Medical Termination of Pregnancy (MTP)
Medical Termination of Pregnancy (MTP)
INDICATIONS:
To save the life of the mother (Therapeutic or Medical termination):
- Cardiac diseases (Grade III and IV)
- Chronic glomerulonephritis
- Malignant hypertension
- Intractable hyperemesis gravidarum
- Cervical or breast malignancy
- Diabetes mellitus with retinopathy.
- Epilepsy or psychiatric illness with the advice of a psychiatrist.
Social indications:
- 80% Parous women having unplanned pregnancy with low socioeconomic status.
- Pregnancy caused by rape or unwanted pregnancy caused due to failure of any contraceptive device also falls in this category (20%).
Eugenic:
- Structural (Anencephaly), chromosomal (Down’s syndrome) or genetic (Hemophilia) abnormalities of the fetus.
- Deformed fetus :teratogenic drugs (warfarin) or radiation exposure (>10 rad) in early pregnancy.
- Rubella, a viral infection affecting in the 1st trimester
RECOMMENDATIONS:
- Termination can only be performed in goverment hospitals
- Pregnancy can only be terminated on the written consent of the woman
- Termination is permitted up to 20 weeks of pregnancy.
- When the pregnancy exceeds 12 weeks opinion of two medical practitioners is 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
- Registered medical practitioner is qualified to perform an MTP provided
- Assisted in at least 25 MTP in an authorized center and having a certificate.
- Got 6 months house surgeon training in obstetrics and gynecology
- Diploma or degree in obstetrics and gynecology
MEDICAL METHODS OF TERMINATION OF PREGNANCY
FIRST TRIMESTER ABORTION:
Mifepristone (RU-486) and Misoprostol:
- Mifepristone antagonise progesterone.
- low-dose prostaglandins (PGE1) improves the efficiency of first trimester abortion.
- Oral mifepristone 200 mg (1 tab) with vaginal misoprostol 800 μg (4 tab, 200 μg each) after 6–48 hours
Methotrexate and Misoprostol:
- Methotrexate 50 mg/m2 IM (before 56 days of gestation) followed by 7 days later misoprostol 800μg vaginally is highly effective
- Misoprostol may have to be repeated after 24 hours if it fails.
Contraindications(Mifepristone):
- Aged over 35 years
- Heavy smokers
- Long-term corticosteroid.
MIDTRIMESTER TERMINATION OF PREGNANCY:
PROSTAGLANDINS: (Prostaglandins and their analogs)
- Act on the cervix and the uterus
- PGE (dinoprostone, sulprostone, gemeprost, misoprostol) and PGF (carboprost) analogs are used
- PGEs are preferred as they have more selective action on the myometrium and less side effects.
Misoprostol (PGE1 analog):
- 400–800μg of misoprostol given vaginally at an interval of 3–4 hours
- First dose of 600 μg misoprostol given vaginally then 200 μg, orally every 3 hours are also found optimum
Mifepristone and prostaglandins:
- Mifepristone 200 mg oral, followed 36–48 hours later by misoprostol 800 μg vaginal; then misoprostol 400 μg oral every 3 hours for four doses is used.
Gemeprost (PGE1 analog):
- 1 mg vaginal pessary every 3–6 hours for five doses in 24 hours
- The mean induction-abortion interval was 14–18 hours
Dinoprostone (PGE2 analog):
- 20 mg is used as a vaginal suppository every 3–4 hours
- PGE2 is thermolabile (needs refrigeration) and is expensive.
Prostaglandin F2α(PGF2α):
- carboprost trometha mine—250 μg IM every 3 hours for a maximum ten doses
OXYTOCIN:
- High-dose oxytocin as a single agent can be used for second trimester abortion.
- used with intravenous normal saline along with any of the medications used either intra-amniotic or extra-amniotic space
COMPLICATIONS:
- Prostaglandins—intractable vomiting, diarrhea, fever, uterine pain and cervicouterine injury
- Oxytocin—water intoxication and rarely convulsions
- Saline—hypernatremia, pulmonary edema, endotoxic shock,DIC,renal failure, cerebral hemorrhage
Exam Important
- Maximum age of foetus for MTP is 20 weeks
- Under the Medical Termination of Pregnancy Act the opinion of two registered medical practitioners is necessary to terminate the pregnancy Where the pregnancy exceeds 12 weeks
- The minimum age for giving consent for medical termination of pregnancy is 18 years
- Hypertonic saline methods of MTP is associated with the complication of coagulopathy
- Prostaglandin cannot be used for MTP in a patient with bronchial asthma
- Mifepristone & misoprostol is used in Ist trimester MTP
- Methotrexate, Mifepristone & Misoprostol are used in the medical termination of early pregnancy
- Pregnancy from rape, Substantial risk of delivering seriously handicapped baby & Injury to physical and mental health of the pregnant women are indication for doing Medical Termination of pregnancy
- Medical termination of pregnancy can be done by a registered medical practitioner if the gestation period is less than 12 weeks
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