Medico-legal aspects of Abortion MTP Act of 1971

1. Dr Arun Pinchu Xavier
Assistant Professor
Dept: Of Forensic Medicine
Sree Mookambika Institute Of Medical Sciences
ABORTION

2. THE GREATEST
DESTROYER OF
PEACE IS
ABORTION
BECAUSE IF A
MOTHER CAN
KILL HER OWN
CHILD, WHAT
IS LEFT FOR ME
TO KILL YOU
AND YOU TO
KILL ME..?
Mother Teresa

3.  Legally ,there is no difference between abortion miscarriage
miscarriage and premature delivery
 Here lady and abortionist are punished except when ,it is
induced to save life of mother
 Mostly deaths are due to abortions
induced secretly by
using crude &
unhygienic
methods

4. YOU CAN BE QUESTIONED..
Medical examination is required when..,
 Substances alleged to have been expelled from the uterus
are products of conception..,if then, What stage of
pregnancy the abortion took place..?
 Allegation of miscarriage is true false..?
 Means employed
 Time of abortion
 Self induced or not..?

5. ABORTION
 Premature expulsion of products of conception from the
uterus, at any time before the full term
Classification:
ABORTION
INDUCED /
ARTIFICIAL
LEGAL /
JUSTIFIABLE
ILLEGAL /
CRIMINAL
NATURAL /
SPONTANEOUS

6. NATURAL /SPONTANEOUS ABORTION
Maternal causes
 Due to natural causes, Mostly in first 3 months
 Disease of uterus ,decidua placenta
 Metabolic / Circulatory Diseases
 Strenuous exercise ,travel ,fall, blunt impacts to abdomen
Foetal causes
 Faulty Development of embryo
 Rh and ABO incompatibility
Placental causes
• Endarteritis resulting from syphilis ,chronic nephritis

7. JUSTIFIABLE AND CRIMINALABORTION
JUSTIFIABLE:
 Intentional abortion done in good faith to save the life of
mother, if her life is endangered by continuance of
pregnancy as per the indications of MTP ACT
CRIMINAL ABORTION:
 Abortion induced in defiance of the provisions of MTP ACT
 Abortifacient drugs & mechanical methods

8. NATURAL & CRIMINAL ABORTION
Features NATURALABORTION CRIMINAL ABORTION
Cause Local /general diseases
Sudden shock /fear/sorrow
Preg in unmarried
woman/widow
Illicit relationships
Toxic
effect of
drugs
Absent Erosions and inflammation of
cervix due to local application
Genital
organs
Injuries usually absent Abrasion contusions
&lacerations may be seen in
the vagina cervix uterus
Infection Rare Frequent
Foreign
bodies
Not present May be present
Foetal
injuries
Usually absent May be present

9. JUSTIFIABLE / THERAPEUTIC ABORTION
 Carried out by RMP in a certified MTP center for
therapeutic purpose in accordance with the provisions of
Medical Termination of Pregnancy act,1971
 WHO adopted a resolution –Declaration of Oslo(1970)
 This act has made certain provisions for legal medical
termination of pregnancy

10. MEDICAL TERMINATION OF PREGNANCY
ACT
• Governed by MTP Act 34 of 1971
• Amendment in 2002 & then came to be known as MTP
Act , 64 of 2002
• Enacted by the Indian
Parliament for Liberalising
abortions in India on
socio-medical grounds
• 1st April 1972,MTP act came into force which
eliminated abortion by untrained and by unhygienic
condition thus saving mothers life from its
complications

11. MTP ACT - Indications :
 Therapeutic :when continuation of pregnancy endanger the life
of women or may cause serious injury to her physical or
mental health
 Eugenic: when there is risk of the child born is likely to suffer
from severe mental or physical abnormalities,
eg: TORCH in first trimester, X-ray exposure, Radioisotope
during pregnancy , Insanity of parents, Treated with
antidepressants or teratogenic drugs
 Humanitarian: Pregnancy has been caused by rape
 Social: Contraceptive failure in married women, severe
economical constraints to bring up the child.

12. H-TES

13. MTP ACT – DURATION OF GESTATION
1. Below 12 weeks: One RMP alone can take decision
2. Between 12 to 20 weeks: Opinion of 2 RMP are
required and the procedure can be done by one single doctor.

