ou should know that an abortion which does not fulfil the conditions is considered a crime under the general law on crimes in India. Abortion of under 4 to 5-month pregnancy - The punishment for getting an illegal abortion is jail time of up to 3 years and/or fine.

2. LESSON PLAN ON MEDICAL
TERMINATION OF
PREGNANCY
PRESENTED BY,
MS. SNEHAL V. JAMBHULKAR
1ST YEAR MSC NURSING
KNC, SEWAGRAM

3. GENERAL OBJECTIVES
• At the end of the seminar the group will
be able to gain the knowledge regarding
the medical termination of pregnancy
and its implication in obstetrics &
gynecology in nursing practice.

4. SPECIFIC OBJECTIVES
At the end of the seminar the group will be able to:-
1. Introduction of MTP
2. Definition of MTP
3. Explain what is legal abortion?
4. Enlist indication?
5. Discuss termination of pregnancy?
6. Explain place where termination of pregnancy done?
7. Discuss methods of MTP?
8. Elaborate complications of MTP?
9. Discuss MTP Act ?

5. INTROCUCTION
Medical termination of pregnancy is refers as the induction of abortion.
The induction of abortion may be legal & illegal. There are many
countries in the globe where the abortion is not yet legalized. In India the
abortion was legalized by “medical termination of pregnancy Act” of
1971, and has been inforced in the April 1972.

6. DEFINITION
Deliberate termination of pregnancy either by the medical &
surgical method before the viability of the fetus is called
induction of abortion.

8. LEGAL ABORTION
- Termination is performed by the medical practitioners (assisted in at least 25
MTP and degree in OBG by the act.
- Termination is done at the place approved under the act.
- Termination done for condition and within the gestation week prescribed by
the act.
- The abortion has to be reported to the director of health service of the state.

9. INDICATIONS
- Women whose physical and /or mental health were endangered by the
pregnancy.
- Women facing the birth of a potentially handicapped or malformed child.
- Rape.
- Pregnancies in unmarried girls under the age of eighteen with the consent
of a guardian.
- pregnancies that are a result of failure in sterilization.

10. TERMINATION OF PREGNANCY
- Termination is permitted upto 20 wks of gestation.
- When pregnancy > 12 weeks 2 medical practitioners opinion
required.
- The abortion has to be performed confidentially and reported
to Director Of Health Services in prescribed form.

11. CONTTT…
- Consent : can only be terminated on a written informed consent of the
women, husband consent not required
- <18 yr or lunatic- written consent of parent or legal guardian.

12. PLACE WHERE MTP PERFORMED
- Place established and maintained by Govt.
- Non Govt. institution can performed provided
they obtain license from Chief Medical Officer of
the district.

13. METHODS OF MTP
I Trimester
Medical method:
- Mifepristone+ misoprostol method.
Surgical method:
- Menstrual regulation
- Dilatation and suction evacuation

14. II Trimester
Medical method:
- Misoprostol method
- By the prostaglandin
- Extra amniotic ethacridine lactate method
- Intra amniotic hypertonic saline method
- High dose oxytocin method

15. Surgical method:
Hysterectomy
Hysterotomy

16. COMPLICATION OF MTP
Immediate:
- Injury to the cervix
- Uterine perforation during D& E
- Hemorrhage and shock due to trauma, incomplete abortion,
atonic uterus or rarely coagulation failure
- Thrombosis & embolism

17. Remote:
The complications are grouped into :
1. Gynecological
 Menstrual disturbances
 Chronic pelvis inflammation
 Scar endometritis

18. 2. Obstetrical
 Ectopic pregnancy
 Preterm labour
 Dysmaturity
 Rupture uterus

20. MTP ACT
Since legalisation of abortion in India deliberate induction of
abortion by a registered medical practitioner in the interest of
mother’s health and life is protected under the MTP Act}
The following provisions are laid down :

21.  The continuation of pregnancy would involve serious risk of
life or grave injury to the physical and mental health of the
pregnant woman.
 There is a substantial risk of the child being born with
serious physical and mental abnormalities so as to be
handicapped in life.

