2. Termination of pregnancy, either spontaneously
or intentionally
Pregnancy termination prior to 20 weeks’
gestation or less than 500-g birthweight [who
&national centre for health statistics¢re for
disease control and prevention]
Definition vary according to state laws for
reporting abortions, fetal deaths, and neonatal
deaths
Word abortion derives from latin word aborii – to
miscarry
3. ABORTION -1-SPONTANEOUS/MISCARRIAGE
2-INDUCED
SPONTANEOUS MAY BE 1- SPORADIC
2-RECURRENT
BOTH MAY BE 1-THREATENED
2-INEVITABLE
3-COMPLETE
4-INCOMPLETE
5-MISSED
6-SEPTIC
2-INDUCED ABORTION MAY BE LEGAL/MTP&ILLEGAL
OR UNSAFE
4. Before 8 wks –the ovum surrounded by villi with
the decidual covering is expelled out
intact,sometimes entire mass is accomodated in
cervical canal ,ext os fails to dilate k/as cervical
miscarriage.
b/w 8-14wks-expulsion of fetus occurs leaving
behind the placenta and membranes.a part of it
may be partially separated with brisk hege or
remains totally attached to uterine wall.
Beyond 14 wks- process is similar to that of a
minilabour –expelsion of fetus-f/by expelsion of
placenta and membranes.
5. Abortion occurring without medical or mechanical means
to empty the uterus is referred to as spontaneous
Another widely used term is miscarriage
Pathology
Hemorrhage into the decidua basinalis, followed by
necrosis of tissues adjacent to the bleeding
If early, the ovum detaches, stimulating uterine
contractions that result in its Expulsion
Gestational sac is opened , fluid surrounding a small
macerated fetus or alternatively no fetus is visible →
blighted ovum-is also called as silent miscarriage –it’s a
sonographic diagnosis,there is absenceof fetal pole in a
gestational sac with a diameter of 3cm or more ,uterus is
to be evacuated if diagnosis is made.
6. Pathology
In later abortion, the retained fetus may undergo
maceration
The skull bones collapse, the abdomen distends with
blood-
stained fluid, and the internal organs degenerate
The skin softens and peels off in utero or at the slightest
tough
When amnionic fluid is absorbed, the fetus may become
compressed and desiccated → fetal compressus
The fetus become so dry and compressed that it
resembles parchment - a fetus papyraceous
7. 1-genetic
A-autosomal trisomy-is the commonest(50%)
most common trisomy is trisomy 16(30%)
B-polyploidy
C-monosomy
Structural chromosome rearrangement
2-endocrine and metabolic factors(10-15%)
Luteal phase defect ,thyroid disorders,DM
Anatomical-1-cong malformation of uterus(3-
38%)
2-cervical incompetence
3-fibroid and uterine synechia
10. Etiology
The exact mechanism responsible for abortion are not
apparent
In the first 3 months of pregnancy
Death of the embryo or fetus nearly always precedes
spontaneous expulsion of the ovum
Finding of the cause of early abortion involves ascertaining
the cause of fetal death
In subsequent months
The fetus frequently does not die before expulsion
Other explanations for its expulsion should be sought
11. Aneuploid abortion
Approximately 50 to 60 percent of embryos and early
fetuses
that are spontaneously aborted contain
chromosomal abnor-malities accounting for most of
early pregnancy wastage
Jacobs and Hassold (1980)
95 percent of chromosomal abnormalities
d/t maternal gametogenesis error
5 percent → d/t paternal error
12.
13. Aneuploid abortion - Autosomal trisomy
The most frequently identified chromosomal
anomaly associated with first-trimester abortions
Most trisomies result from isolated
nondisjunction , balanced structural
chromosomal rearrangements are present in one
partner in 2 to 4 percent of couples with a history
of recurrent abortions
Autosomes 13, 16, 18, 21, and 22 – most
commom
14. Monosomy X
The second frequent chromosomal abnormality
Usually results in abortion
Much less frequently in liveborn female infant (Turner
syndrome)
Triploidy
Associated with hydropic placental (molar)
degeneration
Incomplete (partial) hydatidiform moles may contain
triploidy or trisomy for only chromosome 16
15. Tetraploid abortuses
Rarely are liveborn and most often are aborted early in gestation
Chromosomal structural abnormalities
Identified only since the development of banding techniques,
infrequently cause abortionEuploid abortion
Abort later in gestational than aneuploid
Three fourths of aneuploid abortions occurred before8 weeks
Euploid abortions peak at about 13 weeks
The incidence of euploid abortions increased dramatically after maternal
age exceeded 35 years
16. Infections (responsible for 5% of abortions)
Uncommon causes of abortion in human
Acc to AICOG infections are an uncommon cause
of early abortions.