14. MTP ACT –Qualifications of RMP
1. A RMP who has completed ,6 months of experience as house
surgeon in obstetrics in recognized hospital or has one year
experience in obstetrics and gynecology any hospital
2. The RMP before commencing of the act,having experience
in practice of OBG for a period of not less than 3 years
3. RMP assisted another doctor in performance of 25 cases of
MTP in a recognized hospital,out of which atleast 5 have
been performed independently in a training institute
approved by government
4. Specialist with MS(obg) / DGO
MTP up to 20 weeks – Qualification of RMP specified in - 1,2,4

15. In an Emergency..!-
Any RMP irrespective of his training / experience in
any place irrespective of its duration (even after 20
weeks), if he's of the opinion formed in good faith.
Section 5 of MTP Act

16. MTP ACT – WHERE TO PERFORM..?
PLACE :
 Obtain license from District level committee
 Any govt hospital, non govt institution having
“A Certificate Of Approval ” from the appropriate
authority
CONSENT:
 Consent from the pregnant women is alone required provided
she’s above 18yrs of age
 Statement that she was been sexually assaulted & not
necessary that a complaint was lodged with the police
 Minor/ lunatic obtain from - Parent /guardian / locoparents

17. MTP ACT – CONFIDENTIALITY..?
 Owner/head of the hospital maintains a Admission Register
for recording details of MTP
 Patients are given a Reference no: rather than name, and the
same is not entered in any Case sheets, OT registers…
 Register is kept in safely for a period of 5 years

18. Methods of inducing abortion under -MTP ACT
FIRST TRIMESTER(upto 12 weeks)
DRUGS
 Antiprogesterones –Mifepristone
 Prostaglandins - PGE1,PGE2
SURGICAL METHORDS
 Manual vacuum aspiration
 Dilatation and evacuation/ curettage

19. Methods of inducing abortion under -MTP ACT
SECOND TRIMESTER(12-20 weeks)
DRUGS:
 Intrauterine installation of hypertonic solutions:
- hypertonic saline / Urea / Rivanol and PG by various route
 Prostaglandins
 Oxytocin infusion
SURGICAL METHORDS:
 Dilatation and evacuation
 Hysterotomy after 14weeks of pregnanacy

20. CRIMINAL ABORTION

21. CRIMINALABORTION
 Unsafe abortions – Proposed by WHO
 Any abortion conducted outside the purview of MTP Act
 Widows & unmarried woman
 Done before 3rd month
 Induced destruction and expulsion of the fetus from womb of
the mother unlawfully, no therapeutic indication
 Administration of drugs & by Mechanical means
 Investigated only when woman dies or someone gives
intimates the police

22. CRIMINAL ABORTION- METHORDS
 General violence - up to the end of first month
 Abortifacient drugs – up to the end of second month
 Local violence – about the 3rd /4th month, after failing
to procure abortion by the above methods

23. GENERAL VIOLENCE
It acts directly on uterus or indirectly by producing congestion
of pelvic organs or hemorrhage
 Violent exercise, jumping from height
 Intentional- pressure ,blows , kicks
 Alternate hot and cold baths of lower abdomen
 CUPPING:
A flaming light is placed on abdominal wall, that is covered
by a bowl. Air expands due to heat and later air contracts on
cooling. When the bowl is pulled ,abdominal wall with
anterior uterine wall is stretched forward, causing separation
of placenta and consequent abortion..!

24. ABORTIFACIENT DRUGS
 Ecbolics: Stimulate uterine contraction and abort
 Drugs with poisonous effect: Lead oleate– toxic to fetus,
death, also chance of lead toxicity in mother
 Emmenagogues: drugs which promote uterine congestion &
bleeding, resulting in expulsion of products of conception
 Irritants of GIT: irritate the colon produce redness and induce
abortion
 Irritants of Genito-urinary Tract: Turpentine, Potassium
permanganate

25. LOCAL VIOLENCE
 Local irritation followed by septic abortion or dilatation of
cervix with or without rupture of membranes
 Depends upon the skill and knowledge of the anatomy of the
pelvic parts-
 UNSKILLED
 SEMI-SKILLED
 SKILLED

