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Paraguayans have had to take a long look at themselves after the shocking ordeal of the youngster, who is still a child herself, emerged.

It started when the mother became concerned by the girl's swollen belly and took her to hospital.

She thought it could be a tumour in her daughter's abdomen.

But they were stunned when medics revealed the girl was actually an expectant mum carrying a nearly 5-month-old foetus.

The girl was taken to a maternity ward and was seen by a psychologist.

Dr Ricardo Oviedo, head of the maternity ward, said it was a high-risk pregnancy because the girl has not fully become an adolescent.

"The pregnancy is happening as any other, only that it is a girl who is still in the process of development and that can lead eventually to complications during the pregnancy," he said.

Dr Oviedo said the juvenile, whose name has been withheld for her own wellbeing, claimed her step-father, 42, had sexually abused her.

But the mother, who is separated from the girl's father, was said to be in the dark over the sinister allegations despite the stepfather living with them for 11 years.

Inquiries have now been set up to find out how this incestual sex attack happened and to speed up the way the police are alerted to child sex abuse allegations by medics.

Scorn has been poured on the justice system after it was learned allegations of sexual abuse were had been levelled against the girl's father and her stepfather but apparently not fully followed through.

Dr Oviedo said in his 25 years as a gynaecologist he had never seen such a case.

"The case has sensitised us," he told national media.

"It's the first time I have met a girl of this age with an advanced state of pregnancy, 21 weeks, i.e. past four and a half months pregnant."

The case has been referred to the Paraguayan Ministry of Health's Ombudsman for Children and Adolescents.