Listeria monocytogenes
Clamydia trachomatis
Mycoplasma hominis
Ureaplasma urealyticum
Toxoplasma gondii
Spirochetes hardly cause abortion before 20th wk
becoz of effective thickness of placenta
17. Chronic debilitating diseases
In early pregnancy, fetuses seldom abort secondary to chronic wasting disease such as tuberculosis or
carcinomatosis
Celiac sprue
Cause both male and female infertility and recurrent abortions
Endocrine abnormalities
Hypothyroidism
Iodine deficiency associated with excessive miscarriages
Thyroid autoantibodies → incidence of abortion↑
Diabetes mellitus
The rates of spontaneous abortion & major congenital malformations
Poor glucose control → incidence of abortion↑
Progesterone deficiency
Luteal phase defect
Insufficient progesterone secretion by the corpus luteum or placenta
Poor glucose control → incidence of abortion↑
18. Nutrition
Dietary deficiency of any one nutrients → not important cause
Drug use and environmental factor
Tobacco
↑ Risk for euploid abortion
More than 14 cigarettes a day → the risk twofold greater ↑
Smoking increases risk due to formation of carboxy haemoglobin and
Decreased oxygen transfer to fetuses
Alcohol
Spontaneous abortion & fetal anomalies → result from frequent alcohol
use during the first 8 weeks of pregnancy
Drinking twice a week → abortion rates doubled ↑
Drinking daily → abortion rates tripled ↑
Caffeine
At least 5 cups of coffee per day → slightly increased risk of abortion
19. Drug use and environmental factor
Radiation
In sufficient doses → abortifacient,in therapeutic doses given to
treat malignancy radiation is certainly abortifacient.acc to brent
exposure to < 5 rads does not increase risk for miscarriage.
Contraceptives
When intrauterine devices fail to prevent pregnancy → abortion↑
Environmental toxins
Anesthetic gases : exact fetal risk of chronic maternal exposure
is unknown
Arsenic, lead, formaldehyde, benzene, ethylene oxide →
abortifacient
Video display terminal & accompanying electromagnetic fields
short waves & ultrasound do not increase the risk of abortion
20. Immunological factors – two primary pathophysiological models are autoimmune theory –immunity against
self,and alloimmune theory-immunity against another. Autoimmune factors are-
Recurrent pregnancy loss patients : 15%
Antiphospholipid antibody : most significant
Apla are
1-lupus anticoagulant 2-anticardiolipin antibodies 3-beta glycoporin antibodies
Antiphospholipid antibodies are a family of autoantibodies that bind to negatively charged
phospholipids;phospholipids-binding proteins or combination of two they also are found in women without
lupus.instead of causing miscarriage,they more likely are found with fetal death after mid pregnancy.
Women with both a history of early fetal loss and high antibody levels may have a 70% miscarriage recurrence
rate.
LCA (lupus anticoagulant), ACA (anticardiolipin Ab)
Reduce prostacyclin production
→ facilitating thromboxane dominant milieu → thrombosis
Prostacyclin : produced by vascular endothelial cell
→ potent vasodilator & inhibit platelet aggregation
Thromboxane A2 : produced by platelets
→ vasoconstrictor & platelet aggregator
Strong association with
Decidual vasculopathy , placental infarction, fetal growth restriction
Early-onset preeclampsia, recurrent abortion, fetal death
21. Mechanism of pregnancy loss in women with apla are
1-inhibition of trophoblast function and differentiation
2-activation of complement pathway
3-Release of local inflammatory mediators
(cytokines,interlukins)
4- thrombosis of uteroplacental vascular bed
IMMUNE FACTORS-cytokines are immune molecules .its
response may be due to T helper 1orT helper2.
Th1 response is-prodn of IL2,interferon,TNF,
TH2 response is prodn of antiinflammatory cytokines
IL4,6,10
Successful pregnancy is the result of predominantly TH2
Cytokine response,women with recurrent miscarriage have
more th1 response.
