Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Abortion MTP PowerPoint PPT presentation
DEFINITION:-
It is premature Expulsion of fetus from the mother's womb at any time of
pregnancy before full term is completed
Latin word Aboriri- means get detached from the proper site
By convention- Abortion used to denote termination of pregnancy during 1st trimester
Miscarriage- Termination during 2nd semester
Premature birth ? Termination during 3rd semester
Law of the land does not recognize Abortion, Miscarriage or Premature birth as
Separate entities, hence, all those terms are referred as abortion in the Court of Law
? CLASSIFICATION
? NATURAL ( Spontaneous) 10 to 15% of all pregnancy
? a) Maternal causes:-
? i) Disease like severe anemia, Ch. Nephritis, Hepatitis, Hypertension, Syphilis
Thyrotoxicosis, Endocrinal disorders, General ill-health, Under nourishment, etc.
? ii) Poisoning by Lead, Copper, Mercury and others
? iii) Nervous and mental causes like sudden shock, fear, joy etc.
? iv) Injuries like fall from height, from missed steps, blows or pressure on abdomen
? v) Uterine diseases like endometritis, fibroid tumors, retro- verted uterus
? vi) Ovarian diseases
? vii) Placental causes
? viii) Excessive sexual cohabitation
? ix) Hormonal imbalance
? b) Fetal causes:-
Diseases of decidua, mal development, torsion of the cord, etc.
? ARTIFICIAL ( Deliberately induced)
- Justifiable (Therapeutic )
- Criminal
Justifiable (Therapeutic )
? Before the Medical Termination of Pregnancy became a legal option, women were not
allowed to abort, unless there was proven threat to life
? Rape victim, unmarried females, widows if pregnant had to resort to alternative means i.e.
criminal abortion leading high mortality/morbidity.
? Liberalisation of rules owes much to Dr. Alec Bourne, a gynaecologist, of spotless credentials of
suburban London, who performed an abortion with parents consent on a 14 years old girl who
became pregnant due to rape by 5 British soldiers, officers in the Royal Horse Guards, in a London
barrack in 1938.
? He performed operation without fee and without any secrecy at St Mary's Hospital. He later
notified the Police, making a full and clear disclosure
? Dr. Bourne was arrested.
? During trial he justified his action on the ground that the girl would have been carrying around in
her body for rest of the months, a child conceived out of rape, which would have harmed her
mental health
? Dr. Alec Bourne:-
? It was for the first time that mental trauma arising out of an unwanted pregnancy was
highlighted in a court of Law
? Dr. Bourne was acquitted.
? This became a benchmark case, serving as a forerunner for the subsequent liberalisation of
medical termination of pregnancy.
? Abortion act, 1967 In UK
? MTP Act 1971 In India
In Nepal- Termination legalised in 2002
Status in Pakistan- Governed by old IPC Act of 1860
Bangla Des- in 1972 Law allowed abortion for women
raped during war
MTP Act 1971
(No. 34 of 1971)
? It has 8 sections.
? 1. Describes short title, extent and commencement
? 2. Definition ( guardian, lunatic, minor, registered medical practitioner)
? 3. When pregnancies may be terminated by registered medical practitioners
? 4. Place where pregnancy can be terminated
? 5. Sections 3 and 4 when not to apply
? 6. Power to make rules ( by Central Government)
? 7. Power to make regulations ( by State Government)
? 8. Protection of action taken in good faith
MTP Act 1971 was regarded a great step forwards towards the right of women to
decide to be or not to be a mother.
? Presently, it is not a right that every woman can exercise solely by her decision
As per the Act, it is solely at the discretion of the doctor that a woman may or
may not undergo abortion
MTP Act 1971 has greatly liberalized the existing provisions in the Penal Code on abortion:
IPC 312 ( Causing miscarriage)- punishment up to 3 yrs. Simple imprisonment
or fine or with both. Quick with child- up to 7 yrs. SI and also fine).
( With consent of the woman)
313 Without consent of the woman- Imprisonment for life or up to 10 yrs. + fine
314 Causing death of the woman ? (done with consent)- up to 10 yrs + fine
Without consent- life imprisonment +fine
315 Act done with intent to prevent the child being born alive, or to cause it
to die after birth- Imprisonment up to 10 yrs.
316 Causing death of a quick, unborn child- Imprisonment up to 10 yrs.
? Qualifications Required
As per the act, a registered medical officer is qualified to perform MTP
if
* He has assisted in at least 25 cases of MTP in a recognised hospital, out of which
at least 5 cases must have been performed independently.
* Specialist- MD in obstetrics, DGO.
* 6 months experience in house- surgeonship in obstetrics in a recognised hospital.
* One year experience in the dept. of Gynae & Obstetrics
Place
MTP ? In any Govt. hospital,
- or non-government institution, provided that a licence for MTP has been
provided by the district CMO. (The hospital must be well equipped for
anaesthesia and operation)
Emergency Provision:- to save the life of a woman.
Pregnancy caused by rape:-
Woman has not lodged complaint with police, wants MTP
- MTP can be done at government/ approved institution .
(Doctor will report to the police and preserve sample of product of
conception for
DNA profiling).
Under the MTP Act 1971
the termination of pregnancy can be done under the fol owing conditions.
1. Therapeutic grounds as a health measure
When the continuation of pregnancy will cause grave injury to the
physical or mental health/ or life of the pregnant woman
2. On Eugenic ground
If there is evidence to suggest that the child to be born would
suffer from severe physical or mental abnormalities.
