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Advances in Clinical Toxicology Research Article 7 min read

Easiest and Accurate Confirmation of Early Pregnancy during Autopsy

Shrivastava N*, Satpathi DK and Khare R
* Corresponding author
ISSN: 2577-4328  10.23880/act-16000215  Received: April 05, 2021  Published: May 17, 2021
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Abstract

One of the causes for suicide in young and unmarried females is relationship without wed-log which turns into pregnancy. Due to failure of relationship or to hide the condition and guilt, they commit suicide. Sometimes during autopsy, misdiagnosis of pregnancy in absence of pregnancy causes embarrassing and controversial scenarios to families. However, on the other side, often pregnancy findings are not detected in early pregnancy which leads escape of accused from punishment. Therefore, an accurate test of pregnancy is essential. In prevailing practice, size of uterus and corpusluteum are increased during pregnancy, which leads to definitive diagnosis. Nonetheless in early pregnancy, size of uterus and corpusluteum doesn’t increase considerably and findings are usually untraced. The proposed method is easy and confirmatory test for the same. It is done by examining either urine or blood serum for hCG (Human Chorionic Gonadotropin) of deceased by a hCG strip. Test result shows positive if deceased aborted pregnancy within 15 days of death.

Method

Previously, during autopsy in suspected case of pregnancy, urine is collected in a sterile container with the help of sterile catheter or directly from bladder if available; accordingly, which is then tested for pregnancy with the help of hCG strip or pregnancy card (which are readily available). Confirmation of pregnancy is given by getting two red transverse lines in hCG in which upper line is control and lower one is test line. Single line is negative test and if any line doesn’t appear, then test is considered as invalid. This test is routinely used in obstetrics department to confirm pregnancy. It can also be confirmed by ultrasound in which gestational sac is examined in uterus if bladder is full. It becomes positive in form of small sac as early as 5 days, overdue of menstrual period [1, 2, 3, 4, 5]. This cumbersome job is not required when autopsy surgeon is opening the abdomen and directly placing hCG strip vertically downward in the urine or blood and apply the test. In this way, no apparatus and USG is required, only a hCG strip or card is required. In case of blood serum test, it requires more time i.e. 5-10 minutes as serum is viscous and takes time. If pregnancy is positive, accordingly, the product of conception along with uterus should be pre- served for DNA test to identify the accused person, which also save autopsy surgeon from allegation of negligence (Figures 1& 2).

Figure 1: Detection of sample.
Click to enlarge
Figure 1: Detection of sample.
Figure 2: hCG Identification.
Click to enlarge
Figure 2: hCG Identification.

Precaution

This hCG strip must be vertical (90 degrees) and level of urine/blood should reach up to the mark. Container and catheter must be sterilized first if used [6, 7, 8, 9, 10].

Theory

Fertilization occurs 14 days prior to next menstrual cycle and zygote gets implanted in uterus which occurs after 5 days of fertilization i.e 21st day from 1st day of last menstrual cycle.

hCG is produced by the syncytiotrophoblast of the placenta hCG in blood and urine of mother which can be detected in the maternal serum or urine as early as 8 to 9 days following implantation. Time taken by hCG to get doubled is 48 to 72 hours. Maximum level of hCG reaches up to 100 IU to 200 IU per ml between 60 to70 days. The concentration decreases to 10-20 IU per ml between 100 to 130 days and remains constant throughout pregnancy [10, 11, 12]. hCG level disappear from circulation within 2 weeks following delivery or abortion . This is immunologic test of pregnancy. It is a simple rapid accurate test.

Principle of the Test

The Visual hCG Test is a sandwich enzyme immunoassay for the determination of human chorionic 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 as 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 strips are available for instance hCG coated latex particle for essay test. Hormone secreted by syncytiotrophoblast comes in blood and urine, which can be tested by pro- posed 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. For instance in the case of Smt. X1 was collected 7 days before and tested which comes posi- tive. Hence, if we get urine or blood in decomposed body then pregnancy can be tested by proposed method. (Note-Names are decoded) (Table 1).

