Definition of abortion

• Medical Termination Act (MTP Act) is a careful termination of pregnancy by the medical and surgical method.
• Induce Abortion is Done under the MTP Act.
• MTP Act Passed = 1971
• MTP Act implement = 1972
• MTP Act provides legal abortion services, and safe abortion services to women.

Indications of MTP

1. Therapeutic – MTP act Done Abortion when pregnancy is harmful the life of woman or may cause the serious injury to her physical and mental health. eg :- Hypertension, CHD , Renal failure etc.
2. Eugenic – Abortion Done when risk of the fetal abnormalities. Eg: Chromosomal abnormalities 1. Down syndrome 2. NTD, Rubella etc.
3. Humination – MTP act Done abortion when pregnancy Due to rape.
4. Failure of Contraception – When pregnancy is result from the failure of contraceptive method in case of married women.
5. Socio-Economic – When the poor socio-economic environment of the Family.
6. When mother Intake Drugs.
7. Intra Uterine Infection.
8. Maternal mental Health.

What is the Rule of MTP Acts

1. MTP can be done by skilled Doctors-

• 1. Well qualified
• 2. Registered
• 3. Medical Practitioner
• 4. Minimum assist 25 MTP.

1. MTP only done in Government Hospital and Government Recognized Hospital.
2. Private Hospital and clinic homes cannot perform MTP.
3.   Non-Government Hospital Done MTP when may take licensed by CMHO of District.
4. Abortion Can’t Performs on request of husband, only women statement is Necessary.
5. Consent of signature require only women.
6. Patient relatives signature require when a woman is below 18 year of age and women is mentally ill.
7. The women no need to produce proof of her age, MTP act accept women statement.
8. If women statement is that she was raped, then not necessary for extra discussion and complaint to police.
9. MTP admission Registers are professionally secured and secretly maintain. à MTP admission details cannot be share with others.
10. Before 12 weeks of pregnancy à MTP performed by single Doctor.

After 12 weeks of pregnancy à MTP performed by 2 Doctors.

12. Abortion not allow after 20 weeks of pregnancy under MTP Act.
13. If an emergency, pregnancy can be terminated by single Doctors, even not registered, Not Training, and without consent. And also perform in non-recognized hospital.
14. When a Doctor perform MTP without registered in medical practice and perform in an unrecognized hospital, will be punished with rigorous imprisonment for à 2year up to 7 years.

Methods of MTP

Method of MTP in 1st Trimester

1. Medical method

1.   Mifepristone (RU-486) – Progesterone antagonist
2. MTP kit (Mifepristone + Misoprostol)
3. Methotrexate + Misoprostol
4. Tamoxifen + Misoprostol

• Best medical method of MTP in 1st trimester of pregnancy:- MTP-Kit (Mifepristone + Misoprostol)
• MTP –Kit

In MTP kit 5 tablet.

• One tablet = Mifepristone 200mg.
• Four tablet = mesoprost 200mg micro gram (each)

#  Mifepristone is Antagonist of progesterone.

# Misoprostol is the prostaglandin (PGE1)

# MTP-kit use before 56 Days (8 weeks) of LMP.

# MTP – kit Procedure – Firstly take mifepristone orally

How to use MTP KIT:

(Block the progesterone receptor)

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Wait 24-48 hours.

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Then one tablet of misoprostol keeps in the vaginal fornix and takes rest

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Next misoprostol tablets keep in the vaginal fornics in interval of 3-3 hours.

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Expulsion of embryonic mass

# Mifepristone are used for placental Detachment and misoprostol is used for cervical ripening and uterine contraction.

# MTP kit = 97% result is complete Abortion.

# MTP kit complication

• Hemorrhage (Most-common)
• Sepsis
• Incomplete Abortion.
• Anemia
• Menstrual Abnormalities.
• Intrauterine adhesion.

 Surgical Method of Abortion

• The surgical method of MTP is more effective in 1st trimester than medical methods.
• Surgical methods of MTP are: a)  Menstrual Regulation

b)  Vacuum Aspiration

c)  Suction Evacuation with curettage and without curettage.

b) Dilation & Evacuation

e) DNC – Dilation and Curettage

a):- Menstrual Regulation

• Menstrual Regulation is a procedure in which the endometrial cavity is aspiration with 14 Days of missed period in a woman.
• Menstrual Regulation is a OPD procedure.
• During menstrual regulation, use the aseptic precautions.

Procedure steps

• Wear gloves and introduce the posterior vaginal speculum in the vagina.
• Cervix hold by Allis forceps.
• Use Das Dilator for Dilate the cervix 4-5mm.
• 5-6mm Karman’s suction cannula is inserted and connect with 50ml syringe for suction.
• The cannula is roated and aspirate the endometrial and conception tissue.

b) :- Vacuum aspiration

• Vacuum aspiration is a OPD procedure.
• Vacuum aspiration is Done up to 12week with minimal cervical Dilations.
• Vacuum aspiration uses the plastic Disposal Cannula and 60ml plastic syringe use.
• Quick procedure (15 minutes)
• Effective procedure (98-100%)
• Aspiration Negative pressure is – 660mm Hg.
• Less traumatic procedure.

c) :- Suction evacuation and/or curettage

Suction evacuation with/without curettage is most common method for terminate the pregnancy in 1st trimester.

Negative pressure creates = 400-600mm of Hg.

The procedure involve minimal blood loss.

Indication

• MTP in 1st trimester.
• Hydatidiform mole
• Incomplete and inevitable abortion.

Advantage

• OPD procedure
  • • Minimal blood loss
    • Require only local anesthesia
    • Perform only with Paracervical block.
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Method of MTP in 2nd Trimester

1. Medical method

1. Prostaglandin – eg :- Dinoprost (PGE2) , Misoprostol (PGE1) , Gemeprost (PGE1)

• Very most effective in 2^nd Trimester.

2. Oxytocin – 300 units in 500ml Dextrose.
3. Mifepristone + Misoprostol.

2. Surgical method Abortion

Dilation and evacuation – less effective than 1^st trimester.

Intra amniotic instillation of Hypertonic solution

Urea (40%) + Saline (20%)

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Hypertonic Solution

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Intraamniotic Instillation through abdominal route.

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Fetal blood receives the Hypertonic solution and shrink

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Abortion

2. Extra-amniotic instillation of 0% ethacridine lactate Done trans cervically through a no. 16 Foley’s Catheter.

3. Hysterotomy – Hysterotomy Done through the abdominal route.

*  Disadvantage – Not effective after 10 weeks

–Require electricity

— Machine is costly.

* Steps – Post vaginal speculum insert in the vagina.

— Cervix hold by Allis forceps.

— Cervix Dilate by Das Dilator.

— Cannula insert into the Negative Pressure and canulla roated.

— Product of conception and tissues are collect in suction bottale.

D) Dilatation and Evacuation –

1) Dilatation and evacuation procedure done in two phase –

a) Rapid Dilation – by mechauical Dilators.

Eg:- Das Dilators.

b) Slow Dilation – By using the Laminaria tent (Wooden Piece)

2) Rapid Dilation involve – less change of sepsis

— No require hospital admission

— Part go home early.

3) Rapid Dilation Disadvantage is cervical Injury.

4) Slow Dilation Require – Therapeutic Indication.

— Require Hospital admission

— Cervix Dilate within 12hrs.

— Less change of cervical injury.

5) Slow Dilation Disadvantage is the cervix Dilates within 12 hours.