Induced abortion

Medical or surgical termination of pregnancy

1. INDUCED ABORTION DR. SUNIL KUMAR

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 E vidence of adrenal dysfunction H emorrhagic disorders treated with anti-coagulants Where the duration of pregnancy is not known.

8. SIDE EFFECTS N ausea O ccasional vomiting M alaise F aintness H eadache S kin 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

11. 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

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

13. 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.

14. 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.

15. 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

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

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

18. 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