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Journal of Labor and

Extended Abstract Open Access Updated easiest and accurate confirmation of early during Autopsy Neelam Shrivastava1, D. K. Satpathi2 and Rini Khare3 1Gandhi Medical College, India 2,3Laxminayaran Medical College, India

One of the causes, for suicide in young and unmarried females is thing required is hCG strip or card. In case of blood test require relationship without wed log which turns into pregnancy and due little more time that is 5-10 minutes as serum is viscous and take time for to failure of relationship to hide the shameful condition and guilt, test. If pregnancy is positive then the product of conception along with female commits suicide. Sometimes during autopsy, misdiagnosis of uterus should be preserved for DNA test to identify the alleged father of pregnancy cause embar-rassing condition to parents and on the other conception, which prevent allegation of negligence on autopsy surgeon. side, if finding is not detected which leads escape of accused from punishment. Therefore, an accurate test of pregnancy is essential. In Precaution prevailing prac-tice, size of uterus and corpus luteum is compared with non pregnant uterus for diagnosis of preg-nancy but in early pregnancy, This HCG stripe must be vertical and level of or blood should size of uterus and corpus luteum does’t increase considerably and reach unto the mark. .Container and catheter must be sterilized. findings usually missed. The proposed method is easy and confirmatory test for the same which is done by examining urine or blood serum for HCG (Human Chorionic Gonadotrophin) of deceased by HCG strip. Sometimes test may come positive if deceased aborted within 15 days.

Uterus Uterus

Method Theory

Previously during autopsy in suspected case of pregnancy urine is After fertilization, which occurs 14 days before next menstrual period collected in a sterile container with the help of sterile catheter or and get implanted in uterus which occurs, after 5 days of fertilization directly from bladder during autopsy if available then urine is tested that is 21st day from 1st day of cycle. During develop-ment of fetus just for pregnancy with the help of HCG strip or pregnancy card (which after implantation HCG is produced by the syncytiotrophoblast of the are available cheaply). Pregnancy confirmation is given by getting 2 and secreted into blood of mother as well as fetus and can be red transverse lines in HCG strip. Higher one of them is controlled detected in the maternal serum or urine as early as 8 to 9 days following and lower one is test line. If 2 red transverse lines in HCG strip appear . In the early pregnancy doubling time of HCG con-centration then is positive. Single line is negative test of pregnancy in plasma is 1.4 to 2 days. Blood and urine value reach maximum level and if any line doesn’t appear then test is invalid. This is the test which reaching 100 IU to 200 IU per ml between 60 to 70 days of pregnancy. is routinely used in department to confirm pregnancy. It The concentration falls slowly 10 to 20 IU per ml between 100 to 130 can also be confirmed by ultrasonography in which is days and remains constant throughout pregnancy. HCG level in urine examined in uterus if bladder is full. It comes positive in form of small and blood disappear from circulation within 2 weeks following delivery. sac as early as 5 days overdue of menstrual period but now all these This is immunologic test of pregnancy. It is a simple rapid accurate test. cumbersome job is not required when autopsy surgeon is opening the abdomen then direct-ly put hCG strip into the urine or blood vertically Principle of the test: The Visual hCG Test is a sandwich enzyme and apply the test. In this way no apparatus and USG is required, only (8-9) for the deter-mination of human chorionic

International Conference on Natural products & traditional medicine Volume 1 • Issue 4 • 2018 July 13-14, 2020 | Amsterdam, Netherlands Journal of Labor and Childbirth

Extended Abstract Open Access gonadotropin in urine or serum. The method employs two monoclonal antibodies to selectively identify hCG in urine/serum with a high degree of sensitivity. In the strip, hCG react with antibody present in strip and indicator and shows two lines as a positive test.

When urine of non-pregnant is tested then there is no HCG to neutralize. Different indicated strip is available for instance HCG coated latex particle for essay test. This hormone increases every day and reaches maximum and can be test in 20 weeks of pregnancy then it declines. Hormone secreted by syncytiotrophoblast comes in blood and urine, which can be tested by proposed method.

Observation

Routinely it is in practice to confirm pregnancy in hospitals by HCG strip. Hundreds of cases have been confirmed by this method yearly. Test is positive even after 7 days or more after collecting the urine as in the case of Smt. X1 was collected 7 days before and tested which comes positive there-fore if we get urine in decomposed body then pregnancy can be tested by proposed method. (Note-Names are decoded)

Post mortem POLICE NAME OF DATE HOURS AGE RESULT OF TEST NUMBER STATION DECEASED 22-06-2014 1264/14 X1 Y1 36 HRS 21 YRS U P T negative 12-08-2014 1636/14 X2 Y2 24 hrs 22 YRS UP T NEGATIVE 22-06-2014 1270/14 X3 Y3 24 HRS 25 yrs U P T POSITIVE 22-06-2014 1267/14 X4 Y4 24 hrs 16 YRS u p t POSITIVE 22-06-2014 1271/14 X5 Y5 24 hrs 22 yrs u p t negative 26-08-2015 1738/15 X 6 Y6 24 HRS 26 YRS u p t positive 05-09-2015 1798/15 X7 Y7 24 hrs 20 YRS u p t negative 16-09-2016 1872/16 X8 Y8 24 hrs 25 yrs U p t POSITIVE 16-09-2016 1876/16 X9 Y 9 24 hrs 16 yrs u p t negative 22-09-17 1910/17 X10 Y10 24 hrs 17 YRS u p t negative 22-09-2017 1913/17 X11 Y11 24 HRS 26 YRS u p t negative 22-09-2018 1915/18 X12 Y12 24 HRS 10 YRS u p t negative 23-09-2018 1924/18 X13 Y13 24 HRS 25 YRS u p t POSITIVE 26-08-2019 1738/19 X 14 Y14 24 HRS 26 YRS u p t positive 05-09-2019 1798/19 X15 Y15 24 hrs 20 YRS u p t negative

International Conference on Natural products & traditional medicine Volume 1 • Issue 4 • 2018 July 13-14, 2020 | Amsterdam, Netherlands Journal of Labor and Childbirth

Extended Abstract Open Access

Other Signs of Pregnancy Funding

Nipple and Areola become more pigmented and montgomery’s tubercles Outsource funding is not required. are prominent. Thick yel-low secretion (colostrum) sometimes can be expressed by squeezing breast. Acknowledgement

False Positive I am thankful to my family members, medic legal staff and OMICS group.

