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Abortion Procedures..
Abortion Procedures..
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Abortion Laws | Certified Doctors for Abortion | Certified Place for Abortion | Methods of Induced Abortion
| First Trimester Abortion | Second Trimester Abortion |
Introduction
Definition
Abortion is the termination of pregnancy by any method (spontaneous or induced) before the foetus is
sufficiently developed to survive independently. (foetus less than 20 weeks of pregnancy)
Types of Abortions
Abortions can be classified as either of the following:
Spontaneous
Induced.
Induced Abortion:
Out of almost 35 million abortions which take place annually in the world, more than half of them are
illegal and performed by untrained, unskilled persons and done under highly unhygienic conditions.
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Heart diseases.
Epilepsy.
Psychiatric illness.
(ii) Where the continuation of pregnancy could lead to substantial risk to the newborn leading to serious
physical / mental handicaps examples like
Chromosomal abnormalities.
Rh iso-immunisation. link
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.
Consent:
If married--- her own written consent. Husbands consent not required.
If unmarried and above 18years ---her own written consent.
If below 18 years ---written consent of her guardian.
If mentally unstable --- written consent of her guardian.
A consent assures the clinician performing the abortion that she:
Has been informed of all her options.
Has been counseled about the procedure, its risks and how to care for herself after she chosen the
abortion of her own free will.
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ii.
A house surgeon who has done six months post in Obstetrics and Gynecology.
iii.
iv.
3 years of practice in Obstetrics and Gynecology for those doctors registered before the 1971 MTP
Act was passed.
v.
1 year of practice in Obstetrics and Gynecology for those doctors registered on or after the date of
commencement of the Act.
vi.
Whenever the pregnancy exceeds 12 weeks but is below 20 weeks opinion of two registered
medical practitioners is necessary.
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Abortion can be induced by different methods depending on the weeks of pregnancy completed.
Tests to be done:
Surgical methods:
(i) Cervical dilatation followed by evacuation of uterus by:
Curettage /Suction evacuation / vacuum aspiration / Dilatation and evacuation
(ii) Menstrual aspiration (MR)
Cervix is numbed (local anesthesia) with an injection so that the patient is pain free. This is given
alone or with a sedative.
ii.
General anaesthesia can be given if the lady is apprehensive or has a low pain threshold or in
selected cases like unmarried women or if it is her first pregnancy or if she opts for it.
Procedure:
The lady is made to lie on her back with her legs raised and placed in stirrups (lithotomy position)
Dilatation and evacuation:- Cervical dilatation followed by evacuation of uterus by curettage / vacuum
aspiration / suction evacuation / suction curettage/dilation and evacuation
Surgical abortion done in the early pregnancy, that is before 12 weeks is done by first dilating the cervix,
which is done by introducing hollow metal rods of increasing diameters and then evacuating the contents
of the uterus mechanically by scraping or by suction or both. The procedure takes about 15 minutes.
Advantages:
Safe.
Risks
Bleeding
Emotional distress.
Menstrual aspiration/ Menstrual regulation (MR): - Menstrual aspiration also called minisuction,
miniabortion, 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.
Advantages:
No hospitalization required.
Bleeding.
Infection
ii.
Risks
In the first trimester abortions the preference is for termination by the surgical method of dilatation and
curettage as the drugs are not easily available and expensive.
These drugs can be misused and hence FDA approval for these agents has not yet been given.
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Ethacridine lactate.
prostaglandin
Surgical methods
Aspirotomy
Hysterotomy
Hysterectomy
ii.
Prostaglandin:
PG-E2: A gel of prostaglandin called Cerviprime inserted into the mouth of the uterus- (the cervix)
in the evening in the clinic and the patient is asked to lie down for about half an hour and then
allowed to go home. Early the following morning in the hospital a drip of oxytocin is started
intravenously. Abortion is usually achieved in less than 24 hrs and the abortion is complete
Misoprostol: It is available in tablet form and given by mouth or can be inserted vaginally. Two
tablets of Mifepristone is given followed 24 hrs later by an oral or vaginal dose of misoprostol. The
uterus will contract causing cramping followed by the expulsion of the fetus. The cramps and the
bleeding will stop after the products have been expelled
Others: Drugs like urea,hypertonic saline,glucose which are introduced into the pregnant sac have
all been done away with in favour of the above mentioned methods.
Risks
Needs to be in a hospital upto 3 days
Infection.
Increased bleeding.
Retained products, which may need surgical evacuation.
Aspirotomy.
Hysterotomy.
Hysterectomy.
Aspirotomy:
Aspirotomy is a procedure similar to what is done in first trimester. This method can be employed between
13-20 week of pregnancy. To help in dilatation of the cervix prostaglandins may be used.
Hysterotomy:
Hysterotomy is a major operating procedure where the abdomen is opened. In a hysterotomy the uterus is
opened and the contents of the uterus removed directly under vision. This is like a cesarean.
Hysterectomy.
In a hysterectomy, the uterus along with the pregnancy is removed in toto. At times hysterotomy or
hysterectomy may be necessary because of a failure of a medical induction during the second trimester.
In the second trimester of pregnancy, the procedure followed is by the medical methods rather than by the
surgical methods. This is because the risks and the convenience of the medical methods are far less than
surgical termination.
An early diagnosis of pregnancy with early termination is safer than in the second trimester.
Counselling
Counselling is normally done by the attending Obstetrician.The aim of counselling is to help her come to a
decision as to the need of continuation or termination of the pregnancy and to resolve it in the direction
that she chooses.
The purpose of counselling is;
To allay the anxiety of the person who intends to under-go the procedure.