Post Mortem NumberPolice StationName of DeceasedHoursAgeResult of Test
22-06-20141264/14X1Y136 HRS21 YRSUPT Negative
12-08-20141636/14X2Y224 hrs22 YRSUPT Negative
22-06-20141270/14X3Y324 HRS25 yrsUPT Positive
22-06-20141267/14X4Y424 hrs16 YRSUPT Positive
22-06-20141271/14X5Y524 hrs22 yrsUPT Negative
26-08-20151738/15X 6Y624 HRS26 YRSUPT Positive
05-09-20151798/15X7Y724 hrs20 YRSUPT Negative
16-09-20161872/16X8Y824 hrs25 yrsUPT Positive
16-09-20161876/16X9Y 924 hrs16 yrsUPT Negative
22-09-20171910/17X10Y1024 hrs17 YRSUPT Negative
22-09-20171913/17X11Y1124 HRS26 YRSUPT Negative
22-09-20181915/18X12Y1224 HRS10 YRSUPT Negative
23-09-20181924/18X13Y1324 HRS25 YRSUPT Positive
26-08-20191738/19X 14Y1424 HRS26 YRSUPT Positive
05-09-20191798/19X15Y1524 hrs20 YRSUPT Negative

Table 1: Details of Deceased.

Other Signs of Pregnancy

Nipple and Areola become more pigmented and montgomery’s tubercles are prominent. Thick yellow secretion (colostrum) sometimes can be expressed by squeezing nipples.

False Positive

False positive test results may occur for several reasons, including errors of test application, use of drugs containing the hCG molecule, and non-pregnant production of the hCG molecule. Urine tests can be falsely positive in those that are taking the medications like: chlorpromazine, phenothi- azines and methadone among others. False positives may also appear on tests used past their expiration date. A woman who has been given an hCG injection as part of infertility treatment will test positive on pregnancy tests, regardless of her actual pregnancy status [13].

However, some infertility drugs (e.g. clomid) do not contain the hCG hormone. Some diseases of the liver, cancers, and other medical conditions may produce elevated hCG and thus can cause a false positive pregnancy test. These include choriocarcinoma and other germ cell tumors, IgA deficiencies, heterophile antibodies, enterocystoplasties, gestational trophoblastic dis- eases (GTD), and gestational trophoblastic neoplasms. These conditions should be ruled out before confirmation which can be tested by examining organ during autopsy and past history by relative. Positive cases by urine/blood serum hCG examination can further be confirmed under ultrasonography if bladder is full of urine [14].

Results

During autopsy 152 cases were examined between 2014 to 2019 in Medico legal Institute Bhopal Madhya Pradesh, India. 50 cases were of married women in which pregnancy was known. Uterus was considerably enlarged and test was positive with HCG strip. Ten cases were found positive in unmarried women and uterus was preserved along with product of conception for DNA test. Rest of the cases examined was negative with this HCG test [15, 16, 17].

Conclusion

Proposed method is easy 100% accurate confirmatory test which can also be tested by gestational sac in ultrasound. The method proposed as above will give a scientific conclusive and quick result by which we can extract a scientific conclusive opinion immediately. Even sometimes autopsy test comes positive if deceased aborted within 15 days [18, 19].

Suggestion

Proposed method should be used for confirming early pregnancy during autopsy and if found positive, then product of conception and uterus should be preserved for DNA test.

Conflict of Interest

There is no conflict of interest and this study will benefit public and judiciary. No ethical clearance is needed.

Funding

Outsource funding is not required.

Acknowledgement

I am thankful to my family members, medic legal staff

References

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  19. Yalow RS, Berson SA (1960) Immunoassay of endogenous plasma insulin in man. J Clin Invest 39(7): 1157-1175.
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@article{shrivastava2021,
  title   = {Easiest and Accurate Confirmation of Early Pregnancy during
Autopsy},
  author  = {Shrivastava N, Satpathi DK and Khare R},
  journal = {Advances in Clinical Toxicology},
  year    = {2021},
  volume  = {6},
  number  = {2},
  doi     = {10.23880/act-16000215}
}
Shrivastava N, Satpathi DK and Khare R (2021). Easiest and Accurate Confirmation of Early Pregnancy during
Autopsy. Advances in Clinical Toxicology, 6(2). https://doi.org/10.23880/act-16000215
TY  - JOUR
TI  - Easiest and Accurate Confirmation of Early Pregnancy during
Autopsy
AU  - Shrivastava N, Satpathi DK and Khare R
JO  - Advances in Clinical Toxicology
PY  - 2021
VL  - 6
IS  - 2
DO  - 10.23880/act-16000215
ER  -