FIRST TRIMESTER MTP

Medical termination of pregnancy

‘the indian act permits the wilful termination of pregnancy before the age of fetal viability (20-weeks of gestation) for well defined indications.

It has to be performed by recognised medical practitoners in a recognised place approved by the competent authority under the act’

Surgical methods

Menstrual regulation

Vacuum evacuation

Medical methods

Prostaglandins

Mifepristone

Menstrual regulation

Menstrual regulation

Menstrual regulation

Advantages

Safe,efficient,easy to use*

Portable,washable, non-electric

Menstrual regulation

Complications*

Incomplete evacuationHemorrhageCervical laceration,perforation

infection

*failure to evacuateToo early pregancy

Ectopic pregnancy

Bicornuate uterus

Instrumental*

Menstrual regulation

Within 42 days of LMP

Vacuum evacuation

Vacuum evacuation

Up to 12 weeks of gestation

Vacuum evacuation

Advantage

Low failure rateLess complicationsLess mortality

Vacuum evacuationDisadvantageIf attempted curettage*

perforation, synachiae(Asherman syndrome)

placenta accreta

Medical methods

9 weeks of gestation

prostaglandins250mcg IM every 3h upto max 10 doses

mifepristoneSynthetic steroid

Derivative of 19-nortestosterone

Antiprogestogenic

mifepristoneMOA-Compete with Pg receptors

-reduce endometrial glandular activity

-accelerates degenerative changes

-increase stromal action

mifepristone

• ProtocolWritten consent for MTP

Blood group RH ,Hb % urine

USG – uterine pregnancy & duration

mifepristone

•Day 1- 200mg SD

•Day 3-400 mcg oral* – unless abortion occured+ PG

•Day 14- follow up

mifepristone

Contraindications

o IUCD insituo Suspected ectopico On anticoagulanto Previous scaro Lactating womeno After 63 days

Mifepristone

Advantages storage- room temp

Shelf life 3 years

Cheap

Easy administration

mifeprostol

• ComplicationsAdrenal failure

Möbius syndrome in fetus

Longer time for termination

Vomiting*

Surgical or medical?

summary

MTP

SURGICAL

Menstrual regulation

Vacuum evacuation

MEDICAL

mifepristone

prostaglandins

Thank you