NURSING

1.  INTRODUCTION
 Medical terminationof pregnancy is refers as the inductionof abortion.
The inductionof abortionmay be legal & illegal. There are many countries
in the globe where the abortionis not yet legalised. Inindiathe abortion
was legalisedby “medical terminationof pregnancy Act”of 1971, &has
beeninforcedin the april 1972
 DEFINITION
 Deliberate terminationof pregnancy either by the medical & surgical
methodbefore the viability of the fetus is calledinductionof abortion.
 MEDICAL TERMINATION OF PREGNANCY ACT 1971
The Indian abortionlaws falls under the Medical Terminationof
Pregnancy (MTP) Act, which was enactedby the Indian parliament in the
year 1971 withthe intentionof reducing the inccidence of illegal abortion
and consequent meternal mortality andmorbidity. The MTP Act came
intoeffect from1st
april 1972 and was amendedin the years 1975 and
2002.
 Recently, the supreme court permittedarape survivor tothe terminate
her pregnancy at 24 weeks, Whichis beyond the permissible 20 weeks
limit prescribedunder the medical terminationof pregnancy Act, 1971.
 MTP ACT LOGO


2. LEGAL ABORTION
• Terminationis performedby the medical practitioners(assistedinat least
25mtp& degree inOBG) by the act.
• Terminationis done at the place approvedunder the act.
• Terminationdone for condition& withinthe gestationweek prescribed
by the act.
• The abortionhas to be reportedtothe director of healthservice of the
state.
MTP Act specifies
1. The Indications for legal Terminations
2. Who can Terminate
3. The Place where it can be terminated
4. Last but most important Consent requirement
INDICATIONS
 METERNAL CAUSES
• Mentally illness
• Severe cardiac disease
• Malignant hypertension
• Malignancy in breast or cervical
• Rubellavirus infaction
• Hyperemesisgravidarum

3.  FETAL CAUSES
• Mentally &physically illness
• Severe neural tube defect
• Chromosomal (down syndrome)
• Handicapped
• Mall presentation
 SOCIEO ECONOMIC STATUS
• Prevent grave injury tothe physical and mental healthof the pregnant
woman
• Unplanned pregnancy withlow socieoeconomic status
 HUMANTARIAN
• Pregnancy is result of the rape
• Failure of contraceptive device
MTP Act: Objectives
MTP Act
• Aims to improve the maternal healthscenarioby preventing large
number of unsafe abortions and consequent highincidence of maternal
mortality & morbidity.
• Legalizes abortionservices.
• Promotes access tosafe abortionservices towomen.
 Offers protectiontomedical practitionerswhootherwise wouldbe
penalizedunder the IndianPenal code (sections 315-316)

4.  MTP Act, Rules & Regulations
 MTP Act is an Act of Parliament providing an Overviewof Safe abortions
and delegating authority toCentral &State government.
 Rules are framedby the Central Government but must be ratifiedby each
house of Parliament.
 Regulations are framedby the State Government &relate toissues
involving opinions, reporting andmaintaining secrecy.
 PLACE FOR MTP
 Place establishedandmaintainedby government.
 Non government institutioncanperform, they obtainlicence fromCMO
of district.
 Experience of RMP- Up to 12 weeks of gestation only
 Before the commencement of act experience minimum3 years.
 Who is registeredinstate medical register- 6 month of house surgeon-
shipin gynaecology.
 Or experience of working indepartment of gynarcology- 1 year.
 A Practitioner whohas assistedRMP in25 cases of Medical terminationof
pregnancies, at least 5 of whichhave beenperformedindependently ina
hospital establishedor maintainedby government or a training institute
approvedfor this purpose by the Government.
 Experience and TrainingRequired by a RMP– Up to 20
weeks
 PG Degree or Diplomain OBG.

5.  Completed6 months as House Surgeonin OBG
 At least one year experience indept of OBG at any hospital that has all
facilities
 FIRST TRIMESTER TERMINATION OF PREGNANCY
 METHOD OF FIRST TRIMESTER ABORTION:
 Mifepristone (RU-486) andMisoprostol-
 Mifepristone (200mg) ananalog of progestin (norethindrone) acts as an
antagonist, blocking the effect of natural progesterone.
 Additionof low dose prostaglandins (800mg) (PGE1) improves the
efficiency of first trimesterabortion. It is effective upto63 days and is
highly successful whenusedwithin49 days of gestation.
 Methotrexate and Misoprostol-
 Methotrexate 50mg/m2 IM (before 56 days of gestation) followedby 7
days later misoprostol 800ug vaginally is highly effective.
 Misoprostol may have to be repeatedafter 24 hours if it fails.
 Methotrexate andmisoprostol regimenis less expensive but takes longer
time than Mifepristone andMisoprostol.
 SURGICAL METHODS OF FIRST TRIMESTER ABORTION
 MENSTRUAL REGULATION:
 It is the aspirationof the endometrial cavity within14 days of missed
periodin a woman withprevious normal cycle.
 The operationis done as an out patient or an office procedure.
 It is done withaseptic precautions.