26. ABORTION STICK
 12-18cm long stick with cotton clothed soaked in juice of
Marking nut ,Calotropis,Nerium odorum or paste made of
arsenous oxide or lead
 Introduced into os of uterus and retained there till contractions
begin ,used by dais ,so called - midwifes
Complications:
 Inflammation & sloughing
 Sepsis ,Peritonitis
 Perforation of uterus
 Excoriation ,contusion in upper part of vagina

27. 02.SEMISKILLED INTERFERENCE
 Tries to achieve Asepsis
 Enema syringe - Syringing injecting sub into the uterus under
pressure using , Soap,glycerine ,potassium permanganate,
Lysol..
 Death due to vagal inhibition ,Shock, air/fat embolism
 Mettalic /nonmetallic objects -
 LAMINARIA TENT-
swells and dilate the cervix

28. 03.SKILLED INTERFERENCE
 First 3 months-vacuum aspiration or dilatation of cervix
under anesthesia and evacuation of uterus
 Next 3 months-Prostaglandins
 Last 3 months- Amniotic fluid replacement therapy is
generally used
 Electricity – negative electrode at cervix ,positive electrode
at sacrum/lumbar vertebra, uterus expels its contents when
current is passed..!

29. Complications of criminal abortion
Immediate complications:
1. Vagal inhibition & reflex shock
2. Air embolism
3. Severe hemorrhage
4. Amniotic fluid embolism
Delayed complications:
1. Septicemia
2. Tetanus
3. Endotoxic shock
4. Renal failure

31. SECTIONS OF IPC DEALING WITH
CRIMINAL ABORTION

32.  312 IPC – whoever voluntarily causes a women for criminal
abortion, imprisonment up to 3 years +/- fine
May extent to 7 years if women is quick with child
 313-IPC – Causing miscarriage without consent, whether the
women is quick with the child or not imprisonment may be
extended to 10 years and shall be liable for fine
 314-IPC —Death of women caused by act done with intent to
cause miscarriage, min punishment 10 years and life
imprisonment for an act done without consent

33. DUTIES OF A MEDICAL PRACTITIONER IN CRIMINAL
ABORTION
 Take detailed history, circumstances & method employed,
keep as professional secret
 Ask the patient to make a statement on criminal abortion, if
she refuse then don’t pursue !
 Consult a professional
 Treat her to the best of his ability
 If death imminent– record dying declaration
 If patient dies– inform police, arrange for autopsy
 Never issue death certificate..!

34. Medical evidence of abortion-LIVING VICTIM
 Findings as recent delivery, but will depend on the period of
gestation, mode of abortion and time lapse between abortion
and examination
1. Examine breasts for pigmentation
2. Signs of illhealth-abortifacients are irritants of GIT
3. localised sepsis
4. Serum & urine positive for hCG for 7-10 days
5. Presence of tears,marks of instruments
6. Character & amount of discharge to be observed

35. MEDICAL EVIDENCE OF ABORTION-DEAD
VICTIM
 identify the victim ,meticulous examination of clothing
 Face – pale & bluish
 Undergarments show blood clots and fragments of products of
conception
 Abd cavity– clotted blood
 Evidence of peritonitis
 Congested labia and injury to posterior commissure
 Perforation of pelvic organs may be found
 Uterus – presence of paste or markings of instrumentation

36. MEDICAL EVIDENCE OF ABORTION-DEAD VICTIM …
 Intrauterine infection: uterus swollen, spongy & discolored.
Serosal surface brownish in clostridial infections
 Endometrium may exhibit foul smelling purulent discharge
 Vaginal fluid collected for chemical analysis
 Vaginal swab for microbiological examination
 X-ray or CT– suspicious of air embolism
 Uterus and ovaries– sent for chemical analysis to detect
abortifacient

37. EXAMINATION OF ABORTED MATERIAL
HASSE’S RULE

38.  While examining the aborted material it is important
to ascertain its age ,as it has a bearing under the legal
provision which can be determined from HASSE’S
RULE
Measure the Crown Heel Length,
 If the CHL is less than 25cm, the age is calculated by
taking the square root of it.
 But when CHL is more than 25cm,then the age is
calculated by 1ength/5

39. MAY THE GRACIOUS GOD
BLESS US ALL ALWAYS
WISHING YOU ALL SUCCESS
FOR YOUR UPCOMING
EXAMS
Your valuable suggestions are
entertained -
drpinchu89@gmail.com