Termination of pregnancy by premature

expulsion of the fetus from the uterus at any

time of pregnancy
 Natural - 1) Spontaneous
2) Accidental

Artificial- 1) Therapeutic or Justifiable

2) Criminal
 8 to 12 weeks
Defect in ova
Developmental defect of fetus
Low implantation of zygote
Rh incompatibility
Hypertension/Diabetes
Uterine fibroid
Diseases of decidua and placenta
 Shock
Drug toxicity
Metallic poison
Syphilis/Nephritis
Trauma
 Therapeutic or Justifiable- Medical
termination of pregnancy Act 1971
 Alek Bourne case :
In 1938 Dr. Alek Bourne conducted abortion on a 14 year
old girl who was 6 weeks pregnant, in St.Marys Hospital,
London, she being a victim of sexual assault by British
Soldiers.
He conducted the abortion on humanitarian grounds
without fees and also informed the police regarding the
same.
He was arrested and tried in criminal court. He argued for
himself regarding the humanitarian grounds on which he
conducted abortion. He was acquitted.
This initiated the debate and led for liberalization of
indications for abortion all over the world.
MEDICAL TERMINATION OF
PREGNANCY ACT -1971
(MTP ACT 1971)
 Indications of MTP
Who can perform?
Where?
Punishment?
1. Therapeutic: When the continuation of pregnancy
endangers the life of woman, or may cause severe injury to
her physical or mental health.
2. Eugenic: When there is risk of the child being born with
serious physical or mental abnormality. If the pregnant
woman in the first three months suffers from (1) German
measles, (2) Smallpox or chickenpox, (3) viral infection
(4) Toxoplasmosis, pregnant woman is treated with drugs
like thalidomide, cortisone, aminopterin, antidepressants.
X-rays or radio-isotopes. Insanity of the parents. Viral
hepatitis.

3. Humanitarian: When pregnancy has been caused by rape.

4. Social: When pregnancy has resulted from the failure of

contraceptive methods in case of married woman.
 WHO CAN PERFORM MTP?

Registered medical practitioner (RMP) having

MS/DGO
RMP who have assisted at least 25 MTP cases in
a recognized centre, out of which 5 must be
performed independently he is allowed to
MTP upto 12 weeks.
Completion of six months of 'House Surgeon' in
Gynaecology and Obstetrics.
DURATION of PREGNANCY
Less than 12 weeks: Opinion of one RMP for MTP.
From 12 weeks up to 20 weeks: Opinion of two RMP
required for MTP.

WHERE MTP CAN BE PERFORMED?

Government hospitals
Private hospitals, who have permission from District
level committee.

Precautions
Take consent from Pregnant women
Take consent from parent/guardian if she is less than 18
years or mentally ill.
Consent of the husband not necessary and not
mandatory
EMERGENCY
Any doctor can perform MTP
Need not be recognized centre
Any gestational age.

MAINTENANCE OF REGISTER
- Details of the patient
- 5 years.
- Professional secrecy.
 PUNISHMENT
Termination of pregnancy in violation of provisions
of the Act is an offence punishable with Rigorous
imprisonment of 2 years (may extend up to 7 years).

It is now a cognizable offence for which a police

officer can arrest a doctor for violations without
warrant.

If the doctor has followed the above rules and

exercised proper care and skill, doctor is protected
from any legal action for damages caused or likely
to be caused.
 Def: Induced destruction and expulsion of the foetus
from womb of the mother unlawfully

