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Abortion and MTP Act

Abortion

What is abortion or miscarriage?

Abortion is the termination of pregnancy when fetus and other pregnancy products are expelled from womb before it is sufficiently developed to survive independently. (foetus less than 28 weeks of pregnancy). It may occur without any intervention (spontaneous) or may be induced (by medical or surgical methods).

What is spontaneous abortion?

Spontaneous abortion occurs without any intervention by any women or doctor. This occurs due to defects in the either fetus or woman reproductive system. These include chromosomal or genetic or defects in the uterine wall which is not able to support a pregnancy.

 

What are the early symptoms of miscarriage?

Early symptoms of a miscarriage are vaginal bleeding in a pregnant woman before 28 weeks of pregnancy but usually without other symptoms. The woman must consult a doctor immediately so that miscarriage can be stopped.

 

What are the causes of miscarriage?

Most spontaneous early abortion occurs when the unborn baby has fatal genetic problems. Other possible causes include:

  1. Infection,
  2. Diabetes or thyroid disease in mother,
  3. Hormonal factors
  4. Immune responses,
  5. Problems in the reproductive system of the mother

 

Who are the women at higher risk of abortion?

The risk for miscarriage is higher in women who

  1. Are older than 35 years
  2. Have certain diseases such as diabetes or thyroid problems
  3. Have a history of 3 or more previous miscarriage
  4. Have genetic defects in family or earlier pregnancies
  5. Are subjected to domestic violence,
  6. Have to travel frequently
  7. Are engaged in heavy work where they have to lift a lot of weight.
  8. Certain women may have no apparent reason, and still suffer from recurrent abortions

What precautions need to be taken to prevent miscarriage?

Pregnant women should not take medications without consulting a doctor, should have no radiation exposure, during the first three months of pregnancy. If one has a history of miscarriage in past, she should consult her doctor before she plans to have a baby. Her doctor may advise her to take a tablet of folic acid for three months before conception to prevent certain defects in the fetus.

 

A woman has had an abortion; will her next pregnancy also end in abortion?

No, there is normal risk as for the other women. About 15% pregnancies may end in abortion.

 

What is missed abortion?

The fetus has not developed or has died inside the uterus but the pregnancy tissue has not been expelled from the uterus.

 

What is inevitable abortion?

When the process of abortion has reached a stage that the abortion cannot be stopped by either medications or by any surgical means

 

What is incomplete abortion?

Some of the pregnancy tissues have been expelled, while other tissue remains in the uterus. It is important that even if abortion has occurred at home, a doctor must be consulted to ensure that abortion is complete i.e., all pregnancy tissues are expelled.

 

What is Septic (infected) abortion?

A serious infection has developed in the fetal or maternal tissues before, during, or after a miscarriage.

 

How is incomplete abortion managed?

The doctor will do CD &E (cervical dilatation and evacuation) after clinical assessment.

 

What is cervical dilatation followed by evacuation?

It is surgical abortion done in the early pregnancy that is before 12 weeks by opening the mouth of uterus and removing all pregnancy tissues using surgical instruments. The procedure takes about 15 minutes.

 

What are advantages of cervical dilatation and evacuation?

The advantages are:

  1. A single step procedure
  2. Safe.
  3. Possible to carry out Sterilization or insertion of an intra-uterine device.
  4. Can go home on the same day.
  5. Can resume working the next day.

 

What are the risks associated with cervical dilatation and evacuation?

The risks include:

  1. Reaction to the drugs used in anesthesia
  2. Bleeding
  3. Infection of the uterus and fallopian tub
  4. Accidental perforation of the uterus
  5. Emotional distress

 

What are the first trimester methods of abortion?

During first trimester abortion may be induced by using medicines or surgical removal of pregnancy tissues

  1. Medical Methods: Certain drugs can be administered in very early stages of pregnancy. These drugs are to be taken only under strict medical supervision, as they may cause complications in the female.
  2. Surgical methods: Cervical dilatation followed by evacuation of uterus by:
  3. >
    1. Curettage /Suction evacuation / vacuum aspiration / Dilatation and evacuat
    2. Menstrual aspiration (MR).

 

What is menstrual aspiration or regulation?

Menstrual aspiration also called mini-suction, mini abortion, vacuum aspiration, lunchtime abortion which is done between 1 to 3 weeks after the failure to menstruate. This procedure is done as an out patient. A thin plastic tube is inserted into the uterus and its contents sucked out by negative pressure created in a syringe. The procedure takes about 10 minutes to complete

 

What are the advantages of Menstrual Aspiration?

The advantages are:

  1. No hospitalization required.
  2. Done without anesthesia.
  3. Surgical risks are minimal
  4. Person can go home and resume her normal activities

 

What are the risks associated with Menstrual Aspiration?

The risks associated include:

  • Failure of the procedure.
  • Bleeding..
  • Infection
  •  

    What are medical methods of aborting first trimester pregnancy?

