Medical or surgical termination of pregnancy

2. INTRODUCTION
• The medical or surgical
termination of pregnancy before the
time of fetal viability
•Therapeutic abortion
• Termination of pregnancy
before of fetal viability for the
purpose of saving the life of the
mother.

3. INDICATION
• Continuation of pregnancy may threaten the life of
women or seriously impair her health
• Persistent heart disease after cardiac decompensation
• Advanced hypertensive vascular disease
• Invasive carcinoma of the cervix
• Pregnancy resulted from rape or incest
• Continuation of pregnancy is likely to result in the
birth of child with severe physical deformities or mental
retardation

4. ELECTIVE (VOLUNTARY) ABORTION
• Interruption of pregnancy before viability at the
request of the women, but not for reasons of
impaired maternal health or fetal disease
• Counseling before elective abortion
 Continued pregnancy with its risks & parental
responsibilities
 Continued pregnancy with its risks & its
responsibilities of arranged adoption
 The choice of abortion with its risks

5. MEDICAL INDUCTION OF ABORTION
 Outpatient medical abortion is an acceptable
alternative to surgical abortion in women with
pregnancies of less than 49 days’ gestation
 Three medications for early medical abortion
 Antiprogestin mifeprostone
 Antimetabolite methotrexate
 Prostaglandin misoprostol

6. Oxytocin
 Successful induction of 2nd trimester abortion is
possible with high doses of oxytocin administered in
small volumes of IV fluids
 Satisfactory alternatives to PG E2 for mid trimester
abortion
Technique
 It can act effectively on the cervix & uterus (86~95%
effectiveness)
 As a gel through a catheter into the cervical canal &
lowermost uterus
 Injection into the amnionic sac by amniocentesis
 Oral ingestion
→ stimulate uterine contraction & cervical dilatation

7. CONTRA INDICATIONS
 Pregnancy beyond 63 days of gestation
 Suspected ectopic pregnancy
 Evidence of adrenal dysfunction
 Hemorrhagic disorders treated with anti-
coagulants
 Where the duration of pregnancy is not
known.

8. SIDE EFFECTS
Nausea
Occasional vomiting
Malaise
Faintness
Headache
Skin rashes

9. SIGNS AND SYMPTOMS
 Bleeding which progresses from light to heavy
 Severe cramps
 Abdominal pain
 Fever
 Weakness
 Back pain

10. SURGICAL TECHNIQUES FOR ABORTION
Dilatation and curettage
 Performed first by dilating the cervix & evacuating the
product of conception
 Mechanically scraping out of the contents (sharp
curettage)
 Vacuum aspiration (suction curettage)
 Both
 Before 14 weeks, D&C or vacuum aspiration should be
performed
 After 16 weeks, dilatation & evacuation (D&E) is
performed By Wide cervical dilatation and
Mechanical destruction & evacuation of fetal parts

13. MENSTRUAL ASPIRATION
 Aspiration of endometrial cavity using a flexible
cannula and syringe within 1-3 weeks after failure to
menstruate.
Several points at early stage of gestation
 Woman not being pregnant
 Implanted zygote may be missed by the curette
 Failure to recognize an ectopic pregnancy
 Infrequently, a uterus can be perforated

14.  Laparotomy
 Abdominal hysterotomy or hysterectomy
Indications
 Significant uterine disease
 Failure of medical induction during the 2nd
trimester

15. POST ABORTION CARE
 Observe for vaginal bleeding and cramping pain
 Save expelled tissue and lot for examination
 Monitor vital signs for every 5 minutes to 4 hours
according to the maternal status
 Maintain woman on bed rest
 Observe for signs of shock, and institute treatment
measures
 Prepare for dilation and curettage if appropriate
 Assess signs of infection
 Handle every article in a sterile manner
 Provide support but avoid false assurance.

16. MEDICAL TERMINATION OF
PREGNANCY
 MTP is a medical termination of pregnancy .
Its also known as induced abortion .It is the
medical way to getting rid of Unwanted
pregnancy .
 The termination of a pregnancy by the
removal or expulsion of an embryo or fetus
from the uterus.

17. QUALIFICATION FOR MTP
 Assist 25 cases of MTP in approved institution
 6 month houseman ship in OBG.
 PG qualification in OBG.
 3yrs practices in OBG

18. PLACE FOR MTP
 Place established and maintained by govt.
 Non govt. institution can perform, they obtain
license from CMO of district

19. INDICATION FOR MTP
Risk of injury to mental & physical
health of Woman
Abnormalities in foetus .
Pregnancy caused by rape .
Contraceptive failure .

20. METHOD OF TERMINATION
1st trimester :-
 MEDICAL – Mifepristone + Misoprostol
- methotrexate +misoprostol
- tamoxifam +mosoprostol
 SURGICAL –vacuum aspiration
- suction evacuation
- dilatation and curettage
2nd trimester –
 MEDICAL – misoprostol, carboprost
 SUGICAL – D/C and Hystrectomy