Mgm mtp act abortion

VI SEM THEORY CLASS

1. Medical Termination of Pregnancy (MTP), sterilization and birth control

2. Content Questions Q. Define and categorize abortion. Q. Enumerate the complications and sequele of abortions. Q. Describe the condition, person and place covered under MTP act 1971 Q. Explain the male and female terminal methods of contraceptive procedures with their complications Q. Describe the various miscellaneous methods of birth control 2/24/2016 2

3. Abortion = Termination of pregnancy before the foetus becomes viable. Category: Spontaneous: “ Natures method of birth control” Induces: deliberately done legally or illegally

4. Abortion facts Out of 210 m pregnancies, 80 m are unintended 2008: 21.6 m unsafe abortions causing 47,000 deaths 14 unsafe abortions/ 1000 women (15-44 yrs ) Developing countries, its 16 per 1000 women India: ICMR study documented safe 6.1 and unsafe 13.5 per 1000 pregnancies 2/3 rd takes place outside authorized health service

5. Complications and sequelae Early complications : Haemorrhage Shock Sepsis Uterine perforation Cervical injury Thromboembolism Anaesthetic and psychiatric Late sequelae Infertility Ectopic gestation  sed risk of spontaneous abortion Reduced birth weight

6. Medical termination of pregnancy act 1971 Coverage under MTP act 1971 Conditions under which preg can be terminated Person/s who can perform The place – terminations are performed

7. 1. Conditions under which pregnancy can be terminated Five Medical : continuation might endanger mothers life Eugenic : risk of the child being born handicap Socio-economic : could lead to mothers health injury Humanitarian : pregnancy is the result of rape Failure of contraception : anguish caused by unwanted pregnancy causing grave mental injury to the mother Medical termination of pregnancy (MTP) act 1971 (contd.)

8. 2. The Person/s who can perform abortion The act authorises only Registered Medical Practitioner having experience in Gynaec . and obs. ( preg < 12 wks ) 12wks – 20 wks : O pinion of two RMPs is necessary Medical termination of pregnancy (MTP) act 1971 (contd.)

9. 3. The place where abortion is performed NGOs may also take up – licence from dist. CMO Medical termination of pregnancy (MTP) act 1971 (contd.)

10. Strategies of safe MTP centres and service providers At community level: Spread awareness regarding availability of safe MTP Access to confidential counselling: train ANMs, AWW, ASHA Provide post abortion care At the facility level: To provide manual vaccum aspiration facility Provide comprehensive & high quality services at FRUs Encourage private and NGO sectors to establish

11. Terminal methods

12. Sterilization Male Sterilization: 10-15% of sterilization in India though it is simpler, safer & cheaper than female sterilization (85%) Guidelines for sterilization 1) Age of husband should not be <25 yrs or >50 yrs 2) Age of wife should not be<20 yrs or >45 yrs 3) Motivated couple must have 2 living children 4) If the couple has 3 or more children the lower age limit of couple can be relaxed by surgeon 5) Acceptor declares having obtained consent of his/her spouse to undergo sterilization

13. Female sterilization Postpartum/ at time of abortion 2 procedures: Laparoscopy, Mini-laparotomy ( pomeroy )

14. Laparoscopic female sterilization Abdominal approach, specialized instrument called “laparoscope” Abdomen inflated with gas Falope rings (clips) applied to occlude the tubes Specialists availability ensured prior operation Short operating time, short hospital stay, small scar Complications: Puncture of large vessels Patient selection: Not advisable postpartum for 6 wks

15. Minilaparotomy Modification of abdominal Tubectomy Simpler procedure requiring a smaller abdominal incision of only 2.5 – 3cm under LA Minilap / Pomeroy technique Suitable technique at PHC for mass campaigns Suitable for post partum period.

16. Male sterilization (vasectomy) Simpler, faster, less expensive than tubectomy in terms of instruments, hospitalization and doctor’s training Cost wise ratio: 5 vasectomy to 1 tubal ligation Procedure: Acceptor is not immediately sterile after operation usually until 30 ejaculations have taken place Remove at least 1 cm vas after clamping

17. Complications of male sterilization Operative : Pain, h aematoma , wound infection (3%) Sperm granules (7mm) Spontaneous recanalization Autoimmune response Psychological

18. Post – operative advice Pt should be told that he is not sterile immediately after operation, at least 30 ejaculations may be necessary before seminal examination is negative Use contraceptives until aspermia has been established Avoid taking bath for at least 24 hrs after operation Wear T-bandage / scrotal support for 15 days Avoid cycling/heavy wt. lifting for 15 days To have stitch removed on 5 th day after operation

19. No Scalpel Vasectomy (NSV) New technique that is safe, convenient & acceptable to males Accepted by NHFWP Availability of this new technique at the peripheral level will increase the acceptance of male sterilization Project is being funded by UNFPA

20. Miscellaneous methods of birth control Abstinence Coitus interruptus Safe period (rhythm method) Natural methods: Basal body temperature method Cervical mucus method Symptothermic method Breast-feeding Birth control vaccines

21. Safe period (Rhythm method) Calendar method First day of fertile period: Shortest cycle – 18 days Last day of fertile period: Longest cycle – 10 days Eg

22. Safe period (contd.) Drawbacks: Woman’s menstrual cycle is not regular To be used by educated & responsible couples with high degree of motivation Compulsory abstinence of sexual intercourse for nearly half of every month Not applicable during post natal period High failure rate: 9 per 100 HWY Complications: Ectopic pregnancy Embryonic abnormality

23. Natural family planning methods Basal body temperature method (BBT) : Rise of body temp by 0.3 – 0.5 degree C at the time of ovulation Intercourse restricted to post-ovulatory infertile period Cervical mucus method Billings method/ ovulation method At the time of ovulation, cervical mucus becomes watery clear resembling raw egg white, smooth, sleepery After ovulation mucus thickens (progesterone) Symptothermic method (combines temp. cervical and calender technique

24. Miscellaneous methods (Contd.) Breast feeding: Lactational amenorrhoea Birth control vaccine Prepared from B subunit of hCG Research phase

25. Summary 2/24/2016 25

26. ‘THANKS FOR THE ATTENTION’ RE VISE IT Today 2/24/2016 26