Session-VI

Post Conception Methods in Family Planning

Introduction:
A method used to prevent pregnancy after unprotected sexual intercourse, is a highly effective but underutilized birth
control option.

Types:
1. Menstrual regulation
2. Menstrual induction
3. Abortion

1. Menstrual Regulation:
A relatively simple method of birth control is menstrual regulation. It consists of aspiration of the uterine contents 6
to 14 days of missed periods. Cervical dilatation is indicated only in nulliparous and apprehensive subjects.

Immediate complications:
Uterine perforation and trauma
Late Complication:
Tendency to abortion or premature labour, infertility, menstrual disorders, increased in ectopic pregnancies and Rh
incompatibility.
Menstrual regulation is differs from abortion in 3 respects;
a) Lack of certainty
b) Lack of legal restrictions
c) Increased safety of early procedure.

2. Menstrual Induction:

This method is based on disturbing the normal progesterone-prostaglandin balance by intra uterine application of 1-
5 mg solution of prostaglandin F2.
Within few minutes of the prostaglandin impact, performed under sedation, the uterus responds with a sustained
contraction lasting about 7 minutes followed by cyclic contractions continuing for 3-4 hours.
The bleeding starts and continuous for7-8 days.

3. Oral Abortifacient:
Mifepristone (RU486) in combination with misoprostol is 95% successful in terminating pregnancies of upto 9 weeks
duration with minimum complication.
 Common used regimen is dose of mifepristone 600mg on day one, followed by misoprostol 800mcg
vaginally either immediately or within 6-8 hours.
 Commercially it comes as MTP kit having combination of mifepristone 200mg (One tablet)+ misoprostol
200 mcg 4 tablets(800mcg)
 Other regimen is dose of mifepristoneb600 mg (day one) followed by 400mcg orally of misoprostol(on day
3)
Note:
 Patient should return for a follow up visit approximately 14 days after the administration of
mifepristone to confirm by clinical examination or USG that a complete termination of pregnancy has
occurred.
 Contraindication:
 History of allergy or known hypersensitivity
 Confirmed or suspected ectopic pregnancy
 IUD in place
 Chronic adrenal disease
 Haemorrhagic disorder
 Inherited porphyria
 If a patient does not have adequate access to medical facilities equipped to provide emergency treatment of
abortion and blood transfusion.

Abortion:
Abortion is theoretically defined as termination of pregnancy before the foetus becomes viable (capable of
living independently).This has been fixed administratively at 28 weeks, when the foetus weighs approximately
1000g. including birth control.

Legalization of Abortion:

The Medical Termination of pregnancy Act of is a health care measure which helps to reduce maternal
morbidity and mortality resulting from illegal abortions. It also affords an opportunity for motivating such women
to adopt some forms of contraception.

The Medical Termination of pregnancy Act 1971

The medical termination of pregnancy Act 1971 lays down;

1. The condition under which a pregnancy can be terminated,
2. The person or persons who can perform such termination, and
3. The place where such terminations can be performed.

The conditions under which a pregnancy can be terminated under the MTP Act.1971:
a) Medical
b) Eugenic
c) Humanitarian
d) Socio-economic
e) Failure of contraceptive devices

The person or persons who can perform such termination:

The act provides safeguards to the mother by authorizing only a registered medical practitioner having experience in
gynaecology and obstetrics to perform and the length of the pregnancy does not exceed 12 weeks, and if pregnancy
exceeds 20weeks the opinion of two registered medical practitioners is necessary to terminate the pregnancy.

Where abortion can be done:

The act stipulates that no termination of pregnancy shall be made at any place other than a hospital established or
maintained by government or a place approved for the purpose of this act by government. abortion services are
provided in strict confidence.