22.
23. Immunological factors – alloimmune factors
Allogeneity
Genetic dissimilarities between animals of the same species,normal
pregnancy requires formation of blocking factors that prevent maternal
rejection of foreign fetal antigens that are paternally derived.
Human fetus is allogenic transplant tolerated by mother, a woman will
not produce these serum blocking factors if she has HLAs similar to her
husband.
Several test for diagnosis of alloimmune factors
Maternal & paternal HLA comparison
Maternal serum test for blocking antibodies
: blocking antibodies to paternal antigens
: ig G origin
Maternal serum test for antipaternal antibodies
: cytotoxic antibodies to paternal leukocyte
24. Inherited thrombophilia
Many studies of aggregated thrombophilias
These are genetically determined abnormal clotting factors that can cause pathological
thrombosis from an imbalance between clotting and anticoagulation pathway.
The most widely studied include resistance to activated protein c caused by factor V Leiden
mutationor another decreased or absent antithrombin 3 activity,prothrombin gene
mutation,and mutation in gene for methylene tetra hydrofolate reductase that causes elevated
serum levels of homocysteine- hyperhomocysteinemia.
→ excessive recurrent abortions
Laparotomy
Surgery performed during early pregnancy,
→ no evidence of tncreased abortion,if performed prior to10 wks gestation ovary with
corpus luteum is removed then supplemental progesterone is indicated.
If 8-10 wks-only one inj of i/m 17- hydroxyprogesterone caproate 150mg is required ,if 6-
8wks then two additional doses should be given one and
Peritonitis increases the likelihood of abortion
Physical trauma
Major abdominal trauma → abortion↑
25. Uterine defects – acquired uterine defects
Uterine leiomyoma : usually do not cause abortion
Placental implantation over or in contact with myoma
→ placental abruption, abortion, preterm labor ↑
→ location is more important than size
Uterine synechiae (Asherman syndrome)
Partial or complete obliteration of the uterine cavity by
adherence of uterine wall
Cause : destruction of large areas of endometrium by
curettage
→ insufficient endometrium to support implantation &
menstruation
→ recurrent abortion, amenorrhea, hypomenorrhea
26. Uterine defects – acquired uterine defects
Uterine synechiae-asherman syndrome –usually result
from destruction of large areasof endometrium by
curettage.
Diagnosis of uterine synechiae
Hysterosalpingogram → characteristic multiple filling
defects
Hysteroscopy → most accurate & direct diagnosis
Treatment of uterine synechiae
Lysis of adhesions via hysteroscopy
Prevention of adherence : IUD
Promotion of endometrial proliferation
: Continuous high-dose estrogen (60-90 days)
27. 1-Uterine defects – developmental uterine defects,Mostly
responsible for 2nd triamester abortion
Consequence of abnormal mullerian duct formation or fusion
Spontaneously
Induced by in utero exposure to DES (diethylstilbestrol)
Causes of fetal loss are
1-reduced intrauterine vol
2-reduced expansile property of ut
3- reduced placental vascularity when implanted over the
septum
4-increased uterine irritability and contractility
2- uterine fibroid-mainly submucus variety causes distortion or
partial obliteration of uterine cavity
Fibroid causes decreased vascularity at implantation site,red
degeneration of fibroid & increased uterine irritability.
28. Incompetent cervix
Painless dilatation of cervix in the 2nd or early in the 3rd
trimester
→ prolapse & ballooning of membranes into vagina
→ rupture of membrane & expulsion of immature fetus
Unless effectively treated, tends to repeat in each
pregnancy
Diagnosis in nonpregnant women
Hysterography
Pull-through techniques of inflated Foley catheter balloons
Acceptance without resistance at the internal os of
specifically sized cervical dilators
The use of transvaginal ultrasound in pregnant women
Cervical length - shortening
Funneling
29.
