Other and mtp

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Other and mtp

  1. 2. GUIDELINE FOR STERILIZATION <ul><li>Age of husband >25---<50yrs </li></ul><ul><li>Age of wife >20---<45yrs </li></ul><ul><li>Must have 2 living child </li></ul><ul><li>If > 3 child the lower limit of age restriction can be </li></ul><ul><li>relaxed </li></ul><ul><li>Ready to give informed consent </li></ul>
  2. 3. <ul><li>Sterilization :female sterilization and male vasectomy are permanent method of contraception and highly effective </li></ul><ul><li>28% of reproductive age women undergo tubal ligation and 10% of men undergo vasectomy. </li></ul><ul><li>Sterilization methods include: </li></ul><ul><li>1- Vasectomy in males. </li></ul><ul><li>2- Tubal Ligation in females . </li></ul>
  3. 4. <ul><li>Surgical procedure performed on a woman </li></ul><ul><li>Fallopian tubes are cut, tied, cauterized  mechanically blockage of both fallopian tube to prevent the sperm reaching and fertilizing the oocyte </li></ul><ul><li>sterilization performed by laparoscopically(under GA) or through a suprapubic “mini-laparotomy” </li></ul><ul><li>Failure rates vary by procedure, from 0.8%-3.7% </li></ul>
  4. 7. <ul><li>Advantages : </li></ul><ul><li>• intended to be permanent </li></ul><ul><li>• highly effective </li></ul><ul><li>• safe </li></ul><ul><li>• quick recovery </li></ul><ul><li>• lack of significant long-term side effects </li></ul><ul><li>• cost effective </li></ul>
  5. 8. <ul><li>Disadvantage: </li></ul><ul><li>• Complication: </li></ul><ul><li>A women may experienced anesthetic problem or may be damage to intra-abdominal during the procedure. </li></ul><ul><li>NOTE: </li></ul><ul><li>ectopic pregnancy can be a late complications </li></ul><ul><li>and any sterilized women who misses her period and has symptom of pregnancy should seek </li></ul><ul><li>medical advice. </li></ul><ul><li>• difficult to reverse </li></ul><ul><li>• future pregnancy could require assisted reproductive technology (such as IVF) </li></ul><ul><li>• more expensive than vasectomy </li></ul>
  6. 9. <ul><li>Male sterilization procedure </li></ul><ul><li>Vasectomy involve division of the vas deferens on each side to prevent the release of sperm during ejaculation. </li></ul><ul><li>No-scalpel technique available </li></ul><ul><li>Faster and easier recovery than a tubal ligation </li></ul><ul><li>Failure rate = 0.1%, more effective than female sterilization </li></ul><ul><li>Usually done under local anesthesia. </li></ul>
  7. 12. <ul><li>Disadvantages: </li></ul><ul><li>• reversal is difficult, expensive, often unsuccessful </li></ul><ul><li>• not effective until all sperm cleared from the </li></ul><ul><li>reproductive tract (may take up to 12 w) </li></ul><ul><li>• no protection from STDs </li></ul>
  8. 13. <ul><li>Immediately bleeding, wound infection and hematoma may occur. </li></ul><ul><li>At the cut of vas deferens small lump will appear as a result of a local inflammation response this is called sperm granuloma it needs surgical excision. </li></ul><ul><li>some men develop anti-sperm antibody following vasectomy </li></ul>
  9. 15. <ul><li>TERMINATION OF PREGNANCY BEFORE THE FOETUS BECOMES VIABLE…(ADMINISTRATIVELY 28 TH WEEK AND WEIGHT 1000 gm) </li></ul><ul><li>Early complication::: hge, shock, sepsis uterine perforation, thromboembolism. </li></ul><ul><li>Late complication::: Infertility, ectopic </li></ul><ul><li>NEED TO LEGALISED </li></ul>
  10. 16. <ul><li>Abortions are termed legal only when all the following conditions are met: </li></ul><ul><ul><li>Termination done by a medical practitioner approved by the Act </li></ul></ul><ul><ul><li>Termination done at a place approved under the Act </li></ul></ul><ul><ul><li>Termination done for conditions and within the gestation prescribed by the Act </li></ul></ul>
  11. 17. <ul><li>MTP Act - an enabling act which </li></ul><ul><li>Aims to improve the maternal health scenario by preventing large number of unsafe abortions and consequent high incidence of maternal mortality & morbidity </li></ul><ul><li>Legalizes abortion services </li></ul><ul><li>Promotes access to safe abortion services to women </li></ul><ul><li>De-criminalizes the abortion seeker </li></ul><ul><li>Offers protection to medical practitioners who otherwise would be penalized under the Indian Penal Code (sections 315-316) </li></ul>
  12. 18. <ul><li>MTP Act [1971] </li></ul><ul><ul><li>lays down when & where pregnancies can be terminated </li></ul></ul><ul><ul><li>Grants the central govt. power to make rules and the state govt. power to frame regulations </li></ul></ul><ul><li>MTP Rules[1975] </li></ul><ul><ul><li>lays down who can terminate the pregnancy, training requirements, approval process for place, etc . </li></ul></ul><ul><li>MTP Regulations </li></ul><ul><ul><li>lays down forms for opinion, maintenance of records </li></ul></ul><ul><ul><li>custody of forms and reporting of cases </li></ul></ul>
  13. 19. <ul><ul><li>Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental health of woman. [MEDICAL] </li></ul></ul><ul><ul><li>Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped. [EUGENIC] </li></ul></ul><ul><ul><li>Pregnancy caused by rape (presumed grave injury to mental health). [HUMANITARIAN] </li></ul></ul><ul><ul><li>Contraceptive failure in married couple (presumed grave injury to mental health). </li></ul></ul><ul><ul><li>Socio economic condition  if leads to injury to the mother. </li></ul></ul>
  14. 20. <ul><li>Up to 20 weeks gestation </li></ul><ul><li>With the consent of the women. If the women is below 18 years or is mentally ill, then with consent of a guardian </li></ul><ul><li>With the opinion of a registered medical practitioner, formed in good faith, under certain circumstances </li></ul><ul><li>Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks </li></ul>
  15. 21. <ul><li>A hospital established or maintained by Government </li></ul><ul><li>or </li></ul><ul><li>A place approved for the purpose of this Act by a District-level Committee constituted by the government with the CMHO as Chairperson </li></ul>
  16. 22. <ul><li>A medical practitioner (RMP) </li></ul><ul><ul><li>who has a recognized medical qualification as defined in clause (h) of section 2 of Indian Medical Council Act, 1956 </li></ul></ul><ul><ul><li>Whose name has been entered in a State Medical Register and </li></ul></ul><ul><ul><li>Who has such experience or training in Gynecology and Obstetrics as prescribed by Rules made under the Act </li></ul></ul>
  17. 23. <ul><li>For termination up to 12 weeks: </li></ul><ul><ul><li>A practitioner who has assisted a registered medical practitioner in performing 25 cases of MTP of which at least 5 were performed independently in a hospital established or maintained or a training institute approved for this purpose by the Government </li></ul></ul>
  18. 24. <ul><li>For termination up to 20 weeks </li></ul><ul><ul><li>A practitioner who holds a post-graduate degree or diploma in Obstetrics and Gynecology </li></ul></ul><ul><ul><li>A practitioner who has completed six months house job in Obstetrics and Gynecology </li></ul></ul><ul><ul><li>A practitioner who has at least one-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities on or after date of commencement of the act </li></ul></ul><ul><ul><li>A practitioner who has at least three-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities before date of commencement of the 1971 MTP act </li></ul></ul>
  19. 25. THANK YOU

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