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| Women's Health>>
Abortion |
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Abortion
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What is abortion?
Abortion in the first three months of pregnancy
Abortion in the second three months of pregnancy
What is the Indian MTP Act?
What are the approved places where MTP can be performed?
Why is counselling done?
What are the complications from legal abortion?
What are the signs of a Post - Abortion Complication?
How to prevent complications? |
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What is abortion?
Abortion is the termination of pregnancy by any
method (spontaneous or induced) before the foetus is
viable (less than 20 weeks of pregnancy) to survive
independently. |
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Induced abortion:
Out of almost 35 million abortions which take place
annually in the world, more than half of them are
illegal and performed by untrained, unskilled
persons and done under highly unhygienic conditions.
1. Abortion in the first three months of pregnancy
By Cervical dilatation followed by evacuation of
uterus or
Menstrual aspiration (MR)
* Surgical methods in the first three months
* Medical methods
The main drugs in use today are a group of drugs
known as prostaglandin, which can be used either by
mouth, by injection intramuscularly / intravenously,
or vaginally. These drugs are used by themselves or
in combination with other drugs.
1. The methotrexate – misoprostol method: A woman
receives an injection of methotrexate. Between five
to seven days later she returns and inserts
suppositories of misoprostol into her vagina.
2. The mifepristone – misoprostol method:
Mifepristone also known, as RU-486, Mifebort (Taj
Pharma) is antiprogesterone. A woman swallows a dose
of mifepristone. She returns in five to seven days
and inserts suppositories of misoprostol into her
vagina.
Risks:
* Mifepristone, Methotrexate and misoprostol cause
nausea and vomiting, diarrhoea.
* Incomplete abortion may require surgical
evacuation.
* Heavy bleeding, which may continue up to 7 days. |
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2.
Abortion in the second three months of pregnancy:
Methods of second trimester abortion (13 – 20 week)
What are Medical methods?
* Ethacridine lactate.
* prostaglandin
What are the Surgical methods?
* Aspirotomy
* Hysterotomy
* Hysterectomy |
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Medical methods:
1. Ethacradine lactate:This is a drug that is
introduced through a sterile catheter through the
vagina into the uterine cavity and placed behind the
pregnancy sac. This procedure is not painful. A
maximum of 150 ml is installed. It takes between 48
to 72 hours to abort. The procedure is safe, cheap
and easily available. To hasten the abortion,
ethacridine can be used along with prostaglandin or
oxytocin (a naturally available drug to increase
uterine contractions).
2. Prostaglandin:PG-E2: A gel of prostaglandin is
inserted into the mouth of the uterus- (the cervix)
in the evening in the clinic and the patient is
asked to lie down for about half an hour and then
allowed to go home. Early the following morning in
the hospital a drip of oxytocin is started
intravenously. Abortion is usually achieved in less
than 24 hrs and the abortion is complete
3. Misoprostol: It is available in tablet form and
given by mouth or can be inserted vaginally. Two
tablets of Mifepristone is given followed 24 hrs
later by an oral or vaginal dose of misoprostol. The
uterus will contract causing cramping followed by
the expulsion of the fetus. The cramps and the
bleeding will stop after the products have been
expelled
4. Others: Drugs like urea, hypertonic
saline,glucose which are introduced into the
pregnant sac have all been done away with in favour
of the above mentioned methods. |
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Risks:
* Needs to be in a hospital up to 3 days
* Infection
* Increased bleeding
* Retained products, which may need surgical
evacuation.
Surgical methods:
Anaesthesia:General anaesthesia can be given
depending on the pain threshold/apprehension of the
patient.
Procedure:
* Aspirotomy.
* Hysterotomy.
* Hysterectomy.
Aspirotomy: Aspirotomy is a procedure similar
to what is done in first trimester. This method can
be employed between 13-20 week of pregnancy. To help
in dilatation of the cervix prostaglandins may be
used.
Hysterotomy: Hysterotomy is a major operating
procedure where the abdomen is opened. In a
hysterotomy the uterus is opened and the contents of
the uterus removed directly under vision. This is
like a cesarean.
Hysterectomy: In a hysterectomy, the uterus
along with the pregnancy is removed in toto. At
times hysterotomy or hysterectomy may be necessary
because of a failure of a medical induction during
the second trimester.
In the second trimester of pregnancy, the procedure
followed is by the medical methods rather than by
the surgical methods. This is because the risks and
the convenience of the medical methods are far less
than surgical termination.
An early diagnosis of pregnancy with early
termination is safer than in the second trimester.
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What is the Indian MTP Act?
To avoid the misuse of induced abortions, laws have
been enacted the world over so that only qualified
gynaecologists can perform MTP for definite
indications at clinics or hospitals that are
approved. The Medical Termination of Pregnancy Act
was enacted in 1971 and was again revised in 1975.
It lays down the conditions under which a pregnancy
can be terminated and the persons and places
authorized to do so.
1. Indications for an MTP, under the act, are:
2. Where a pregnant woman has a serious medical
disease and continuation of pregnancy could endanger
her life:
* Heart disease
* Severe hypertension
* Uncontrolled vomiting during pregnancy
* cancer of the cervix or breast
* Diabetes mellitus with eye complication
(retinopathy)
* Epilepsy
* Psychiatric disorder |
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3. Where the
continuation of pregnancy could lead to substantial
risk to the newborn causing serious physical or
mental handicap:
* Chromosomal abnormalities.