30. Incompetent cervix – Treatment
The operation is performed to surgically
Reinforcement of weak cervix by some type of purse string
suture
( Cerclage )
Prophylactic surgery : generally performed between 12 &
16weeks
Should be delayed until after 14 weeks’ gestation
→ Early abortion due to other factors will be completed
The more advanced the pregnancy, the more likely the risk that
surgical intervention stimulate preterm labor or membrane
rupture
Usually do not perform after about 23 weeks
31. Incompetent cervix – Preoperative evaluation
Sonography
: Confirm living fetus & exclude major fetal
anomalies
Cervical cytology
Cultures for gonorrhea, chlamydia, group B
streptococci
Obvious cervical infections → treatment is given
For at least a week before & after surgery →
sexual intercourse should be restricted
36. Incompetent cervix – Complications
High incidence when performed much after 20
weeks
Membranes ruptures
Chorioamnionitis
Intrauterine infection
Urgent removal of suture
Operation fails
Signs of imminent abortion or delivery
37. Little is known in the genesis of spontaneous abortion
Chromosomal translocations in sperm can lead to abortion
Common causes of miscarriage
First trimester-
1-genetic factors
2-endocrine disorders –LPD,diabetes,thyroid disorders
3-immunological (autoimmune&alloimmune)
4-infection
5-unexplained
Causes of 2nd triamester abortions
1-anatomical abnormalities
A-cervical incompetence cong/acquired
B-mullerian fusion defects (bicornuate/septate)
C-uterine synechia
D-uterine fibroid
2-maternal medical illness
3- unexplained
38.
39. Definition
Any bloody vaginal discharge or bleeding during 1st half of
pregnancy
Bleeding is frequently slight, but may persist for days or weeks
One physiological cause of bleeding occurs near the time of
expected menses-implantation bleeding
Cervical lesions ,cervical polyp
Frequency
Extremely common (one out of four or five pregnant women)
Prognosis
Approximately ½ will abort
Risk of preterm delivery, low birthweight, perinatal death↑
Risk of malformed infant does not appear to be increased
40.
41. Treatment : slight bleeding persists for weeks
Vaginal sonography
Serial serum quantitative hCG
Serum progesterone
→ can help ascertain if the fetus is alive & its location
Vaginal sonography
Gestational sac(+) & hCG < 1000mIU/ml
→ gestation is not likely to survive
→ If any doubt(+), check the serum hCG level at intervals of
48hrs
→ if not increase more than 65%, almost always hopeless
Serum progesterone value < 5 ng/ml
→ dead conceptus
42.
43.
44. Complete abortion
Following complete detachment & expulsion of
the conceptus
The internal cervical os closes
Incomplete abortion
Expulsion of some but not all of the products of
conception during 1st half of pregnancy
The internal cervical os remains open & allows
passage of blood
The fetus & placenta may remain entirely in utero
or may partially extrude through the dilated os
→ Remove retained tissue without delay
45. Retention of dead products of conception in utero for
several weeks
Many women have no symptoms except persistent
amenorrhea
Uterus remain stationary in size, but mammary
changes usually
regress → uterus become smaller
Most terminates spontaneously
Serious coagulation defect occasionally develop after
prolonged retention of fetus
46. Definition : Three or more consecutive spontaneous
abortions
Clinical investigation of recurrent miscarriage
Parental cytogenetic analysis
Lupus anticoagulant & anticardiolipin antibodies assays
Postconceptional evaluation
Serial monitoring of ß–hCG from missed mens period
ß–hCG>1500mIU/ml → USG
Maternal serum α-fetoprotein assessment (GA16-18wks)
Amniocentesis → fetal karyotype
Prognosis
Depends on potential underlying etiology & number of
prior losses
47. The medical or surgical termination of pregnancy
before the time of fetal viability
Classfication
1-therapeutic
2-elective[voluntary]
Therapeutic abortion
Termination of pregnancy before of fetal viability
for the purpose
of saving the life of the mother
48. 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
49. 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
50.
51.
52. 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 14-15 weeks, D&C or vacuum aspiration should be
performed
After 16 weeks, dilatation & evacuation (D&E) is performed
Wide cervical dilatation
Mechanical destruction & evacuation of fetal parts
53. Dilatation and curettage
Hygroscopic dilators
: swell slowly & dilate cervix → cervical trauma can be minimized
Laminaria tents
: stem of brown seaweed ( Laminaria digitata or japonica)
→ drawing water from proteoglycan complexes of cervix
→ dissociation allow the cervix to soften & dilate
Insertion technique : tip rests just at the level of internal os
Usually after 4-6hours, laminaria dilate the cervix sufficiently to allow
easier mechanical dilation & curettage
May cause cramping pain
→ easily managed with 60 mg codeine every 3-4 hours
Synthetic hygroscopic dilators such as lamicel and dilapan-s are also
available
Prostaglandins-400mcg misoprost kept in vagina 4hrs before
termination causes more dilatation and less pain of insertion compare to
laminaria tent.
