ABORTION & MTP ACT

Definition Classification Methods of criminal abortion Complications Causes of death MTP – Indications , rules , Punishment

Premature expulsion of the fetus from mother’s womb at any time of pregnancy, before full term of pregnancy is completed.

CLASSIFICATION Natural – a) Spontaneous b)Accidental

Artificial – a)Therapeutic ,b) Criminal

Natural abortion –any time due to natural causes (common in 2nd or 3rd month)

Therapeutic or justifiable abortion –when it is done in good faith to save the life of women

CAUSES OF NATURAL ABORTION Maternal Foetal Diet – deficient in calcium, iodine Defective fertilization – inherent defect

in sperm or ova

Criminal abortion – Induced destruction and expulsion of the fetus (products of conception) from the womb of mother unlawfully

METHODS OF PROCURING CRIMINAL ABORTION

1.Using Abortifacient drugs 2.General violence 3.Local violence

1. ABORTIFACIENT DRUGS 1. Drugs acting directly on uterus a) Ecbolics - Ergot , quinine, leadb) Emmmenagogues – causes increase in

menstrual flow – savin, borax, oestrogen2. Irritants of Genito urinary tract - Produce reflex uterine contraction - oil of turpentine, cantherides3. Irritants of GI tracts - irritation of colon- hyperaemia & contraction

of uterus - castor/croton oil, Senna, Magnesium Sulphate

2. GENERAL VIOLENCE Intentional – kicks, jumping, massage

Violent exercise – horse riding , cycling

Cupping – a mug is used to separate placenta

Accidental – violent shaking the body

3.LOCAL VIOLENCE Syringing – enema syringe, Higginson's

syringe Rupture of membrane Dilatation of cervix & curettage Abortion stick Air insufflation

POST MORTEM EVIDENCE OF ABORTION GI tract may show evidence of traces of

drugs, erosions or congestion of cervix or uterus

Instrumental abortion – injury to cervix, vagina, uterus. Blood clots or bleeding , products of conception or placental tags

Segments of intestine, mesentery may enter uterine cavity

Ragged or irregular tears of small or large intestine

Cervical canal may be dilated, mucus plug in the cervix

Collection of fluid in peritoneal cavity – rupture of uterus

COMPLICATIONS OF CRIMINAL ABORTION Cervical necrosis Laceration, perforation of vagina, cervix Vagal inhibition Thrombo-phlebitis – injury to vessels Air embolism Bleeding – hemorrhage & shock Perforation of uterus , salpingitis ,

oophoritis Peritonitis Septicemia

CAUSES OF DEATH Immediate : Vagal inhibition, Air

embolism, Haemorrhage, Fat embolism, Amniotic fluid embolism

Delayed death : Pyaemia, Septicemia , peritonitis, Renal failure, Pulmonary embolism

MEDICAL TERMINATION OF PREGNANCY -1971 Therapeutic – when women life is in

danger if pregnancy is continued Eugenic – when there is risk of child

being born with serious physical or mental abnormalities (Measles, small pox, any viral infection, TORCH, Drugs)

Humanitarian – pregnancy caused by rape

Social – failure of contraceptive methods in married women

Environmental – poor economic status which affects mother/child health status

RULES Who can terminate pregnancy ? Place of MTP ? Consent Duration of pregnancy Medico legal aspects

WHO CAN TERMINATE ?

- Registered Medical Practitioner (MBBS) - RMO if assisted 25 cases of MTP in a

recognized hospital - MD, Diploma in OBG

Place of abortion - Govt Hospital - Hospital recognized by Govt - Private hospital after taking license

from District Health Officer

Consent – 1. Written informed consent from women2. Minor or mentally ill – guardian3. If husband requests for abortion?

Register has to be maintained Duration of pregnancy - if < 12 weeks : single doctor - > 12 weeks : two doctors must agree

that there is an indication - In case of emergency ?

PUNISHMENT Termination of pregnancy by a person

who is not RMP or in an unrecognized hospital shall be punished with rigorous imprisonment for a term which shall not be less than 2 years but may extend to 7 years.

Miscarriage without the consent of women – imprisonment up to 10 years (Sec.313 IPC)