* Rubella (German measles) infection in the mother
during first three months
* Congenital abnormalities in earlier births
* Rh iso-immunisation
* Exposure of the foetus to irradiation.
* Pregnancy resulting from rape.
* Conditions where the socio-economic status of the
mother (family) hampers the progress of a healthy
pregnancy and the birth of a healthy child.
* Failure of a contraception, irrespective of the
method used (natural or barrier or hormonal) |
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Consent:
Married: her own written consent; husband’s consent
not necessary
Unmarried and over 18 years: her own written consent
Below 18 years or mentally unstable: written consent
of guardian
Consent signifies and assures the clinician
performing the procedure that the woman:
* has chosen abortion of her own free will
* has been informed about all her options
* has been counseled regarding the procedure (risks
involved and care to be taken following it) |
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Who are the person(s)
qualified to do MTP?
* Any qualified registered medical practitioner who
has assisted in 25 MTPs
* A house surgeon who has done six months posting in
Obstetrics and Gynaecology
* A person who has a diploma/degree in Obstetrics
and Gynaecology
* Three years of practice in Obstetrics and
Gynaecology for those doctors registered before the
1971 MTP Act was passed.
* One year of practice in Obstetrics and Gynaecology
for those doctors registered on or after the date of
commencement of the Act.
* Whenever the pregnancy exceeds 12 weeks but is
less than 20 weeks, opinion of two registered
medical practitioners is mandatory |
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What are the
approved places where MTP can be performed?
Any institution licensed by the Government to
perform MTP. The certificate issued by the
Government has to be prominently displayed at a site
readily visible to persons visiting the place.
Why is counselling done?
Counselling is normally done by the attending doctor
with the aim of helping her come to a decision as to
the need of continuation or termination of the
pregnancy and to resolve it in the direction that
she chooses.
The purpose of counselling is to:
* allay the anxiety of the patient who intends to
undergo the procedure.
* provide information about the methods, safety,
risks etc
* screen for guilt, or any psychiatric ailment.
* help the patient understand and to cope with her
feelings.
* help her to prevent future unplanned pregnancy. |
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Serious complications arising from abortions before
13 weeks are quite unusual. About 89% of the women
who obtain abortions are less than 13 weeks
pregnant. Of these women, 97% report no
complications; 2.5% have minor complications that
can be handled in the OPD or abortion facility; and
less than 0.5% require some additional surgical
procedure and/or hospitalization. Complication rates
are somewhat higher for abortions performed between
13 and 24 weeks. General anesthesia, which is
sometimes used in abortion procedures, carries its
own risks.
In addition to the duration of the pregnancy,
significant factors that affect the possibility of
complications include:
* technical expertise of the provider;
* anaesthetic risk;
* general health of the woman; and
* method employed |
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What are the complications from
legal abortion?
Although rare, possible complications from a
surgical abortion procedure include:
* blood clots accumulating in the uterus, requiring
another suctioning procedure, which occur in less
than 1% of cases;
* infections, most of which are easily identified
and treated if the woman carefully observes
follow-up instructions, which occur in less than 3%
of cases;
* a tear in the cervix, which may be repaired with
stitches, which occurs in less than 1% of cases;
* perforation (a puncture or tear) in of the wall of
the uterus and/or other organs, which may heal
itself or may require surgical repair or, rarely,
hysterectomy, which occurs in less than 1/2 of 1% of
cases;
* missed abortion, which does not end the pregnancy
and requires the abortion to be repeated, which
occurs less than 1/2 of 1% of cases;
* incomplete abortion, in which tissue from the
pregnancy remains in the uterus, and requires the
abortion to be repeated, which occurs in less than
1% of cases;
* excessive bleeding caused by failure of the uterus
to contract and which may require a blood
transfusion, which occurs in less than 1% of cases. |
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What are the signs
of a Post - Abortion Complication?
If a woman has any of the following symptoms after
having an abortion, she should immediately contact
the facility that provided the abortion:
* severe pain;
* chills or fever with an oral temperature of 100.4
0F or more;
* bleeding that is heavier than the heaviest day of
her normal menstrual period or that soaks through
more than one sanitary pad in an hour;
* foul-smelling discharge or drainage from her
vagina; or
* continuing symptoms of pregnancy. |
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How to prevent complications?
There are some things women can do to lower their
risks of complications. The most important thing is
not to delay the abortion procedure. After six weeks
LMP, the earlier the abortion, the safer it is.
Asking questions is also important. Just as with any
medical procedure, the more relaxed a person is and
the more she understands what to expect, the better
and safer her experience will be.
In addition, any woman choosing abortion should:
* find a good clinic or a qualified, licensed
practitioner
* inform the practitioner of any health problems,
current medications or; allergies to medications or
anaesthetics, and other health information;
* follow post-operative instructions; and
* return for a follow-up examination. |
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Disclaimer - The
contents of this site are for informational purposes
only. Always seek the advice of a qualified
physician for any doubts. |
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