54.
55.
56. Complications : uterine perforation
2 important determinants
Skill of the physician
Position of the uterus (retroverted)
Small defects by uterine sound or narrow dilator
→ often heal without complication
Suction & sharp curettage
→ Considerable intra-abdominal damage risk↑
→ Laparotomy to examine abdominal content (safest
action)
Other complications – cervical incompetence or
uterine synechiae
57. 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
Manual vaccum aspiration-
Office based procedure used for termination upto 12 wks,uses a
60ml syringe n canula .a vaccum is created in the syringe and
attached to canula which is inserted transcervically
58.
59.
60.
61.
62. 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
midtrimester abortion
Laminaria tents inserted the night before
Chance of successful induction is greatly
enhanced
63. 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
midtrimester abortion
Laminaria tents inserted the night before
Chance of successful induction is greatly
enhanced
64. Prostaglandins
Used extensively to terminate pregnancies, especially in the 2nd
T
PG E1, E2, F2α
Technique
: Can act effectively on the cervix & uterus (86~95%
effectiveness)
Vaginal prostaglandin E2 suppository & prostaglandin E1
(misoprostol)
As a gel through a catheter into the cervical canal & lowermost
uterus
Injection into the amnionic sac by amniocentesis
Parenteral injection
Oral ingestion
65. Intra-amnionic hyperosmotic solutions
20-25% saline or 30-40% urea injected into amnionic sac
→ stimulate uterine contraction & cervical dilatation
Action mechanism : prostaglandin mediated ?
Complications of hypertonic saline
Death
Hyperosmolar crisis (early into maternal circulation)
Cardiac failure
Septic shock
Peritonitis
Hemorrhage
DIC
Water intoxication
Hyperosmotic urea : less likely to be toxic
66. Antiprogesterone RU 486
Oral agent used alone in combination with oral PG to effect
abortions in early gestation
High receptor affinity for progesterone binding site
→ Block progesterone action
Abortion rate
Single 600mg dose prior 6 weeks → 85%
Addition of oral, vaginal or injected PG → over 95%
If given within 72 hours
Also highly effective as emergency postcoital contraception
Progressively less effective after 72 hours
Side effects
Nausea, vomiting, & gastrointestinal cramping
Major risk → hemorrhage is a risk if abortion is incomplete
67.
68.
69.
70.
71. Septic abortion
Most often associated with criminal abortion
Metritis is usual outcome, but parametritis,
peritonitis, endocarditis, and septicemia may all
occur
Management
Prompt evacuation of products of conception
Broad-spectrum IV antimicrobials
72.
73. Any abortion associated with clinical
evidences ofinfection of the uterus and its
contents is called septic abortion.
Criterias are
1-temp of atleast 100.4degree faranhite for
24hrs or more
2-offensive or purulent vaginal discharge
3-other evidences of infection such as lower
abdominal pain and tenderness
10% abortions are septic either due to
incomplete or due to illegal
74. Due to endogenous microorganisms present
in vagina these are
Anaerobic-bacteroides,anaerobic
strepto,c.welchi and tetani.
Aerobic-
ecoli,klebsialla.pseudomonas,staph,beta
hemolytic streptococcus(usually
exogenous),methcillin resistant
staphylococcus.
75. History of unsafe termination by an unauthorized person
mostly concealed
Women looks sick and anxious
Temp> 38 c
Chills &rigors
Persistent tachycardia >90bpm
Hypothermia (endotoxic shock)<36c
Abdominal or chest pain
Tachypnea RR >20/min.
Impaired mental state
Diarrhea and or vomitting
Renal angle tenderness
Pelvic examinations- offensive,purulent vaginal
discharge,uterine tenderness,boggy feel in the POD(PELVIC
ABSCESS)
76. Grade 1-infection is localised to uterus
Grade2-beyond the uterus to parametrium ,tubes,ovaries or pelvic
peritonium
Grade 3-generalised peritonitis ,endotoxic shock ,or jaundice,or renal
failure
INVESTIGATIONS-1-
1-hvs
2-culture in aerobic and anaerobic media
3- sensitivity towards antibiotics
4-smer for gram+ or gram_
5-cbc ,haemogram,ABO cross match
6-usg for rpocs any foreign body or pelvic abscess
Blood culture,serum lectrolytes,CRP,coagulation profileserum lactate
greater than or equal to 4mmol/l indicates tissue hypoperfusion.
