1. MEDICAL TERMINATION OF PREGNANCY

2. INDUCTION OF ABORTION
Deliberate termination of pregnancy before the viability of the fetus is called induction of abortion.

3. PROVISIONS OF THE MTP ACT
The continuation of pregnancy would involve serious risk of life or grave injury to the physical and mental health of the pregnant women.
There is a substantial risk of the child being born with serious physical and mental abnormalities so as to be handicapped in life.

4. 3. When pregnancy is caused by rape, both in case of major and minor girl and in mentally imbalanced women.
4. Pregnancy caused as a result of failure of contraceptive.

5. INDICATIONS FOR TERMINATION UNDER THE MPT ACT
To save the life of the mother.
Social Indications.
Eugenic.

6. RECOMMENDATION
Registered medical practitioner is qualified to perform an MTP provided:
One has assisted in at least 25 MTP cases in an authorized centre 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.

7. 2. Termination can only be performed in hospitals, established or maintained by the government or places approved by the government.
3. Pregnancy can only be terminated on the written consent of the woman .Husband’s consent is not required.
4. Pregnancy in a minor girl (below the age of 18 years) or lunatic cannot be terminated without written consent of the parent or legal guardians.

8. 5. Termination is permitted up to 20 weeks of pregnancy
5. Termination is permitted up to 20 weeks of pregnancy. When the pregnancy exceeds 12 weeks, opinion of two medical practitioner is required.
6. The abortion has to be performed confidentially and to be reported to the director of health services of the state in prescribed form.

9. METHODS OF TERMINATION FIRST TRIMESTER (UPTO 12 WEEKS)
Menstruation regulation (M.R)
Suction evacuation and / or curettage
Dilatation and evacuation:
Rapid method
Slow method
4. Prostaglandins
5. Mifepristone
6. Methotrexate

10. FIRST TRIMESTER TERMINATION 1. MENSTRUAL REGULATION
Definition:
Menstrual regulation is the aspiration of the endometrial cavity within 14 days of the missed period in a previously normal cycle when the presence of an early pregnancy cannot be diagnosed accurately.

11. Contraindication:
Pregnancy of more than 44 days.
Presence of local pelvic inflammation.

12. 2. SUCTION EVACUATION [SYN: VACCUM ASPIRATION OR CURETAGE]
Definition:
It is a procedure in which the products of conception are sucked out from the uterus with the help of cannula fitted to a suction apparatus.

13. Indications:
Medical termination of pregnancy during first trimester (commonest).
Inevitable abortion.
Recent incomplete abortion.
Hydatidiform mole.

14. Complications: Immediate → Excessive hemorrhage Injury Shock
Increased morbidity
Late →
Pelvic inflammation
Infertility
Cervical incompetence
Uterine synechiae

15. Advantages: It is done as an outdoor procedure.
2. Hazards of general anesthesia are absent.
Ideal for termination for therapeutic indications.
Blood loss is minimal.
Chance of uterine perforation is much less specially with the plastic cannula.

16. Drawbacks: 1. Not suitable if uterus size is more than 10 weeks.
2. Requires electricity to operate and the machine is coastly.

19. 3. DILATATION AND EVACUATION
Definition:
D & E operation consists of dilatation of the cervix and evacuation of the products of conception from the uterine cavity.
The operation may be performed as :
One stage operation
Two stage operation

24. Incomplete abortion (commonest). Inevitable abortion.
ONE STAGE OPERATION
Indications:
Incomplete abortion (commonest).
Inevitable abortion.
Medical termination of pregnancy (6-8 weeks).
Hydatidiform mole in the process of expulsion.

25. TWO STAGE OPERATION Indications Induction of first trimester abortion.
Missed abortion( uterus 8-10 weeks).
Hydatidiform mole with unfavourable cervix.

26. DANGERS OF D+E OPERATIONS
Immediate:
Excessive hemorrhage
Injury
Shock
Increased morbidity
Late:
Pelvic inflammation
Infertility
Cervical incompetence
Uterine synechiae

27. ADVANTAGES Rapid method → It can be done as out door procedure.
Chance of sepsis is minimal.
Slow method →
Chance of cervical injury is minimal.
Suitable in cases of therapeutic indications.

28. DRAW BACK Rapid method→ Chance of cervical injury is more.
Uterus should not be more than 6-8 weeks of pregnancy.
All draw backs of D+E.
Slow method→
Hospitalization required.
Chance of introducing sepsis is more.
All the complications of D+E.

29. SECOND TRIMESTER (13-20 WEEKS)
Intra uterine instillation of hypertonic solutions.
Intra – amniotic – 20% saline, 40% urea, mannitol.
Extra – amniotic – Ethacrydine lactate.
Prostaglandins
Oxytocin infusion
Hysterotomy

30. MID TIMESTER TERMINATION
Between weeks
It is difficult to terminate
Between weeks
Intra – uterine instillation of hypertonic solution.
Intra – amniotic.
Extra – amniotic.

31. INTRA-AMNIOTIC
Contraindication:
Cardiovascular lesion
Renal lesion
Severe anemia

33. Complications:
Retained products of conception.
Infection.
Hypernatremia .
Cervical tear and laceration.
Minor complications like headache, fever, nausea & vomiting.
DIC.
Occasionally deaths

34. EXTRA – AMNIOTIC INSTILLATION OF 0.1% ETHACRYDINE LACTATE
Used where saline is contraindicate
OXYTOCIN
It is administered by intra venous drip method
It is used to augment abortion
HYSTEROTOMY
Performed through abdominal route

35. Indications:
Termination of pregnancy on therapeutic grounds
Failure of medical induction in second trimester
Hazards:
Immediate  1. haemorrhage and shock
2. anaesthetic complications
3. peritonitis
4. intestinal obstruction

36. Remote  1. Menstrual abnormalities.
2. Scar endometriosis.
3. Incisional hernia.
4. Scar rupture.

37. 4. PROSTAGLANDINS use in obstetrics:
Induction of abortion (MTP and missed abortion).
Termination of molar pregnancy.
Induction of labour.
Cervical ripening prior to induction of abortion or labour.
Acceleration of labour.
Management of atonic post partum hemorrhage.
Medical management of tabal ecotopic pregnancy.

38. Contraindications: Absolute → Hypersensitivity of the compound Asthma
Acute PID
Relative →
Hypertension
Cardiovascular disease
Renal disease
Peptic ulcer
Jaundice
Uterine scar

39. Draw backs:
It is costly and is not available widely.
Unpleasant side effects.
Cervical laceration.
The hyperactivity of the uterus, if occurs continue for a variable period even after discontinuation of its administration.

40. Advantages:
It has got a powerful oxytocic effect.
In later months, where the pre induction score is low or in intra uterine death, it is more effective than oxytocin.
It has got no antidiuretic effect.

41. COMPLICATIONS OF MTP Immediate→ Trauma to the cervix and uterus .
Hemorrhage and shock .
Thrombosis or embolism .
Remote →
Menstrual disturbances
Chronic PID
Infertility due to cornual block
Scar endometriosis
Uterine synechae

42. Obstetrical complications include 
Recurrent mid trimester abortion due to cervical incompetence
Ectopic pregnancy
Dysmaturity
Increased perinatal loss
Rupture of uterus
Rh iso-immunisation

43. Instruments used in MTP

45. thank you