The document discusses medical termination of pregnancy (MTP) in India according to the MTP Act. It defines MTP as terminating a pregnancy before fetal viability. The MTP Act allows termination up to 20 weeks for reasons like risk to the woman's life or health or fetal abnormalities. Methods for terminating pregnancies in the first and second trimesters are discussed, including risks and recommendations for qualified practitioners.

1. MEDICAL TERMINATION
OF PREGNANCY

2. INDUCTION OF ABORTION
Deliberate termination of
pregnancy before the viability of the
fetus is called induction of abortion.

3. PROVISIONS OF THE
MTP ACT
1. The continuation of pregnancy would
involve serious risk of life or grave injury
to the physical and mental health of the
pregnant women.
2. There is a substantial risk of the child
being born with serious physical and
mental abnormalities so as to be
handicapped in life.

4. 3. When pregnancy is caused by rape, both
in case of major and minor girl and in
mentally imbalanced women.
4. Pregnancy caused as a result of failure
of contraceptive.

5. INDICATIONS FOR TERMINATION
UNDER THE MPT ACT
1. To save the life of the mother.
2. Social Indications.
3. Eugenic.

6. RECOMMENDATION
1. Registered medical practitioner is
qualified to perform an MTP provided:
– One has assisted in at least 25 MTP
cases in an authorized centre and having
a certificate.
– One has got six months house surgeon
training in obstetrics and gynecology.
– One has got diploma or degree in
obstetrics and gynecology.

7. 2. Termination can only be performed in
hospitals, established or maintained by the
government or places approved by the
government.
3. Pregnancy can only be terminated on the
written consent of the woman .Husband’s
consent is not required.
4. Pregnancy in a minor girl (below the age of
18 years) or lunatic cannot be terminated
without written consent of the parent or
legal guardians.

8. 5. Termination is permitted up to 20
weeks of pregnancy. When the
pregnancy exceeds 12 weeks, opinion
of two medical practitioner is required.
6. The abortion has to be performed
confidentially and to be reported to the
director of health services of the state
in prescribed form.

9. METHODS OF TERMINATION
FIRST TRIMESTER (UPTO 12
WEEKS)
1. Menstruation regulation (M.R)
2. Suction evacuation and / or curettage
3. Dilatation and evacuation:
i. Rapid method
ii. Slow method
4. Prostaglandins
5. Mifepristone
6. Methotrexate

10. FIRST TRIMESTER TERMINATION
1. MENSTRUAL REGULATION
Definition:
Menstrual regulation is the aspiration of the
endometrial cavity within 14 days of the
missed period in a previously normal cycle
when the presence of an early pregnancy
cannot be diagnosed accurately.

11. Contraindication:
Pregnancy of more than 44 days.
Presence of local pelvic inflammation.

12. 2. SUCTION EVACUATION [SYN:
VACCUM ASPIRATION OR CURETAGE]
Definition:
It is a procedure in which the products
of conception are sucked out from the
uterus with the help of cannula fitted to
a suction apparatus.

13. Indications:
1. Medical termination of pregnancy
during first trimester (commonest).
2. Inevitable abortion.
3. Recent incomplete abortion.
4. Hydatidiform mole.

14. Complications:
Immediate →
1. Excessive hemorrhage
2. Injury
3. Shock
4. Increased morbidity
Late →
• Pelvic inflammation
• Infertility
• Cervical incompetence
• Uterine synechiae

15. Advantages:
1. It is done as an outdoor procedure.
2. Hazards of general anesthesia are absent.
3. Ideal for termination for therapeutic
indications.
4. Blood loss is minimal.
5. Chance of uterine perforation is much
less specially with the plastic cannula.

16. Drawbacks:
1. Not suitable if uterus size is more than 10
weeks.
2. Requires electricity to operate and the
machine is coastly.

19. 3. DILATATION AND EVACUATION
Definition:
D & E operation consists of dilatation of
the cervix and evacuation of the products of
conception from the uterine cavity.
The operation may be performed as :
One stage operation
Two stage operation

24. ONE STAGE OPERATION
Indications:
1) Incomplete abortion (commonest).
2) Inevitable abortion.
3) Medical termination of pregnancy (6-8
weeks).
4) Hydatidiform mole in the process of
expulsion.

