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MEDICAL TERMINATION OF PREGNANCY (MTP)

MEDICAL TERMINATION OF PREGNANCY (MTP). Approved by Indian Parliament 1971 Came into force in April 1972 (Except in J & K). MTP act permits MTP in the fall cases :

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MEDICAL TERMINATION OF PREGNANCY (MTP)

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  1. MEDICAL TERMINATION OF PREGNANCY (MTP) Approved by Indian Parliament 1971 Came into force in April 1972 (Except in J & K)

  2. MTP act permits MTP in the fall cases : 1)Where continuation of pregnancy would involve a risk to the life of the pregnant women or grave injury to the physical or mental health. 2) Congenital anomalies incompatible with life e.g., anencephaly. 3) Failure of contraception, rape or incest.

  3. Who can perform MTP ? • Obstetricians & Gynaecologists • Doctors who have training in MTP • Upto 12 weeks – certification of 1 qualified doctor between 13 to 20 weeks – approval of 2 qualified doctors.

  4. PLACE OF MTP : • PHC clinic or hospital or nursing home maintained by Govt. or approved by Government for this purpose. • Proper MTP registers to be maintained.

  5. METHODS OF 1ST TRIMESTER MTP : • Medical • Surgical Medical methods : Upto 63 days (9 weeks) • Day I : Mifepristone 200mg (1 tab) • Day III : 4 Tab Misoprostol 200mg each • Success rate 92 to 95%

  6. RU 486 – MIFEPRISTONE : ANTIPROGESTERONE : • Acts – • On target cells of endometrium and decidua • Affects the pituitary gonadotrophic cells producing a decrease LH secretion – luteolysis and shedding of endometrium and bleeding in the luteal phase of the cycle, irrespective of implantation of the blastocyst.

  7. 3) In early weeks of pregnancy – luteolysis – shedding of decidua and abortion. 4) Causes softening and ripening of the cervix and produces increase contractilibility of myometrium. 5) Increase sensitivity of the uterus to exogenous PGs.

  8. SURGICAL METHODS OF 1ST TRIMESTER MTP DILATATION & EVACUATION : • Vacuum aspiration (7 to 8 weeks) • Instrumental evacuation (8 to 12 weeks) Investigation : • Blood group Rh CBC, HIV, HBsAg, VDRL, FBS, Urine RE, UPT.

  9. General physical exam – systematic examination. • Vital signs. • Day care procedures • NPO x 8 hrs. • Inj. Ampicillin 1gm (AJD) IV stat. • Anaesthesia – sedation and local or general. • Sedation & local anaesthesia – Para cervical block.

  10. TECHNIQUE : • Patient asked to void urine. • Lithotomy position. • Part painted and draped. • P/V done. • Sims speculum – to retract post vag. wall. • Hold Ant. lip of Cx with vulsalum. • Pass the sound • Cervix dilated • Suction cannula (Karman’s) • 8 weeks size 8mm cannula • 10 weeks size 10mm cannula. • Methyl ergometrine .2mg IM/IV • Check curettage.

  11. If little or no tissue obtained – think of – • Failure to interrupt the pregnancy. • Non pregnancy • Ectopic pregnancy • Incomplete abortion. • V. early pregnancy • False passage. • Uterine perforation.

  12. Watch patient for 2 hrs. • Discharge with cap. Ampicillin 500mg TDS x 5 days – review x 2 weeks. • Counselling of family planning methods. • Can resume normal activity except intercourse x 2 weeks. • To revisit the physician earlier in case of • Acute pain abdomen. • Rise of temperature • Persistent pain for – 7 days • Heavy or persistent fresh bleeding. • Persistent pregnancy symptoms.

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