Plain xray abdomen to rule out any bowel injury xray chest for cases
with pulmonary complications.
77. Haemorrhage
Injury may occur to uterus or adjacent bowel
Spread of infection may lead to
1-generalised peritonitis
2-endotoxic shock
3-acute renal failure ATN –common with
c.welchii
4-lungs-atelactass,ARDS,thrombophlebitis
Mainly occurs with grade 3.
Remote complications are 1-chr debility,2-chr
pelvic pain and backache ,3-dyspareunia,4-
ectopic pregnancy,5-sec infertility due to tual
blockage
78. Hospitalization
To take hvs
Vaginal examination
Assessment of case
Inv protocols
Principles of m/m are
To control sepsis
To remove the source of infection
To give supportive therapy to bring back normal
homeostatic and cellular metabolism
To assess the response of treatment
79. Grade 1-
Antibiotics
Prophylactic anti gasgangrene serum of
8000units anti tetanus serum of 3000 units
i/m are givenif there is a history of
interference
Analgesics and sedatives
Evacuation should be performed within 24
hrs of antibiotic therapy
Blood transfusion to improve anemia and
body resistance
80. Grade 2-broad spectrum antibiotics
Analgesic,AGS,ATS,blood transfusion
Clinical monitoring CVP to be > 8mhg
Surgery- evacuation of uterus
Posterior colpotomy
Grade 3as grade 2except surgery
Active surgery-injury to ut,bowel injury,presence
of foreign body in abdomen,unresponsive
peritonitis,septic shock or oliguria not
responding to conservative m/m,uterus too big
to be safely evacuated per vaginum.
82. Following provisions are laid down
Continuation of pregnancy would involve serious
risk of life or grave injury to the physical and
mental health of pregnant women
There is a substantial risk of child being born
with serious physical and mental abnormalities
so as to be handicapped in life
When pregnancy is caused by rape both in cases
of major and minor girl and in mentally
imbalanced women
Pregnancy caused as a result of failure of
contraceptive
83. Indications for terminations under MTP act
To save life of mother (therapeutic or medical indications)
1-cardiac ds grade 3 and grade4 with h/o decompensation in prev pregnancy 0r in between
pregnancies
Chr glomerulonephritis
Malignant hypertension
Intractable hyperemesis
Cervical or breast malignancy
DM with retinopathy
Epilepsy or psychiatric illness with advice of a psychiatrist
Social indicationa-this is almost sole indication and is covered under the provision to prevent
grave injury to the physical and mental health of the pregnant women
In80% cases it is limited to parous womenhaving unplanned pregnancy with low socioeconomic
status.
Pregnancy caused by rape or unwanted pregnancy caused due to failure of any contraceptive
device
Eugenic-this is under the provision of sustantial risk of child being born with serous physical
and mental abnormalities so as to be handicapped in life the indication is rare
1- structural anencephaly,chromosomal downs syndromeor genetic hemophilia
2-fetus is likely to be deformed due to action of teratogenic drugs warfarin or radiation
exposure >10 rad in early preg.
Rubella infection is an indication for termination
84. Recommendations
In revised rules rmp is qualified to perform an mtp provided
1-one has assisted atleast 25 mtp in an authorised centre and
having a certificate
2-one has got 6 months house surgeon training in ob gy
3-one has got diploma or degree in ob gy.
Termination can only be performed in hospitals,established or
maintained by govt or places approved by gov.
Pregnancy can only be terminated on the written consent of the
women. Husband s consent is not required.
Pregnancy in a minor girl or lunatic cannot be terminated without
written consent of parents or legal guardian.
Termination is permitted up to 20 wks of pregnancy.when preg
exceeds 12 wks opinion of two medical practitioners is required.
The abortion has to be performed confidentially and o be
reported to director of health services in prescribed form.
![ Termination of pregnancy, either spontaneously
or intentionally
Pregnancy termination prior to 20 weeks’
gestation or less than 500-g birthweight [who
&national centre for health statistics¢re for
disease control and prevention]
Definition vary according to state laws for
reporting abortions, fetal deaths, and neonatal
deaths
Word abortion derives from latin word aborii – to
miscarry](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)