MTP recent advances finalllllllllllll.pptx

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1. MTP ACT AND RECENT ADVANCES Presented by : Dr Nibedita Rabha, 2nd year PGT, FAAMCH Moderated by: Dr Bharat Talukdar, Assoc proff, FAAMCH

2. INTRODUCTION An act to provide for termination of certain pregnancies by registered medical practitioner and for matters connected therewith and incidental thereto" ( Act No :: 34 of 1971) Deliberate termination of pregnancy either by medical and surgical method before the viability of the fetus is called induction of abortion.

3. AIMS Legalizes abortion services Decriminalizes abortion seekers To improve maternal health by preventing large number of unsafe abortion It provides opportunity to motivate women for adopting some forms of contraception Promotes access to safe abortion services to women

4. OBJECTIVES To improve the maternal health scenario by preventing large number of unsafe abortions and consequent high incidence of maternal mortality and morbidity To regulate and ensure access to safe abortion care and defines " when ", " Where " And under " What " conditions abortion is permissible Offers protection to medical practitioners who otherwise would be penalized under Indian Penal Code Health care measures which helps to reduce maternal mortality and morbidity resulting from illegal abortions

5. CONDITIONS UNDER WHICH PREGNANCY CAN BE TERMINATED 1. Medical or therapeutic: Grave injury to physical and mental health of mother if pregnancy is continued 2. Eugenic: substantial risk of the child being born with serious physical or mental abnormalities so as to be handicapped for life 3. Humanitarian: pregnancy is the result of rape 4. Socio economic: where actual or reasonably forseeable environment can lead on to risk of injury to the physical or mental health of the mother 5. When pregnant women is not mentally sound.

6. The MTP Act, Rules, Amendments The Medical Termination of Pregnancy Act, 1971 ( Act No 34 of 1971) The Medical Termination of Pregnancy Rules, 1975 The Medical Termination of Pregnancy Amendment Act, 2002 ( Act No 64 of 2002) The Medical Termination of Pregnancy Rules, 2003 The Medical Termination of Pregnancy Amendment Act, 2021 ( Act No 8 of 2021)

7. The MTP Act 1971 Can be terminated upto 20 weeks of pregnancy Requires a second doctor's approval beyond 12 weeks When conducted: To save the life of a mother when continuation may cause grave physical or mental injury When pregnancy is due to rape Contraceptive failure in married women Substantial risk that if child born, would be seriously affected with mental and/or physical disability Written consent: By the women By legal guardian if women is lunatic or minor

8. Continued.... Who can conduct : Registered medical practitioner with recognized medical qualification in Clause (b) Section 2 of The Indian Medical Council Act, 1956 Registered in any State Medical Register Have training experience as per MTP rules

9. Experience required as per MTP rules, 1975 Upto 12 weeks : 1 year experience in O&G department 6 months of house surgeon ship in O&G Worked with an RMP - 25 cases done 5 of which by own Before commencement of act - minimum 3 years of experience From 12 - 20 weeks : PG degree or Diploma in O&G Completed 6 months of house staff ship in O&G At least 1 year experience in O&G at any govt hospital having all facilities

10. Abortion Law Reform Since 2000 Act amended - 2002 , Rules and Regulation amended - 2003 Power shift to district level from state level Provision of punishment 2-7 years for provider and owner of unapproved place Approval within 60 days with inspection by CMO/ DLC pr within 60 days after rectification of any deficiency found Facilities does not require onsite management of emergency Allowed medical abortion facility ( up to 7 weeks) RMP does not need approval from DLC for place Only registered doctor can prescribe Need to follow all rules and regulations under MTP act

11. PLACE FOR CONDUCTING MTP A hospital established or maintained by government A place approved for the purpose of this act by a district level committee constituted by the government with the CMHO as chairperson A clinic ( but the doctor needs to be attached to government approved MTP center

12. THE MTP AMENDMENT ACT 2021 Allows abortion for upto 20 weeks based on the judgement of 1 medical practitioner 2 Doctor's consent required - pregancies between 20 - 24 weeks The District Level Medical Board - evaluate whether medical abortions after 24 weeks are permissible based on significant foetal anomalies only A written petition has to be filed - rape and a gestation period of more than 24 weeks Upto a period of 20 weeks by a married women if any of the contraceptive method or device fails. The amended act has also allowed unmarried women to terminate a pregnancy under suchi circumstances No RMP shall reveal the name and other particulars of a woman whose pregnancy has been terminated under this act except to a person authorized by any law for the time being in force.

13. STRENGTH AND WEAKNESS OF THE AMENDED LAW Strength : It amends the Act to increase the upper limit for termination from 20 - 24 weeks Upper limit can be extended on recommendation of the Medical Board Privacy clause has been introduced and violation is punishable Weakness : Silent on terminating pregnancies due to rape which has crossed the 24 week limit Time frame for Medical Boards decision not specified

14. APPROACH FOR MTP STEP 1:: PREGNANT PATIENT COMES FOR MTP STEP 2:: 1. Confirmation of pregnancy 2. Confirmation of gestational age ( p/v or USG) 3. Identify indication for MTP 4. Discussion on method of MTP: medical or surgical 5. Provide counselling for contraception

15. STEP 3:: 1. Obtain informed consent of woman/ guardian in form C 2. Complete the form I (if gestational age is more than 12 weeks , opinion of 2 RMP’s is required. STEP 4:: PROVIDE MTP SERVICE.

16. STEP 5 :: 1. Form C and Form I should be placed in an sealed envelope. 2. Secret and serial no should be written on the envelope 3. Complete Form III : Admission register. 4. All forms to be kept in custody of Head/owner of institute and should not be open for routine inspection. 5. Only the Chief Medical Officer(CMO) has the authority to inspect these confidential documents. 6. Strict confidentiality is to be maintained 7. Form II is to be submitted to CMO’s office every month.

17. STEP 6:: 1. Even in case of Medical Abortion – All the above forms have to be filled. 2. All the records to be preserved till a period of 5 years from the last entry in the register. 3. In the admission register the serial no of hospital /clinic for each year will restart from serial number 1 every calendar year ( from January)

18. THANK YOU