Medical Termination Of Pregnancy (MTP)

Medical Termination Of Pregnancy (MTP)

Indications:   If the continuation of pregnancy would involve serious risk of life or grave injury to the physical and mental health of the pregnant women.

  • To save life of mother.
  • Social indications: If the pregnancy caused due to failure of contraception or rape etc…
  • Eugenic: Substantial risk of the child being born with serious physical and mental abnormalities so as to be handicapped in life.

Methods of termination:

First trimester termination:

Suction evacuation and curettage: This method consist of suction machine connected with a cannula.After dilating the cevix the evacuation of the placenta is done.And the remaining things are taken out by curette.

Dilatation and curettage: This procedure is very simple and can be done under Diazepam sedation.

Prostaglandins : Before surgical methods cervical ripeningbe achieved by use of1mg PGE1 vaginal pessary.This is done 3hours before procedure.

Misoprestone and Methotrexate medications can also be used for abortion.

Mid trimester abortion:

Intrauterine isolation of hypertonic solution:  Intraamniotic instillation of hypertonic saline 20% is the commonly used method in many parts of the globe.

Procedure;- Preliminary amniocentesis is done by a 15cm 18 gauge needle. A fine polythene tube is passed through the needle into the amniotic sac followed by withdrawal of the needle. The polythene tube is connected to the drip set containing the required amount of hypertonic saline.

           Extra amniotic instillation of 0.1% Ethacrydine lactate (estimated amount is 10ml per week). It is done transcervically through No.16 Foley’s catheter. The catheter is passed up to the cervical canal for about 10cm above the internal os between the membranes and myometrium and the balloon is inflated with saline. It is removed after 4 hrs.

             Other methods of mid trimester abortion are;

  • Prostaglandins :- Vaginally, intramuscularly, extra amniotically and intraamniotically.
  • Oxytocin:- Administered as IV drip along with chemicals.
  • Hysterectomy:- Removal of uterus for the termination of pregnancy on therapeutic grounds if the chemical agents are contraindicated.

Complications of MTP.

Immediate:

  • Trauma to the cervix leading to hemorrhage and shock.
  • Thrombosis or embolism.
  • Incomplete abortion.

Remote:

Gynecological complications:

a)    Menstrual disturbances.

b)    Infertility due to corneal block.

c)    Scar endometriosis.

d)    Uterine synechae.

Obstetrical complications:

a)         Recurrent mid trimester abortion due to cervical incompetence.

b)         Ectopic pregnancy.

c)         Premature labour.

d)         Dysmaturity.

e)         Increased perinatal loss.

f)          Rupture uterus.

g)         Isoimmunization in Rh negative women, if not prophylatically protected. 

Leave a Reply