False positive test results may occur for several reasons, including Reference errors of test application, use of drugs containing the hCG molecule, and non-pregnant production of the hCG molecule. Urine tests 1. Wilcox AJ, Baird DD, Weinberg CR (1999). “Time of implantation of can be falsely positive in those that are taking the medications: the conceptus and loss of pregnancy”. New England Journal of Medicine , phenothiazines and among others. False 340 (23): 1796–1799. doi:10.1056/NEJM199906103402304. PMID positives may also appear on tests used past their expiration date. 10362823.

A woman who has been given an hCG injection as part of infertility 2. Fan XG, Zheng ZQ (1997). “A study of early pregnancy factor treatment will test positive on pregnancy tests that assay hCG, regardless activity in preimplantation”. Am. J. Reprod. Immunol. 37 (5): 359–64. of her actual pregnancy status. doi:10.1111/j.1600-0897.1997.tb00244.x. PMID 9196793.

However, some infertility drugs (e.g., clomid) do not contain the hCG 3. Waddell, Rebecca Smith (2006). “FertilityPlus.org”. Home Pregnancy hormone. Test hCG Levels and FAQ. Retrieved 2006-06-17.

Some diseases of the , , and other medical conditions may 4. Woo, Joseph (2006). “Why and when is Ultrasound used in produce elevated hCG and thus cause a false positive pregnancy test. Pregnancy?”. Obstetric Ultrasound: A Comprehensive Guide. Retrieved 2007-05-27. These include and other germ cell tu-mors, IgA deficiencies, heterophile antibodies, enterocystoplasties, gestational 5. Boschert, Sherry (15 June 2001). “Anxious Patients Often Want Very trophoblastic diseas-es (GTD), and gestational trophoblastic neoplasms. Early Ultrasound Exam”. OB/GYN News (Find Articles.com). Retrieved 2007-05-27. These conditions should be ruled out before confirmation which can be tested by gestational sac in uterus with the help of ultrasound 6. Bastian LA, Nanda K, Hasselblad V, Simel DL (1998). “Diagnostic and examining organ during autopsy and past history. Positive efficiency of home pregnan-cy test kits. A meta-analysis”. Arch Fam Med cases by urine/blood serum HCG examination can further be 7 (5): 465–9. doi:10.1001/archfami.7.5.465. PMID 9755740. Retrieved confirmed under ultrasonography if bladder is full of urine. 2008-05-12.

Result 7.http://www.ncbi.nlm.nih.gov/pubmed/10362823 During autopsy 200 cases were examined during 2014 to 2019 in Medico legal Institute Bhopal Madhya Pradesh, India in which 30 8. Weschler, Toni (2002). Taking Charge of Your Fertility (Revised ed.). cases were control married women in which pregnancy was known New York: HarperCollins. p. 374. ISBN 0-06-093764-5. and uterus was considerably enlarge and test was positive with HCG strip. Ten cases were found positive in unmarried women and 9. Ellington, Joanna (2004). “Sperm Transport to the Fallopian Tubes”. uterus was preserved along with product of conception for DNA test. Rest of the cases examined was negative with this HCG test. Frequently Asked Questions with Dr. E. INGfertility Inc. Archived from the original on 2006-07-13. Retrieved 2006-08-13. Conclusion 10. Wallach, Jacques (2007). Interpretation of diagnostic tests (8th Proposed method is easy, 100% accurate confirmatory test which can ed. ed.). Philadelphia: Wolters Kluwer Health/Lippincott Wiliams & also be tested by gestational sac in ultrasound. The method proposed as above will give a scientific conclusive and quick result by which we Wilkins. p. 866. ISBN 9780781730556. can extract a scientific conclusive opinion immediately. Even sometimes autopsy test comes positive if deceased aborted within 15 days. 11. Phillips, Pat (2007). “Early Pregnancy Tests”. Pregnancy Test FAQ. Retrieved 2007-03-04. Suggestion 12. Clark, Stephanie Brown. (2005).Jan Steen: The Doctor’s Visit. Proposed method should be used for confirming early Literature, Arts, and Medicine Database. Retrieved 27 May 2007. pregnancy during autopsy and if found posi-tive, then Lubsen-Brandsma, M.A. (1997). Jan Steen’s fire pot; pregnancy test or product of conception should be preserved for DNA test. gynecological therapeutic method in the 17th century? Ned Tijdschr Geneeskd, 141(51), 2513–7. Retrieved 24 May 2006. Conflict of Interest “The Doctor’s Visit.” (n.d.). The Web Gallery of Art. Retrieved 24 May There is no conflict of interest and this study will benefit publicd an 2006. judiciary. No ethical clearance is needed.

International Conference on Natural products & traditional medicine Volume 1 • Issue 4 • 2018 July 13-14, 2020 | Amsterdam, Netherlands Journal of Labor and Childbirth

Extended Abstract Open Access

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International Conference on Natural products & traditional medicine Volume 1 • Issue 4 • 2018 July 13-14, 2020 | Amsterdam, Netherlands