Hannah was found strangled two days after she went missing
Teenager Hannah Foster may have struggled and scratched at the hands of her attacker while being strangled, a court has heard.
Pathologist Dr Hugh White said that when he examined the body of the 17-year-old, her clothes were tangled up.
He told Winchester Crown Court she had suffered scratches which appeared to have been caused while she was alive.
Hannah vanished in Southampton in 2003. Maninder Pal Singh Kohli denies murder, rape, kidnap and false imprisonment.
Dr White told the court that when he examined Hannah's body her clothing and underwear were not fitting as they should have been.
He said that the scratches she had to her body, hands and legs were probably caused by brambles.
Hannah's body was found in Allington Lane, West End, Southampton
Some had been inflicted when she was alive and others after her death, he told the court. There was evidence that the injuries had been caused with items of clothing removed.
He said she was found wearing a pair of boots but the soles of her feet were dirty.
Dr White said Hannah suffered haemorrhages to her face and eyes which were symptoms of her neck being compressed.
She had suffered bruising to her neck and windpipe and there was a 2.4in (6cm) scratch to her neck caused by a fingernail.
"The marks were caused by the movement of hands on Hannah's neck and the implication is that she has been struggling while this process is going on," he said.
He said the fingernail scratch could have been caused by Hannah herself scratching the hands of her assailant.
Maninder Pal Singh Kohli denies all the charges against him
The jury also heard statements from Hannah's parents Hilary and Trevor, who confirmed the voice on the 999 recording was that of their daughter.
Mrs Foster said: "Prior to actually listening to the recording I felt a rising panic. At the first listening, I heard the word Sarah quite clearly.
"Since I have not heard Hannah that scared, I could not be sure it was her. The second time I believe it was Hannah, her trying to control her panic, particularly because of the way she said Sarah. I think it was Hannah."
Mr Foster said: "Although there was a tremor in her voice, the controlled intonation was Hannah. There was no doubt in my mind that the voice I heard in the recording was my daughter, Hannah."
The body of the A-level student, who was planning to study medicine at university, was found in a bramble-filled ditch at the side of Allington Lane, West End, Southampton, on 16 March, two days after she went missing missing.
Mr Kohli, 40, a former sandwich delivery van driver, took a flight to India two days after her body was discovered.
The case continues.