6.  After introducing the posterior vaginal speculum, the cervix is steadied
withan allis force
 Scecond trimester of pregacy
 MEDICAL METHODS:
 PROSTAGLANDINS:
 They act on the cervix andthe uterus.
 ThePGE(dinoprostone, sulprostone, gemeprost, misoprostol) andPGF
(carboprost) analogues are commonly used.
 PGEs are preferredas they have more selective actiononthe
myometriumand less side effects
2.Mifepristone and prostaglandins:
 Mifepristone 200mg oral, followed36-48 hours later by misoprostol.
 800ug vaginal;thenmisoprostol 400ug oral every 3 hours for 4 doses is
used.
 Success rate of abortionis 97% and median inductiondelivery interval is
6.5 hours.
 Pretreatment withmifepristone reduces the induction- abortioninterval
significantly comparedtouse of misoprostol alone.
3.PROSTAGLANDIN F2 (CARBOPROST):-
 -250mg IM every 3 hours for a maximum 100 dose can be used.
4.OXYTOCIN:
 Highdose oxytocinas a single agent can be usedfor secondtrimester
abortion.

7.  It is effective in80% of cases.
 It can be usedwithintravenous normal saline along withany of the
medications usedeither intra-amniotic space inanattempt toaugment
the abortionprocess.
5.MODE OF ACTION:
 Myometrial oxytocinreceptor concentrationincreases maximum(100-
200 fold) during labour.
 Oxytocinacts throughreceptor andvoltage mediatedcalciumchannels to
initiate myometrial contractions.
 SURGICAL METHOD
 HYSTEROTOMY
 Hysterotomy is anoperative procedure of extracting the productsof
conceptionout of the womb before 28th
week by cutting throughthe
anterior wall of the uterus.
 The operationis usually done through the abdominal route.
 The operationis rarely done these days these days for the purpose of
MTP.
 Complications:
 Hemorrhage and shock
 Peritonitis
 Intestinal obstruction
 COMPLICATION OF MTP
 IMMEDIATE:-

8.  Injury to the cervix (cervical lacerations)
 Uterine perforationduring D and E
 Haemorrhage and shock due to trauma, incomplete abortion, atonic
uterus or rarely coagulationfailure
 Thrombosis or embolism
 Remote
 Gynecological
 Obstetrical
 Gynecological complications include-
 Menstrual disturbances
 Chronic pelvic inflammation
 Obstetrical complications include-
 Ectopic pregnancy (three-foldincrease)
 Pretermlabour
 Dysmaturity
 Rupture uterus
 CONCLUSION
 In india abortionwas legalizedby “Medical terminationof pregnancy Act”
of 1971.
 It has beeninforcedinthe 1st
april 1972.
 It was amended in the year 1975.

9.  The government is intentionof reducing the incidence of illegal abortion.
 Reducing the meternal moratality andmorbidity.
 24 week abortion – 2 RMP.
 12 week gestationabortion – 1 RMP
 BIBLIOGRAPHY
 The textbook of obstetrics and gynecology (D.C.Dutta’s) 7th
addition.
 https://www.slideshare.net


10. 1. Medical termiation of pragnancy act was passed in –
a) 1984
b) 1975
c) 1981
d) 1971 ans. ( d )
2. A registered medical practioner may terminate pragnancy if it is –
a) Not less than 20 week old
b) Not more than 20 week old
c) Not more than 12 week old
d) None of the above ans. ( d )
3. Medical termination of pregnancy act 1971 was passed with
ojectives –
a) Termination of certain pregnancy by any one
b) Termination of certain pragnancy by rmp
c) Termination of certain pragnancy by pharmasist
d) Termination of pragnancy by nurse ans. ( b )
4. 12 week pragnancy can be terminated with the consentof –
a) 1 rmp
b) 2 rmp
c) 3 rmp
d) Non of the above ans. ( a )
5. Minimum 2 rmp may given consent of termination of pregnancy when it is-
a) More than 12 week old
b) More than 20 week old
c) More than 18 week old
d) More than 10 week old ans. ( b )
6. A rmp may terminate pregnancy if –
a) He has complited 3 month of house surgery
b) 6 month of house surgery
c) 1 month of house surgery
d) 12 month of house surgery ans. ( b )

11. 7. Pregnancy may be terminated by at –
a) Any other place
b) Hospital approved by state government
c) Any hospital
d) None ans. ( b )
8. The admission gesiter and its maintainance is regulated is under mtp
regulation –
a) 1971
b) 1972
c) 1973
d) 1975 ans. ( d )
9. Hospital or place for termination approved if –
a) Mci
b) Di
c) Dco
d) Cmo of district ans. ( d )
10. What is mean by guardiance –
a) A person having the care of a minor or lunatic
b) A person having the care of a major or lunatic
c) A person having the care of a major or minor
d) None of the above ans. ( a )
11.Termination record is maintain for –
a) 1 year
b) 5 year
c) 2 year
d) 20 month ans. ( b )
12.Mtp act constitued by –
a) Central government
b) State government
c) Pci
d) Mci ans. ( a )

12. 13.If fail to comply the regulation of mtp act which amount taken as
punishment –
a) 500
b) 2000
c) 1000
d) 10000 ans. ( c )
14.If any persondoing mtp is not rmp can punished with imprisoment of –
a) 2 – 7 year
b) 1 year
c) 5 – 10 year
d) None of the above ans. ( a )
15. Which drug used in first trimester –
a) Mifepristone and misoprostol
b) Methotraxte and misoprostol
c) Prostaglandin
d) Oxytocin ans. ( a,b )
16.Which drug used in second trimester –
a) Mifepristone and misoprostol
b) Methotraxte and misoprostol
c) Prostagladin
d) Oxytocin ans. ( c,d )