Example:- TORCH infection in mother in 1st trimester of
pregnancy
3. Humanitarian
Pregnancy resulted from rape
4. Social
Pregnancy resulted from failure of contraceptive in a married woman
or her husband
? Consent
Any woman over the age of 18 yrs.
Minor or woman suffering with mental illness:- consent of the guardian
Married woman:- consent of the husband:- not legally required
Duration of gestation (i.e. Up to what period pregnancy can be terminated?)
(a) Up to 12 weeks:- One medical officer alone in good faith can take the decision of
performing an abortion
(b) 12-20( twenty) weeks:- Such opinion must be of 2 doctors (or more)
More than 20 (twenty) weeks:-
Only one condition i.e. Termination of pregnancy immediately necessary to save the life
of the pregnant woman
( In such situation only one doctor can form opinion in
good faith for termination and will proceed for termination )
NOTE:- As per MTP Act 1971 on Eugenic ground termination can be done up to 20
weeks
? As per MTP Act 1971 punishment for willfully violating the rules
RMP shall be liable to be punished with fine which may extend
to 1000 rupees.
No suit for other legal proceeding shal lie against the RMP for any
damage caused / likely to be caused by anything which is in good faith done
or intended to be done under this Act
MTP ( AMENDMENT ) ACT, 2002
Changes
Medical Termination of Pregnancy Act 1971 referred as the PRINCIPAL Act
Word Lunatic changed to mental y il person
Substitution of new section for section 4 ? Place where the pregnancy may be
terminated
Termination of pregnancy can be done only-
- In Govt. hospital
- In other hospital approved by the Govt. or District Level Committee .
- Constituted by that Govt. or Chief Medical Officer or District Health Officer.
District Level Committee- not less than 3 and not more than 5 members including
Chairperson.
CMO/ DHO will be the Chairperson
Amendment of section 5 ? Termination of pregnancy by a person who is not RMP:- RI
(Rigorous Imprisonment) 2-7 yrs.
-Termination in a place other than place mentioned in section 4: ? RI 2 to 7 yrs.
- Owner of such place (administrative head or otherwise ):- RI 2 to 7 yrs.
IN 2018, Medical Termination of Pregnancy Act, 1971 (PRINCIPAL Act) was further
amended and it is cal ed the
Medical Termination of Pregnancy ( Amendment ) Act, 2018
? Amendment of section 3 clause(b)for the words "twenty weeks" the words " twenty-four
weeks
? in case of rape survivor", anytime during the pregnancy, but before twenty-seven weeks"
shall be substituted.
? After section 4 of the principal Act, the following has been inserted
Central Supervisory Board members
- Medical Genetics
- Gynaecologists and Obstetricians
- Paediatricians,
- Social Scientists
- Representatives of Women Welfare organisation
Chairperson of the Board - from among the members
? Majority opinion of the Central Supervisory Board:- continuation of pregnancy may
involve a major risk in case the child is born with following abnormalities
? a) Chromosomal abnormalities
? b) Genetic metabolic diseases
? c) Haemoglobinopathies
? c) sex- linked genetic diseases
? e) congenital abnormalities or
? f) another abnormalities or diseases as may be specified by the
Central Supervisory Board,
pregnancy irrespective of its length, shall be terminated in accordance with
the provisions of section 4 ( place)
MTP Rules1972 was repealed
? MTP Rules 1975
? which was further Repealed in 2003 and the new rules are called
? MTP Rules 2003
( Medical Termination of Pregnancy (Amendment) Bil , 2020 introduced Lok Sabha
on Mar 02,2020 and passed on Mar 17,2020.)
? Duration of pregnancy
Up to 12 weeks
12 to 20 weeks
Up to 20 weeks - opinion formed in good faith for the termination ?
by a single doctor
Between 20 to 24 weeks ? opinion of two doctors
only apply to specific category of women
Rape survivor- Pregnancy be terminated within 27 weeks of such pregnancy
Central Supervisory Board- Medical Genetics
- Gynaecologists and Obstetricians
- Paediatricians,
- Social Scientists
- Representatives of Women Welfare organisation
Upper limit of termination in foetal abnormalities ? opinion of the above Board.
? The MTP (Amendment ) Bil 2020
? Pregnancy as a result of failure of any device or method-
? - replaces `married woman or her husband' with `woman or her partner'
Protection of privacy of a woman
RMP will not be allowed to reveal the name and other particulars of a
woman whose pregnancy has been terminated, except to a person authorized by Law.
On violation of this rule- Imprisonment up to one year, or fine or with both
Methods of Inducing MTP
? Depends on duration of pregnancy in each case
? Medical ? Mifepristone (RU- 486) and Misoprostol {effective upto 63 days}
? 1st 3 months:-
Dilatation and curettage ( D & C )
Vacuum suction and curettage
Under both methods:-
Cervical canal is first dilated by no. 4 Hegar's dilator under LA/GA
and then the product of conception removed by scooping out by a uterine curettage
or Sucked out by connecting to vacuum suction evacuation equipment.
Beyond 3 months:-
Induction by I.V. drip of Prostaglandin E1 and E2. It causes uterine contraction and
expel the fetus
Amniocentesis
Abdominal hysterectomy- preferred after 4 months of pregnancy.
This post was last modified on 12 August 2021