MTP

1. MEDICAL TERMINATION OF
PREGNANCY

2. • The continuation of pregnancy would involve serious risk of
life or grave injury to the physical and mental health of the
pregnant woman.
• There is a substantial risk of the child being born with
serious physical and mental abnormalities so as to be
handicapped in life.
• When the 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 a contraceptive.

3. INDICATIONS FOR TERMINATION UNDER
THE MTP ACT

4. TO SAVE THE LIFE OF THE MOTHER
• (i) Cardiac diseases with history of decompensation in the
previous pregnancy or in between the pregnancies
• (ii) Chronic glomerulonephritis
• (iii) Malignant hypertension
• (iv) Intractable hyperemesis gravidarum
• (v) Cervical or breast malignancy
• (vi) Diabetes mellitus with retinopathy
• (vii) Epilepsy or psychiatric illness with the advice of a
psychiatrist.

5. SOCIAL INDICATIONS
• To prevent grave injury to the physical and mental
health of the pregnant woman
• unplanned pregnancy with low socioeconomic status
• caused by rape or unwanted pregnancy caused due to
failure of any contraceptive device

6. EUGENIC
• Structural (Anencephaly), chromosomal (Down’s syndrome) or
genetic (Hemophilia) abnormalities of the fetus.
• When the fetus is likely to be deformed due to action of
teratogenic drugs in early pregnancy.
• Rubella, a viral infection affecting in the first trimester, is an
indication for termination

7. RECOMMENDATIONS

8. •RMP 
• assisted in at least 25 MTP in an authorized center
and having a certificate.
• One has got six months house surgeon training in
obstetrics and gynecology.
• One has got diploma or degree in obstetrics and
gynecology.

9. • Termination can only be performed in hospitals,
established or maintained by the government or
places approved by the government.
• Pregnancy can only be terminated on the written
consent of the woman. Husband‘s consent is not
required.
• Pregnancy in a minor girl (below the age of 18 years)
or lunatic cannot be terminated without written
consent of the parents or legal guardian.

10. • Termination is permitted upto 20 weeks of pregnancy.
When the pregnancy exceeds 12 weeks, opinion of
two medical practitioners is required.
• The abortion has to be performed confidentially and
to be reported to the Director of Health Services of the
State in the prescribed form.

11. FIRST TRIMESTER TERMINATION
OF PREGNANCY

12. MEDICAL METHODS OF FIRST TRIMESTER
ABORTION
• Mifepristone (RU-486) and Misoprostol

13. SURGICAL METHODS OF FIRST TRIMESTER
ABORTION
• VACUUM ASPIRATION (MVA/EVA) is done upto 12 weeks with
minimal cervical dilatation
• SUCTION EVACUATION AND/OR CURETTAGE
• DILATATION AND EVACUATION

14. DILATATION AND EVACUATION
• Rapid method: This can be done as an outdoor
procedure with diazepam sedation and paracervical
block anesthesia
• Slow Method: Slow dilatation of the cervix is achieved
by inserting laminaria tents into the cervical canal This
is followed by evacuation of the uterus after 12 hours

15. MID TRIMESTER TERMINATION
OF PREGNANCY

16. MEDICAL METHODS
• PROSTAGLANDINS  They act on the cervix and the uterus
• OXYTOCIN: used with intravenous normal saline along with any
of the medications

17. SURGICAL METHODS
• Between 13 and 15 weeks: Dilatation and Evacuation
• Between 16 and 20 weeks: INTRAUTERINE
INSTILLATION OF HYPERTONIC SOLUTION
• There is liberation of prostaglandins following necrosis of
the amniotic epithelium and the decidua. This in turn excites
uterine contraction and results in the expulsion of the fetus.

18. COMPLICATIONS OF MTP

19. IMMEDIATE
(1) Injury to the cervix (cervical lacerations)
(2) Uterine perforation during D and E
(3) Hemorrhage and shock due to trauma, incomplete
abortion, atonic uterus or rarely coagulation failure
(4) Thrombosis or embolism
(5) Postabortal triad of pain, bleeding and low grade
fever due to retained clots or products.

20. REMOTE
• Gynecological complications
(a) menstrual disturbances
(b) chronic pelvic inflammation
(c) infertility due to cornual block
(d) scar endometriosis (1%) and
(e) uterine synechiae leading to secondary
amenorrhea.

21. • Obstetrical complications
(a) recurrent midtrimester abortion due to cervical
incompetence,
(b) ectopic pregnancy (three-fold increase),
(c) preterm labor,
(d) dysmaturity,
(e) increased perinatal loss,
(f) rupture uterus,
(h) failed abortion and continued pregnancy.

22. MORTALITY
• First trimester: The maternal death is lowest
• Midtrimester: The mortality rate increases 5–6 times to that of
first trimester