The document discusses methods for medical termination of pregnancy (MTP) in the first trimester. It describes surgical methods like menstrual regulation and vacuum evacuation that can be used for termination up to 12 weeks of gestation. It also outlines two medical methods - mifepristone and prostaglandins. Mifepristone is an antiprogestogenic drug that is administered orally up to 9 weeks of gestation to terminate the pregnancy. Prostaglandins are also described as a medical method to terminate pregnancy. The document provides details on protocols, advantages and disadvantages of both the surgical and medical termination methods for the first trimester of pregnancy.

1. FIRST TRIMESTER
MTP

4. Medical termination of
pregnancy
‘the indian act permits the wilful
termination of pregnancy before the age
of fetal viability (20-weeks of gestation)
for well defined indications.
It has to be performed by recognised
medical practitoners in a recognised
place approved by the competent
authority under the act’

6. Surgical methods
Menstrual regulation
Vacuum evacuation

7. Medical methods
Prostaglandins
Mifepristone

8. Menstrual regulation

9. Menstrual regulation

10. Menstrual regulation
Advantages
Safe,efficient,easy to use*
Portable,washable,
non-electric

11. Menstrual regulation
Complications*
Incomplete evacuation
Hemorrhage
Cervical
laceration,perforation
infection

12. *failure to evacuate
Too early pregancy
Ectopic pregnancy
Bicornuate uterus
Instrumental*

13. Menstrual regulation
Within 42 days of LMP

14. Vacuum evacuation

15. Vacuum evacuation
Up to 12 weeks of gestation

16. Vacuum evacuation
Advantage
Low failure rate
Less complications
Less mortality

17. Vacuum evacuation
Disadvantage
If attempted curettage*
perforation,
synachiae(Asherman
syndrome)
placenta accreta

18. Medical methods

19. 9 weeks of gestation

20. prostaglandins
250mcg IM every 3h upto max 10
doses

21. mifepristone
Synthetic steroid
Derivative of 19-
nortestosterone
Antiprogestogenic

24. mifepristone
MOA
-Compete with Pg receptors
-reduce endometrial glandular activity
-accelerates degenerative changes
-increase stromal action

25. mifepristone
• Protocol
Written consent for MTP
Blood group RH ,Hb % urine
USG – uterine pregnancy & duration

26. mifepristone
• Day 1- 200mg SD
• Day 3-400 mcg oral* – unless
abortion occured+ PG
• Day 14- follow up

27. mifepristone
Contraindications
o IUCD insitu
o Suspected ectopic
o On anticoagulant
o Previous scar
o Lactating women
o After 63 days

28. Mifepristone
Advantages
 storage- room temp
Shelf life 3 years
Cheap
Easy administration

29. mifeprostol
• Complications
Adrenal failure
Möbius syndrome in fetus
Longer time for termination
Vomiting*

30. Surgical or
medical?

31. summary
MTP
SURGICAL
Menstrual
regulation
Vacuum
evacuation
MEDICAL
mifepristone prostaglandins

33. Thank you