Criminal abortion is the unlawful expulsion of the fetus at any stage of gestation by a qualified or unqualified doctor. It does not come under the rules of the Medical Termination of Pregnancy (MTP) Act 1971 and hence is punishable under the law. The motives behind criminal abortion might be female feticide, avoiding the addition of a member to the family especially in cases of poor families, when the child is the product of illicit sexual intercourse.
There are several ways to induce criminal abortion. One method is by using abortifacient drugs like Ecbolics, emmenagogues, irritant poisons, systemic poisons, abortion pills, abortion sticks. The other method is by general or local violence. As these procedures might be performed by a skilled or unskilled person and are not done most appropriately, it can have complications or even result in the death of an individual.
The immediate complications include hemorrhage, fat embolism, air embolism, amniotic fluid embolism, perforation of the uterus, incomplete abortion, local injury, and shock due to vaginal inhibition resulting from instrumentation. The delayed complications include septicemia, endometritis, peritonitis, tetanus, renal failure, sterility. Most of these complications can become the cause of death in a criminal abortion. IPC sections 312, 313, 314, 315 and 316 deal with the offense of criminal abortion or attempted criminal abortion and punishment for these offenses.
Postmortem Evidence in Criminal Abortion
The source of evidence of a criminal abortion is obtained from the victim’s or deceased’s medical history and whereabouts before death, clinical or autopsy examination, examination of the aborted material (if available).
1) Evidence from the Scene of Crime
In cases where you suspect criminal abortion the condition of the bed linen (check for any type of stains), clothing condition, especially the underclothing. Check if the cloth smells of Dettol or carbolic soap. Check the wastebins or packages and hidden places for discarded linen, dress, cotton wool, swabs, bowls, etc.
If the autopsy reveals that the death was due to the use of an abortion instrument and if any such instrument was absent at the scene of crime then suspect for the presence of a second person. Also, check for the presence of any abortifacient drugs.
2) Abortion by Drugs
If irritant poison is consumed then it can be detected from the gastrointestinal tract and hence necessary tissue and organ samples should be preserved for analysis. If cantharides or turpentine were consumed then signs of inflammation will be found in the urinary tract.
Inflammation and erosion can also be observed in the vaginal and cervix if irritants or caustic substances like phenol, Lysol, mercuric chloride, arsenic, potassium permanganate, formaldehyde, or oxalic acid is used for local application resulting in the formation of a necrotic pseudomembrane in the vagina and severely damaged cervix.
3) Instrumental Abortion
High chances of finding signs of injury in the abdomen region. Check for punctures in the internal organs. Also, the presence of ruptures, hemorrhages, or inflammation can indicate the use of an abortion instrument.
The presence of air in the large veins and in the heart can be due to embolism. Gas bubbles may be seen in the walls of the placental bed on opening the uterus. The uterus might be crepitant and bubbles can be observed under the serosal surface or even under the parietal peritoneum of the pelvis.
4) Pelvis Dissection
The color, texture, and size of the uterus should be noticed. Open the uterus by a classical cesarean incision to collect any fluid retained in the lower uterine segment. Evidence of scooping in the endometrium indicates evacuation done by curetting.
Next, the cervical canal is opened and examined for injuries. Note the state of dilatation of the cervical canal. Wounds of the cervix occur in about fifty percent of the cases, which may be groove-like, parallel notches of the cervical canal, tenaculum marks on the external orifices, cavitation of the wall, fissures, lacerations, and perforations.
The perforations of the vagina and uterus are of different sizes and forms varying from. Sometimes, one or more perforations may be present in the fundus. Examining all the parts is necessary, as the nature of the injury can indicate the probable type of instrument used.
If an abortion stick has been used excoriation, bruising or perforation of the upper part of the vagina or uterus can occur. Sometimes, foreign bodies may be found in the genital tract which should be preserved.
This happens especially when an unskilled person is involved in conducting the abortion. Due to infection, the uterine will become swollen, spongy, and discolored. The serosal surface may appear to be brownish and the endometrium may be ragged, foul-smelling, and even purulent.
Even chances are there to develop signs of septicemia. In extreme cases, the kidneys may show bilateral cortical necrosis. In natural abortion infection is rare.
Samples of tissues from the uterus, ovaries, and fluid from the uterine cavity, blood from ventricles are collected for histological and chemical, bacteriological examinations. This sample collection and analysis is very important especially when there is no evidence of fetal parts or placental remains.
Fluid from the cut surface of the lung and pulmonary blood should be collected for fatty acid estimation and phenolic derivatives depending on the agent used. A full photographic record should be maintained.
6) Abortion Using Syringe
The cervical canal may be dilated and injured and the use of antiseptics can cause corrosion or tissue damage. Foamy-red or dark-red fluid may be seen between the uterine wall and fetal membranes with the partial detachment of the placenta.
The injected fluid enters the uterine sinusoids under pressure and the fluid and bubbles of gas can be detected in the venous system extending from the sides of the uterus up to the right heart. The right side of the heart, the superior and inferior vena cava, and pulmonary conus contain foamy blood and are “ballooned out” and have a characteristic elastic feel.
When fatal venous air embolism has occurred, the inferior vena cava, uterine, ovarian, and pelvic veins present a beaded appearance due to the air within their lumens. The large abdominal veins should be examined for the presence of air by gently moving aside the bowel before the thoracic cavity is opened and the internal mammary vessels are incised.
Segmentation of the coronary vessels is seen due to gas bubbles. In air embolism, collapse occurs in about two minutes and death in ten minutes. Delayed death may occur when the victim is at rest and the air is temporarily locked in the uterus. When the woman moves about, uteroplacental detachment increases and air enters uterine sinusoids.
7) Expelled Material
The expelled material should be examined to confirm it to be a product of conception and not a blood clot or fibroid. If it is found to be a blood clot then a grouping and precipitin test should be done to know whether it is compatible with the woman’s blood group and if it is a fetus, then age should be determined.
Despite the enactment of the MTP Act, the number of illegal, unsupervised, and unsafe abortions in India is very high. These abortions are most of the time performed by an unskilled person in complete unhygienic conditions resulting in pregnancy-related deaths.
The death can be suspected to be due to criminal abortion if the deceased is pregnant and deeply cyanosed, presence of abortion instruments and abortifacient drugs at the scene of crime, underclothing appears to be disturbed after death, fluids, soapy or blood is coming out of the vagina.
It is necessary to establish that the dead woman was pregnant, that the accused acted to conduct an illegal abortion and the death occurred due to it to convict the abortionist.