Abortion means spontaneous or induced expulsion of products of conception before the period of viability( 28 weeks). In medical practice, the abortion occurs in 1st trimester, miscarriage in the 2nd trimester and premature labor in the 3rd trimester. legally all the above terms are synonymous.

1. ABORTIONS
AND MTP
Presented by:
Michael Kino
MBBS, NEIGRIHMS

2. OVERVIEW
 Definition
 Incidence
 Types of abortion and clinical features
 Aetiology of early pregnancy bleeding(D/D of abortion)
 Diagnosis
 Treatment
 MTP
 Methods of MTP
 Complications of abortion

3.  ABORTION?
 MISCARRIAGE?
 EARLY PREGNANCY LOSS?
In the first trimester, the terms miscarriage, spontaneous
abortion, and early pregnancy loss are used
interchangeably.

4. DEFINITION
 Abortion:the expulsion of a fetus from the uterus before it has
reached the stage of viability ( the 20th week of gestation)
 An abortion that occurs without intervention is known as
a miscarriage or "spontaneous abortion" .
 When deliberate steps are taken to end a pregnancy, it is called
an induced abortion, or less frequently "induced miscarriage".
 The unmodified word abortion generally refers to an induced
abortion.

5. DEFINITION (WHO & CDC): Termination of
pregnancy prior to 20 weeks of gestation/fetus
born weighing less than 500 grams( abortus).
RCOG : 24 weeks

6. Incidence
10% of all pregnancies
80% occur in the 1st trimester

7. Etiology and Risk Factors
 Fetal chromosomal abnormalities(80%)
 Advanced maternal age
 Prior early pregnancy loss

8. Latest update on abortion laws in
INDIA
 The MTP (amendment bill) 2020: Proposes
to extend the upper limit from 20 to 24 weeks.
Need to increase the upper limit?

9. TYPES OF ABORTIONS
 INDUCED
 SPONTANEOUS

10. TYPES OF ABORTIONS
 THREATENED ABORTION
 INEVITABLE ABORTION
 INCOMPLETE ABORTION
 COMPLETE ABORTION
 MISSED ABORTION
 SEPTIC ABORTION
 INDUCED ABORTION

13. Differential diagnosis of early
pregnancy bleeding
Related to pregnancy Unrelated to pregnancy
Implantation bleeding Cervical or vaginal pathology such as
erosion, polyp , fibroids, cancer
Miscarriage Trauma to the cervix and vagina
Ectopic pregnancy
Gestational trophoblastic neoplasms
Cervical insufficiency

14. Diagnosis
 Serum ß hCG
 Serum Progesterone
 Transvaginal USG

15. Serum B hCG
 Rate of increase of 2 levels done 48 hours
apart <50%
Serum Progesterone:
<5ng/ml

16. Transvaginal USG
 The single most important investigation in a
woman with bleeding in early pregnancy
 TVS > transabdominal
 Increase quality and accuracy

18.  Treatment of an early pregnancy loss before
confirmed diagnosis can have detrimental
consequences, including interruption of a
normal pregnancy, pregnancy complications,
or birth defects

19. Management
 Principles:
- Acknowledgement of loss of a pregnancy by
the care provider and appropriate counselling
- Assessing the need for uterine evacuation
- Method of uterine evacuation

20. Management
 Conservative/Expectant
 Medical
 Surgical

21. Management
 Definite and urgent need for uterine
evacuation :
- Significant vaginal bleeding with shock or a
change in haemodynamic parameters
- Evidence of infection
- Pain or discomfort

22. INDUCED ABORTION
 MEDICAL : 1st and 2nd trimester
 SURGICAL: 1st trimester
PREFERRED METHOD?

23. For pregnancies of less than 14
weeks of gestation
 Surgical abortion
 Either manual or electric vacuum aspiration:
 • There is no lower limit of gestation for surgical
abortion.
 • It is best practice to inspect aspirated tissue at
all gestations to confirm complete evacuation; this
is essential following vacuum aspiration at under 7
weeks of gestation.

24. For pregnancies of less than 14
weeks of gestation
 Medical abortion:
 If mifepristone is available, it is best practice to use it
in combination with misoprostol as it shortens the
induction–abortion interval, reduces side effects and
decreases the rate of ongoing pregnancy.
 at up to 63 days of gestation, mifepristone 200mg
orally, followed 24–48 hours later by misoprostol 800
micrograms given by the vaginal, buccal or sublingual
route.

25. For pregnancies of less than 14
weeks of gestation
 from 64 days to 13 weeks and 6 days, mifepristone
200mg orally, followed 24–48 hours later by misoprostol
800 micrograms given by the vaginal, buccal or
sublingual route, followed by misoprostol 400
micrograms every 3 hours until abortion occurs
 OR • If mifepristone is not available, and for all
gestations up to 13 weeks and 6 days, misoprostol 800
micrograms given by the vaginal, buccal or sublingual
route, followed by misoprostol 400 micrograms every 3
hours until abortion occurs.

26. For pregnancies of 14 weeks of
gestation or more
 Surgical abortion Surgical abortion can be performed by trained
providers using: • vacuum aspiration using large bore cannulae •
dilatation and evacuation (D&E)
 Medical abortion At 14 weeks of gestation or more, medical
abortion should be undertaken in a medical facility.
 Mifepristone 200 mg orally, followed 12–48 hours later by
misoprostol 800micrograms vaginally, followed by misoprostol
400micrograms orally or vaginally every 3 hours until abortion
occurs; if after 24 hours abortion does not occur, mifepristone can be
repeated 3 hours after the last dose of misoprostol, and 12 hours
later misoprostol may be recommenced
 -where mifepristone is not available, misoprostol 800 micrograms
followed by misoprostol 400 micrograms every 3 hours until abortion
occurs.

28. INDUCED ABORTION
 SURGICAL METHODS: 1st trimester
 1. VACUUM ASPIRATION
 2. DILATATION AND EVACUATION

29. Vacuum aspiration

30. DILATATION AND
EVACUATION

32. INDUCED ABORTION
 MEDICAL METHODS:
1. MIFEPRISTONE (RU 486): Inhibits Progesterone
receptors.
2. MISOPROSTOL: Prostaglandin E1.

33. MEDICAL TERMINATION OF
PREGNANCY
 TYPE OF INDUCED ABORTION

34. IS ABORTION LEGAL IN INDIA?
MEDICAL TERMINATION OF
PREGNANCY(MTP) ACT

35. UNWANTED PREGNANCY AND ITS
IMPLICATIONS
 Every child should be desired and every pregnancy
planned.
 Premarital unsafe sexual intercourse has become prevalent
the world over: ramifications of acting on impulses may have
undesirable consequences.
“Unsafe” – No safeguard against
pregnancy or STD’s (Sexually
transmitted diseases).

36. UNSAFE ABORTION
conducted by a “Quack”,
carried out in a set up not
approved by the
Government.
CONCERNS:
 Complications related to
the procedure.
 Long term psychological
effects.

37. Complications of abortion
 Uterine haemorrhage
 Pelvic infection
 Cervical injury
 Uterine perforation
 Retained products
 Continuation of pregnancy
 Maternal mortality and morbidity
 Long term sequelae

38. UTERINE PERFORATION

39.  ANTI D
 CONTRACEPTION

40. PRO LIFE/ PRO CHOICE?

41. THANK YOU