Punishment- Sec 312 to 316 IPC

Sec 312 causing miscarriage, 7yrs
Sec 313 causing miscarriage without consent, 10yrs
Sec 314 death (of the woman) caused by act done
to cause miscarriage, 10yrs( Rigorous imprisonment)
 Sec 315 - act done with intent to prevent child being
born alive or to cause it to die after birth, 10 years
Sec 316 - causing death of quick unborn child by act
amounting to culpable homicide, 10 years
 First month - violent exercises, hot baths and
purgatives.
Second month - abortifacient drugs
Third or fourth month Mechanical interference.
 Acts directly on uterus, or indirectly by producing congestion
of pelvic organs, haemorrhages between uterus and
membranes.
1. Intentional: 1. Severe pressure on the abdomen, blows,
kicks, jumping, etc .,
2. Violent exercise: horse riding, cycling, jumping from a
height, severe jolting as driving over rough road, running
upstairs and downstairs and carrying or lifting heavy weights.
3. Cupping: A mug is turned mouth downwards over a lighted
wick & placed on the hypogastrium & the mug is pulled-
partial separation of placenta.
1. Syringing: ordinary enema syringe with a hand-bulb is used
to inject fluid into the uterus.
The suction valve is placed in a bowl of fluid & pressure
applied on the bulb. Due to imperfect filling, a mixture of air
& fluid is forced into the uterine cavity Detaches amniotic
sac & placenta Hemorrhage, uterine contraction &
abortion.
Soap water is often used as an injection material.
Death may result from air embolism. Sudden death from
vagal inhibition.
 2. Rupturing of the Membranes: introduction of an
instrument, Eg: uterine sound, catheter, probe, stick, pencil,
penholder, umbrella rib, knitting needle, curtain rod, nail,
Hairpin, piece of wire, glass rod, screw driver, douche
cannula, etc. Into the uterine cavity.
3. Dilation of the Cervix: Foreign bodies left in the cervical
canal, such as pessaries, laminaria tent (a dried seaweed) or
obturator, dilate the cervix, irritate the uterine mucosa and
produce marked congestion and uterine contractions.
Slippery elm bark is obtained from tree grown in America.
The pieces are cut into desired length & breadth & inserted
into cervical canal.
4. Abortion Stick: a thin wood or bamboo stick, 12 to 18 cm.
long. It is wrapped round at one end with cotton wool or piece
of cloth & soaked with juice of marking nut, calotropis, abrus
precatorius, or paste made of arsenious oxide, arsenic
sulphate, red lead.
5. Air Insufflation: pumps, syringes, and oral-genital contact.
6. Electricity: negative pole is placed over cervix in the
posterior vaginal vault and positive over the sacrum or lumbar
vertebrae. When current is passed, uterus contracts and may
expel its contents.
7. Curettage: dilatation and curettage.
8. Pastes: Utus pastes containing iodine and thymol or mercury.
Produce necrosis and infection of the uterine wall.
 Drugs acting Directly on the Uterus:
1. Ecobolics- increase uterine contractions
Eg: ergot preparations, quinine, strychinine, synthetic
estrogen, pituitary extracts
2. Emmenagogues- i.e Drugs initiating/ increasing
menstrual flow eg- estrogen, borax, savin, sanguianarin
Drugs irritating genito-urinary tract- eg-
cantharides, oil of turpentine, oil of tansy.
 Drugs irritating G.I tract: eg - purgatives like
castor oil, croton oil, phenolphthalein, podopylum,
saline purgatives
Drugs causing systemic toxicity: eg: arsenic,
phosphorus, copper, mercury, antimony, organic
irritants like abrus precatorius, calatropis, plumbago,
unripe fruit of papaya.
 D&C
Vacuum aspiration
Low rupture of membranes
Dilation & oxytocin infusion
Amniotic fluid replacement by hypertonic saline
Abdominal hysterotomy
Prostaglandin preparations.
 Rapid death-Hemorrhage
-Perforation
-Vagal shock
-Fat embolism
-Air embolism
 Delayed death -Peritonitis
-Local infection
-Tetanus
-Septicemia
 Remote death Renal failure
-Meningitis, Endocarditis,
- Pneumonitis
-Hepatitis
 Recent delivery
Pregnancy
Stains +
Genital signs- congestion, Injuries, tears in post-
commissure, fourchette
Blood clots & chemical stains
Cervix congested, dilated os
 External examination
Injury
Presence of fluid, blood, sticks or other material
 Perforation
Presence of instruments, Blood clots, products of
conception, other stains
Chemical stains, soap water froth
Enlarged soft thickened and congested
Endometrial scooping, placenta.
Internal and external os- congested.
Vagina- perforation, blood clots, products of
conception, and chemical stains.
 Lungs: air embolism, fat embolism, smell of
anesthetic drug, congested or pale.
Heart: air embolism- froth, sub endocardial
haemorrhage- septicemia.
Ovaries: injuries, corpus leuteum
Meninges: congested and inflamed
Blood vessels: air embolism.
Kidneys: congested.
Liver: congested.
Stomach: congested, presence of drugs.
 Uterus, ovaries and vagina- normal saline.
Blood and urine without preservatives.
 Presence of injury, stains to be noted.
Age of the fetus to be calculated by HASSES RULE.