25. TWO STAGE OPERATION
Indications
1) Induction of first trimester abortion.
2) Missed abortion( uterus 8-10 weeks).
3) Hydatidiform mole with unfavourable
cervix.

26. DANGERS OF D+E OPERATIONS
Immediate:
1. Excessive hemorrhage
2. Injury
3. Shock
4. Increased morbidity
Late:
1. Pelvic inflammation
2. Infertility
3. Cervical incompetence
4. Uterine synechiae

27. ADVANTAGES
Rapid method →
1. It can be done as out door procedure.
2. Chance of sepsis is minimal.
Slow method →
1. Chance of cervical injury is minimal.
2. Suitable in cases of therapeutic
indications.

28. DRAW BACK
Rapid method→
1. Chance of cervical injury is more.
2. Uterus should not be more than 6-8 weeks
of pregnancy.
3. All draw backs of D+E.
Slow method→
1. Hospitalization required.
2. Chance of introducing sepsis is more.
3. All the complications of D+E.

29. SECOND TRIMESTER (13-20
WEEKS)
1. Intra uterine instillation of hypertonic
solutions.
a) Intra – amniotic – 20% saline, 40% urea,
mannitol.
b) Extra – amniotic – Ethacrydine lactate.
2. Prostaglandins
3. Oxytocin infusion
4. Hysterotomy

30. MID TIMESTER TERMINATION
Between 13-15 weeks
It is difficult to terminate
Between 16-20 weeks
Intra – uterine instillation of hypertonic solution.
– Intra – amniotic.
– Extra – amniotic.

31. INTRA-AMNIOTIC
Contraindication:
Cardiovascular lesion
Renal lesion
Severe anemia

33. Complications:
1. Retained products of conception.
2. Infection.
3. Hypernatremia .
4. Cervical tear and laceration.
5. Minor complications like headache, fever,
nausea & vomiting.
6. DIC.
7. Occasionally deaths

34. EXTRA – AMNIOTIC INSTILLATION
OF 0.1% ETHACRYDINE LACTATE
Used where saline is contraindicate
OXYTOCIN
It is administered by intra venous drip method
It is used to augment abortion
HYSTEROTOMY
Performed through abdominal route

35. Indications:
 Termination of pregnancy on therapeutic
grounds
 Failure of medical induction in second
trimester
Hazards:
Immediate  1. haemorrhage and shock
2. anaesthetic complications
3. peritonitis
4. intestinal obstruction

36. Remote  1. Menstrual abnormalities.
2. Scar endometriosis.
3. Incisional hernia.
4. Scar rupture.

37. 4. PROSTAGLANDINS
use in obstetrics:
Induction of abortion (MTP and missed
abortion).
Termination of molar pregnancy.
Induction of labour.
Cervical ripening prior to induction of abortion
or labour.
Acceleration of labour.
Management of atonic post partum hemorrhage.
Medical management of tabal ecotopic
pregnancy.

38. Contraindications:
Absolute →
Hypersensitivity of the compound
Asthma
Acute PID
Relative →
Hypertension
Cardiovascular disease
Renal disease
Peptic ulcer
Jaundice
Uterine scar

39. Draw backs:
It is costly and is not available widely.
Unpleasant side effects.
Cervical laceration.
The hyperactivity of the uterus, if occurs
continue for a variable period even after
discontinuation of its administration.

40. Advantages:
It has got a powerful oxytocic effect.
In later months, where the pre induction score
is low or in intra uterine death, it is more
effective than oxytocin.
It has got no antidiuretic effect.

41. COMPLICATIONS OF MTP
Immediate→
1. Trauma to the cervix and uterus .
2. Hemorrhage and shock .
3. Thrombosis or embolism .
Remote →
• Menstrual disturbances
• Chronic PID
• Infertility due to cornual block
• Scar endometriosis
• Uterine synechae

42. Obstetrical complications include 
1. Recurrent mid trimester abortion due to
cervical incompetence
2. Ectopic pregnancy
3. Dysmaturity
4. Increased perinatal loss
5. Rupture of uterus
6. Rh iso-immunisation

43. Instruments used in MTP