22.  When the pregnancy is caused by rape, both in cases of
major and minor girl and in mentally imbalanced women.
 Pregnancy caused as a result of failure of a
contraception.

23. In practice, the following are the indications for
termination under the MTP Act:
 To save the life of the mother
(Therapeutic or Medical termination) :
The indications are limited and scarcely justifiable now-a-days
except in the following cases :

24. (i) Cardiac diseases (Grade-III & IV) with history of decompensation in the
previous pregnancy or in between the pregnancies
(ii)Chronic glomerulonephritis
(iii)Malignant hypertension
(iv)Intractable hyperemesis gravidarum
(v) Cervical or breast malignancy
(vi)Diabetes mellitus with retinopathy
(vii)Epilepsy or psychiatric illness with the advice of a psychiatrist.

25.  Social indications :
- This is almost the sole indication and is covered under the provision “to
prevent grave injury to the physical and mental health of the pregnant
woman”
- In about 80%, it is limited to parous women having unplanned
pregnancy with low socioeconomic status.
- Pregnancy caused by rape or unwanted pregnancy caused due to failure
of any contraceptive device also falls in this category (20%).

26.  Eugenic :
This is done under the provision of “substantial risk of the child
being born with serious physical and mental abnormalities so as to be
handicapped in life”. The indication is rare.
(i) Structural (Anencephaly), chromosomal (Down’s syndrome) or genetic
(Haemophilia) abnormalities of the fetus.
(ii)When the fetus is likely to be deformed due to action of teratogenic
drugs (warfarin) or radiation exposure (> 10 rads) in early pregnancy.

27. CONTTT….
• Rubella, a viral infection affecting in the first trimester, is
an indication for termination

29. RECOMMENDATIONS
In the revised rules, a registered medical practitioner is qualified to
perform an MTP provided:
(a) One has assisted in at least 25 MTP in an authorised centre and
having a certificate.
(b) One has got six months house surgeon training, in obstetrics and
gynecology.
(c) One has got diploma or degree in obstetrics and gynecology.

30. Termination can only be performed in hospitals, established or
maintained by the government or places approved by the government.
- Pregnancy can only be terminated on the written consent of the woman.
Husband’s consent is not required.
- Pregnancy in a minor girl (below the age of 18 years) or lunatic cannot
be terminated without written consent of the parents or legal guardian.
Termination is permitted upto 20 wks of pregnancy

31. - When the pregnancy exceeds 12 weeks, opinion of two
medical practitioners is required.
- he abortion has to be performed confidentially and to be
reported to the Director of Health Services of the State in
the prescribed form.

32. METHODS OF TERMINATION OF PREGANCY:
First trimester (upto 12 weeks)
o Medical:
 Mifepristone
 Mifepristone and misoprostol(PGE1)
 Methotrexate and misoprostol
 Tamoxifen and misoprostol

33. o Surgical:
Menstrual regulation suction evacuation and /or
curettage
Vacuum aspiration
Dilatation and evacuation

34. Second trimester (13-20 weeks)
PGE1 (misoprostol), carboprost, dinprostone and their
analogues.
D&E , hysterectomy
Intrauterine instillation of hyperosmotic solutions
Oxytocin infusion high dose used along with either of the
above 2 method

35. SUMMARY
In this lesson plan we had discuss in details about MTP,
Definition of MTP, legal abortion, indication, termination of
pregnancy, place where termination of pregnancy done, methods of
MTP, complications of MTP, MTP Act that help to improve the
knowledge of the students and they will use this knowledge in
clinical setting.

36. CONCLUSION
• At the end of this lesson plan students get in depth knowledge
about multiple pregnancy and they will apply this knowledge in
clinical area and their studies.

37. BIBLIOGRAPHY
1. D C Datta, textbook of obstetrics, published by new central
agency (p) ltd.
2. Annamma Jacob, a comprehensive textbook of midwifery and
gynecological nursing ,Jaypee publications.
3. www.mtp.in