Abortion & mtp

FMT- Study materials

1. Abortion & MTP Act

2. Definition Classification Methods of criminal abortion Complications Causes of death MTP – Indications , rules , Punishment

3. Premature expulsion of the fetus from mother’s womb at any time of pregnancy, before full term of pregnancy is completed.

4. Classification Natural – a) Spontaneous b)Accidental Artificial – a)Therapeutic ,b) Criminal Natural abortion –any time due to natural causes (common in 2 nd or 3 rd month) Therapeutic or justifiable abortion –when it is done in good faith to save the life of women

5. Causes of natural abortion Maternal Foetal Diet – deficient in calcium, iodine Defective fertilization – inherent defect in sperm or ova

6. Criminal abortion – Induced destruction and expulsion of the fetus (products of conception) from the womb of mother unlawfully

7. Methods of procuring criminal abortion 1.Using Abortifacient drugs 2.General violence 3.Local violence

8. 1. Abortifacient drugs 1. Drugs acting directly on uterus a) Ecbolics - Ergot , quinine, lead b) Emmmenagogues – causes increase in menstrual flow – savin , borax, oestrogen 2. Irritants of Genito urinary tract - Produce reflex uterine contraction - oil of turpentine, cantherides 3. Irritants of GI tracts - irritation of colon- hyperaemia & contraction of uterus - castor/croton oil, Senna , Magnesium Sulphate

9. 2. General violence Intentional – kicks, jumping, massage Violent exercise – horse riding , cycling Cupping – a mug is used to separate placenta Accidental – violent shaking the body

10. 3.Local violence Syringing – enema syringe, Higginson's syringe Rupture of membrane Dilatation of cervix & curettage Abortion stick Air insufflation

11. Post mortem evidence of abortion GI tract may show evidence of traces of drugs, erosions or congestion of cervix or uterus Instrumental abortion – injury to cervix, vagina, uterus. Blood clots or bleeding , products of conception or placental tags Segments of intestine, mesentery may enter uterine cavity Ragged or irregular tears of small or large intestine

12. Cervical canal may be dilated, mucus plug in the cervix Collection of fluid in peritoneal cavity – rupture of uterus

13. Complications of criminal abortion Cervical necrosis Laceration, perforation of vagina, cervix Vagal inhibition Thrombo -phlebitis – injury to vessels Air embolism Bleeding – hemorrhage & shock Perforation of uterus , salpingitis , oophoritis Peritonitis Septicemia

14. Causes of death Immediate : Vagal inhibition, Air embolism, Haemorrhage, Fat embolism, Amniotic fluid embolism Delayed death : Pyaemia, Septicemia , peritonitis, Renal failure, Pulmonary embolism

15. Medical termination of pregnancy -1971 Therapeutic – when women life is in danger if pregnancy is continued Eugenic – when there is risk of child being born with serious physical or mental abnormalities (Measles, small pox, any viral infection, TORCH, Drugs) Humanitarian – pregnancy caused by rape Social – failure of contraceptive methods in married women Environmental – poor economic status which affects mother/child health status

16. Rules Who can terminate pregnancy ? Place of MTP ? Consent Duration of pregnancy Medico legal aspects

17. Who can terminate ? - Registered Medical Practitioner (MBBS) - RMO if assisted 25 cases of MTP in a recognized hospital - MD, Diploma in OBG

18. Place of abortion - Govt Hospital - Hospital recognized by Govt - Private hospital after taking license from District Health Officer Consent – Written informed consent from women Minor or mentally ill – guardian If husband requests for abortion?

19. Register has to be maintained Duration of pregnancy - if < 12 weeks : single doctor - > 12 weeks : two doctors must agree that there is an indication - In case of emergency ?

20. Punishment Termination of pregnancy by a person who is not RMP or in an unrecognized hospital shall be punished with rigorous imprisonment for a term which shall not be less than 2 years but may extend to 7 years. Miscarriage without the consent of women – imprisonment up to 10 years (Sec.313 IPC)