    The main drugs in use today are a group of drugs known as prostaglandin which can be used through various routes namely by mouth (referred to as the Abortion Pill), 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. The pregnancy usually ends at home within a day or two. The embryo and other tissue that develops during pregnancy are passed out through the vagina.
    2. The mifepristone – misoprostol method: Mifepristone also known, as RU-486 is antiprogesterone. A woman swallows a dose of mifepristone. She returns in five to seven days and inserts suppositories of misoprostol into her vagina. The pregnancy usually ends at home within four hours. The embryo and other tissue that develops during pregnancy are passed out through the vagina

     

    Does the Abortion Pill always have to be taken under medical supervision?

    Yes, the Abortion Pill must always be taken under medical supervision.

     

    What are the risks associated with use of medical methods of abortion?

    The risks associated with use of medical methods include:

    1. Mifepristone, Methotrexate and misoprostol cause nausea and vomiting, diarrhea, chills and rigor.
    2. Incomplete abortion may require surgical evacuation.
    3. Heavy bleeding, this may continue upto 7 days
    4. Drugs are not easily available and expensive

     

    What is the recommended dose regimen for medical abortion?

    A doctor should be consulted. It should be taken under supervisions

     

    How effective is medical abortion?

    The efficacy of medication abortion methods depends on both the drug regimen and duration of pregnancy. For all three methods of medication abortion, efficacy decreases with increasing period of pregnancy. However, medication abortion regimens can be safely and effectively used throughout the first 49 days of pregnancy.

     

    What is spontaneous abortion?

    Spontaneous abortion occurs without any intervention by any women or doctor. This occurs due to defects in the either fetus or woman reproductive system. These include chromosomal or genetic or defects in the uterine wall which is not able to support a pregnancy.

     

    When a woman has a medical abortion, what does she experience?

    The amount and duration of bleeding after a medical abortion is different for each woman and depends on both the method used and the length of the pregnancy. Many women experience a heavy, crampy, long period, others compare it to the process to a spontaneous miscarriage. The average bleeding differs by method but can range from one to four weeks after initiating the abortion. Many women also report passing blood clots, which can be large. Some women report passing gray or tan tissue (the products of conception). This tissue is usually less than one inch in length.

     

    What are the advantages of medical abortion in comparison to vacuum aspiration abortion?

    The advantages of medical abortion are:

    1. Available during early pregnancy
    2. Resembles a "natural miscarriage".
    3. Often considered to be more "private".
    4. Usually avoids surgical intervention
    5. High success rate (95%).

     

    Is Anesthesia required for medical abortion?

    No, anesthesia is not required

     

    What are the disadvantages of medical abortion?

    The disadvantages of medical abortion are:

    1. Requires at least two clinic visits
    2. May take days, sometimes weeks, to complete
    3. Efficacy decreases at later gestational ages.
    4. Post-procedure bleeding may last for weeks.
    5. Abortion may not be complete.
    6. Mifepristone is expensive.

     

    Who should not use medical abortion?

    Medical abortion is not suitable/ advisable in certain conditions. Hence, should always be taken on the advice and supervision of a qualified doctor

     

    What are the side effects and complications of medical abortion?

    Side effects of medication abortion vary by regimen. Vaginal bleeding and cramping are expected effects of medication abortion methods and are the part of the abortion process. Common side effects associated with the medications are Nausea, vomiting, diarrhea, headache, dizziness, fever, warmth, hot Flashes, and chills.

     

    How these side effects can be reduced?

    Many of these side effects can be reduced by using appropriate medicines for pain and nausea. The doctor should be consulted

     

    What are the complications of medical abortion?

    The most significant complication is prolonged uterine bleeding. Some women will require an intervention to stop it.

     

    What happens if a medical abortion fails to terminate the pregnancy?

    A woman may continue to bleed if abortion is incomplete. Sometimes pregnancy may continue in both situations. Doctor should be consulted

     

    How long does the medical abortion process take? What follow-up care is required when having a medical abortion

    The medication abortion process varies in length depending on both the regimen and the protocol. For all regimens, the medication abortion process requires at least two clinic visits

     

    What is spontaneous abortion?

    Spontaneous abortion occurs without any intervention by any women or doctor. This occurs due to defects in the either fetus or woman reproductive system. These include chromosomal or genetic or defects in the uterine wall which is not able to support a pregnancy.

     

    How long after having medical abortions will a woman resume normal periods?

    Woman will have normal period within 4-5 weeks.

     

    How long after having a medical abortion can a woman become pregnant?

    Medical abortion has not shown to have any long term effects on a woman's health or fertility. Most women will ovulate within the first cycle. Thus, a woman can become pregnant within weeks of having a medication abortion. Immediate use of an effective family planning method is highly recommended

     

    How long after having a medical abortion can a woman resume sexual intercourse?

    After having a medical abortion a woman should not engage in vaginal intercourse or insert anything into the vagina for approximately one week. A woman can become pregnant the very next cycle of having a medical abortion. Thus immediate use of an effective family method is highly recommended.

     

    Does medical abortion have long term effects on a woman's health?

    Medical abortion methods have not been shown to have any long term effects on a woman's health or fertility. It is however advised not to opt for repeated abortions by any method.

