
identified. The fetal parts begin to appear by the 10th week of gestation.

c. Palpation of the Entire Fetus. Palpation must include the fetus head, back,
and upper and lower body parts. This is a positive sign after the 24th week of
pregnancy if the woman is not obese.

d. Palpation of Fetal Movement. This is done by a trained examiner. It is easily

elicited after 24 weeks of pregnancy.

e. X-ray. An x-ray will identify the entire fetal skeleton by the 12th week. In utero,
the fetus receives total body radiation that may lead to genetic or gonadal
alterations. An x-ray is not a recommended test for identifying pregnancy.

f. Actual Delivery of An Infant. Self-explanatory.

Development of the Fetus

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Estimated date of Delivery

Childbirth usually occurs about 38 weeks after conception. In women who have a
menstrual cycle length of four weeks, this is approximately 40 weeks from the start
of the last normal menstrual period (LNMP). Health authorities recommend that
women not artificially begin delivery with labor induction or caesarean
section before 39 weeks as this amount of time is considered "full term" for the
child to develop.
Proofs of Fetal Death
Fetal death - death prior to the complete expulsion or extraction from its mother of
a product of human conception, irrespective of the duration of pregnancy and which
is not an induced termination of pregnancy.
The death is indicated by the fact that after such expulsion or extraction, the fetus
does not breathe or show any other evidence of life, such as beating of
the heart, pulsation of the umbilical cord, or definite movement of
voluntary muscles. Heartbeats are to be distinguished from transient cardiac
contractions; respirations are to be distinguished from fleeting respiratory efforts or
gasps.

ABORTION
Related Laws in the Revised Penal Code
Art. 256. Intentional abortion. Any person who shall intentionally cause an
abortion shall suffer:

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1. The penalty of reclusion temporal, if he shall use any violence upon the
person of the pregnant woman.
2. The penalty of prision mayor if, without using violence, he shall act without
the consent of the woman.
3. The penalty of prision correccional in its medium and maximum periods, if the
woman shall have consented.
Art. 257. Unintentional abortion. The penalty of prision correccional in its
minimum and medium period shall be imposed upon any person who shall cause an
abortion by violence, but unintentionally.
Art. 258. Abortion practiced by the woman herself of by her parents. The
penalty of prision correccional in its medium and maximum periods shall be
imposed upon a woman who shall practice abortion upon herself or shall
consent that any other person should do so.
Any woman who shall commit this offense to conceal her dishonor, shall suffer
the penalty of prision correccional in its minimum and medium periods.
If this crime be committed by the parents of the pregnant woman or either of
them, and they act with the consent of said woman for the purpose of
concealing her dishonor, the offenders shall suffer the penalty of prision
correccional in its medium and maximum periods.
Art. 259. Abortion practiced by a physician or midwife and dispensing of
abortives. The penalties provided in Article 256 shall be imposed in its
maximum period, respectively, upon any physician or midwife who, taking
advantage of their scientific knowledge or skill, shall cause an abortion or assist
in causing the same.
Any pharmacist who, without the proper prescription from a physician,
shall dispense any abortive shall suffer arresto mayor and a fine not exceeding
1,000 pesos.
Methods of Abortion
Chemical / Medical Abortion
Carried out in the early stages of pregnancy, this is usually up to the 9th week of
pregnancy although it can be given at a later stage.
It involves you taking two types of medication at least 48 hours apart. The idea is
that this medication will induce an abortion, the effects of which will be very similar
to a miscarriage.
On the first appointment you will be given medication (tablet) called mifepristone.
This prevents hormones from preparing the lining of your womb to receive the
fertilised egg (it stops hormones for allowing pregnancy to continue).
48 hours later is the second form of medication (another tablet). This is called
prostaglandin which causes uterine contractions and vaginal bleeding.

Medical Jurisprudence Midterm Expanded Outline Sam Tirthdas

The lining of the womb breaks down within 6 hours of taking prostaglandin which is
then expelled from the vagina along with the fetus. This bleeding is accompanied by
cramps and is very similar to a very heavy period.

Mechanical / Surgical Abortion

There are 2 types:
1. Vacuum aspiration (suction method)
Carried out on women who are between 7 to 15 weeks pregnant
A small tablet (known as a pessary) inserted into the vagina beforehand which helps
to dilate (open) the cervix.
Once this has dilated a small suction tube, connected to a pump, will be placed
inside the womb. The vacuum action of this suction tube will remove the fetus and
any surrounding tissue.
2. Dilation and evacuation
Performed at 15 weeks of pregnancy
It is a more complex procedure than vacuum aspiration with a longer recovery
period.
The procedure involves opening up the neck of the womb (cervix) before using
forceps and a small suction tube to remove the fetus.
The doctor will use an instrument called a speculum which enables him/her to
stretch the cervix. A slim rod shaped instrument called a laminaria is also inserted
into the cervix to help keep it open.
The doctor will use forceps and a curette (curvy instrument) to remove the fetus
and scrape away the lining of the womb. A suction tube is also used to remove any
surrounding tissue. The tissue that has been removed is carefully examined to
ensure that all signs of pregnancy have been removed.