     

    Are there psychological consequences to medical abortion?

    Medical abortion methods have not been shown to have any long term psychological consequences. It will however also depend on the acceptance by the woman.

     

    Does medical abortion increase a woman's risk of breast cancer?

    Medical abortion methods have not been shown to have any impact on a woman's risk of breast cancer.

     

    Is there a difference between medical abortion and emergency contraception (also known as the morning after pill)?

    Yes, medical abortion and emergency contraception are different. The use of emergency contraception does not cause an abortion. In fact, emergency contraception prevents pregnancy and thereby reduces the need for induced abortion. Emergency contraceptives work before implantation and not after a woman is already pregnant. When a woman is already pregnant, emergency contraception does not work

     

    What is incompetent Cervix (loose mouth of womb)?

    A miscarriage/abortion sometimes occurs because there is a weakness of the cervix, called an incompetent cervix (mouth of the womb), which cannot hold the pregnancy beyond a certain period.

     

    When does miscarriage occur because of incompetent cervix?

    A miscarriage from an incompetent cervix usually occurs after the 14th to 16th week of pregnanc

     

    What are the symptoms of this type of abortion?

    There are usually few symptoms prior to a miscarriage. A woman may feel sudden pressure, her "water" bag may break, and tissue from the fetus and placenta may be expelled without too much pain.

     

    Is there any treatment for incompetent cervix?

    An incompetent cervix can usually be treated with a "circling" stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed until it is pulled out around the time of delivery.

     

    What are the methods employed for MTP in second trimester?

    The methods may include medical methods and surgical methods.

     

    What is done in case of using medical methods for aborting second trimester pregnancy?

    Medical methods involve the use of Prostaglandin related drugs which may be given orally or intra-vaginally or injected directly into the uterine cavity.

     

    What are risks associated with medical methods of abortion in second trimester?

    The risks include: Patient needs to

    1. Patient needs to be in a hospital upto 3 days
    2. Infection.
    3. Increased bleeding.
    4. Retained products, which may need surgical evacuation

     

    What are the surgical methods for aborting second trimester pregnancy?

    The surgical methods include

    1. Aspirotomy: Similar to Dilatation and Evacuation
    2. Hysterotomy: Opening the uterus and removal of foetus
    3. Hysterectomy: Removal of the entire uterus.

     

    What are the long-term effects of an abortion?

    Women who have had an abortion worry that it may affect their ability to conceive or bear a child in the future. They will be relieved to learn that now it is generally believed that a single abortion performed in the first 12 weeks of pregnancy does not pose a threat to future childbearing potential. However, a recent World Health Organization study has shown that women who underwent two or more abortions had a two-to-three times greater chance of miscarriage, premature delivery, or low birth weight infants.

     

    MTP

    Is abortion permitted legally?

    Yes, abortion is legal under provisions of MTP Act of 1972

     

    When can legal abortion be done?

    In India a woman can undergo abortion legally till 20 weeks of gestation.

     

    What are the legal implications for getting an induced abortion done?

    The legal implications for getting an abortion done are laid with the Medical Termination of Pregnancy Act. This Act was framed with the aim to counter the problem of illegal abortions in India.

     

    According to the MTP act, what are the reasons for which a woman can undergo abortion?

    The reasons for which a woman may seek abortion under the MTP Act are as follows

    1. Where a pregnant woman has a serious medical disease and continuation of pregnancy could endanger her life like:
      • Heart diseases.
      • Severe rise in blood pressure.
      • Uncontrolled vomiting during pregnancy
      • Cervical/ breast cancer.
      • Diabetes mellitus with eye complication (retinopathy).
      • Epilepsy.
    2. Psychiatric illness
    3. Where the continuation of pregnancy could lead to substantial risk to the newborn leading to serious physical / mental handicaps examples like
      • Chromosomal abnormalities.
      • Rubella (German measles) viral infection to mother in first three months
      • If previous children have congenital abnormalities
      • Rh iso-immunisation
      • Exposure of the foetus to irradiation
    4. Pregnancy resulting of rape.
    5. Conditions where the socio-economic status of the mother (family) hampers the progress of a healthy pregnancy and the birth of a healthy child.
    6. Failure of Contraceptive Device irrespective of the method used (natural methods/ barrier methods/ hormonal methods).This condition is a unique feature of the Indian Law. All the pregnancies can be terminated using this criterion.

     

    Does a woman require a written consent of her husband to get an MTP done?

    woman can give her own consent if she is above 18 years of age, she does not require the consent of her husband

     

    Whose consent is needed if she is below 18 years of age?

    In such cases she will require a written consent from her guardian.

     

    What is spontaneous abortion?

    Spontaneous abortion occurs without any intervention by any women or doctor. This occurs due to defects in the either fetus or woman reproductive system. These include chromosomal or genetic or defects in the uterine wall which is not able to support a pregnancy.

     

    Which are institutions that are authorized to perform an MTP??

    Any institutions licensed by the Government are authorized to perform MTP

     

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