AIM

MTP

Certificate of Authenticity
 th
This is to certify that SARATH DEKKAPATI a student of class12 has
successfully completed the research product on the topic
“MTP”underthe guidance of sir RANJITH KUMAR.V

This project is absolutely genuine and does not indulge in plagiarism

of any kind. This reference taken in making this project has been
declared at the end of this project.

Signature {subject teacher} Signature {examiner}

 Acknowledgement

I feel proud to present my investigatory project in Biology on the “MTP”

This project would not have been feasible without the proper rigorous
guidance of biology teacher Ranjith kumar sir who guided me throughout
this project in every possible way. An investigatory project involves various
difficult lab experiments, which have to obtain the observations and
conclude the reports on a meaningful note. There by, I would like to thanks
Ranjithkumar sir for guiding me on a systematic basis and ensuring that
incompleted all my research with ease. Rigorous hardwork has put in this
project to ensure that it proves to be the best. I hope that it proves to be
the best. I hope that this project will prove to be a breeding ground for the
next generation of students and will guide them in every possible way .
 Introduction
Abortion is the ending of pregnancy by removing a fetus or embryo from
the womb before it can survive on its own. An abortion which occurs
spontaneously is also known as a miscarriage. An abortion may be caused
purposely and is then called an induced abortion, or less frequently,
"induced miscarriage". The word abortion is often used to mean only
induced abortions. A similar procedure after the fetus could potentially
survive outside the womb is known as a "late termination of
pregnancy","postviabilityabortion","late-term abortion", "later-term
abortion", or simply "abortion".

Modern methods use medication or surgery for abortions. The drugs

mifepristone and prostaglandin are as good as surgery during the first
trimester. While medical methods may work in the second trimester,
surgery has lower risk of side effects. Birth control, such as the pill or
intrauterine devices, can be started at once after an abortion. When
allowed by local law abortion in the developed world is and has long been
one of the safest procedures in medicine. Uncomplicated abortions do not
cause any long term mental or physical problems. The World Health
Organization recommends safe and legal abortions be available to all
women.Every year unsafe abortions cause 47,000 deaths and 5 million
hospital admissions.

Around 44 million abortions occur each year in the world, with a little
under half done unsafely. Abortion rates have changed little between 2003
and 2008, before which they decreased for decades due to better education
about family planning and birth control. As of 2008, 40% of the world's
women had access to legal abortions without limits as to reason. However,
different governments have different limits on how late in pregnancy
abortion is allowed.

Since ancient times abortions have been done using herbal medicines,
sharp tools, with force, or through other traditional methods. Abortion
laws and cultural or religious views of abortions are different around the
world. In some areas abortion is legal only in special cases such as rape,
problems with the fetus, poverty, risk to a woman's health, or incest. In
many places there is much debate over the moral, ethical, and legal issues
of abortion. Those who are against abortion largely claim that an embryo or
fetus is a human with a right to life and may compare it to murder.
Supporters point to a woman's right to decide over her own body and to
human rights in general.
 History
Induced abortion has long history, and can be traced back to civilizations as
varied as China under Shennong (c. 2700 BCE), Ancient Egypt with its
Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal
(c. 200 CE). There is evidence to suggest that pregnancies were terminated
through a number of methods, including the administration of abortifacient
herbs, the use of sharpened implements, the application of abdominal
pressure, and other techniques. One of the earliest known artistic
representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found
in a series of friezes that represent judgment after death in Hindu and
Buddhist culture, it depicts the technique of abdominal abortion.

Some medical scholars and abortion opponents have suggested that the
Hippocratic Oath forbade Ancient Greek physicians from performing
abortions; other scholars disagree with this interpretation, and state the
medical texts of Hippocratic Corpus contain descriptions of abortive
techniques right alongside the Oath. The physician ScriboniusLargus wrote
in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus,
although apparently not all doctors adhered to it strictly at the time.
According to Soranus' 1st or 2nd century CE work Gynaecology, one party
of medical practitioners banished all abortives as required by the
Hippocratic Oath; the other party —to which he belonged— was willing to
prescribe abortions, but only for the sake of the mother's health.
Aristotle, in his treatise on government Politics (350 BCE), condemns
infanticide as a means of population control. He preferred abortion in such
cases, with the restriction "[that it] must be practised on it before it has
developed sensation and life; for the line between lawful and unlawful
abortion will be marked by the fact of having sensation and being alive." In
Christianity, Pope Sixtus V (1585–90) was the first Pope to declare that
abortion is homicide regardless of the stage of pregnancy; the Catholic
Church had previously been divided on whether it believed that abortion
was murder, and did not begin vigorously opposing abortion until the 19th
century. Islamic tradition has traditionally permitted abortion until a point
in time when Muslims believe the soul enters the fetus, considered by
various theologians to be at conception, 40 days after conception, 120 days
after conception, or quickening. However, abortion is largely heavily
restricted or forbidden in areas of high Islamic faith such as the Middle East
and North Africa.

In Europe and North America, abortion techniques advanced starting in the

17th century. However, conservatism by most physicians with regards to
sexual matters prevented the wide expansion of safe abortion techniques.
Other medical practitioners in addition to some physicians advertised their
services, and they were not widely regulated until the 19th century, when
the practice was banned in both the United States and the United Kingdom.
Church groups as well as physicians were highly influential in anti-abortion
movements. In the US, abortion was more dangerous than childbirth until
about 1930 when incremental improvements in abortion procedures
relative to childbirth made abortion safer. The Soviet Union (1919), Iceland
(1935) and Sweden (1938) were among the first countries to legalize
certain or all forms of abortion. In 1935 Nazi Germany, a law was passed
permitting abortions for those deemed "hereditarily ill", while women
considered of German stock were specifically prohibited from having
abortions. Beginning in the second half of the twentieth century, abortion
was legalized in a greater number of countries. A bill passed by the state
legislature of New York legalizing abortion was signed by Governor Nelson
Rockefeller in April 1970.
 (Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion
by pounding the abdomen of a pregnant woman with a pestle.)

Types Of Abortions
There are 2 kinds of induced abortions: surgical and chemical.

Surgical Abortion Procedures

1. Manual Vacuum Aspiration:within 7 weeks after last menstrual period

Dilators (metal rods) are used to stretch the cervical muscle until the
opening is wide enough for abortion instruments to pass through the
uterus. A hand-held syringe is attached to tubing, which is inserted into the
uterus. The fetus is suctioned out.
2. Suction Curettage:after 14 weeks from the last menstrual period

The abortionist uses a dilator or laminaria to open the cervix. Laminaria

are thin sticks from a kelp species that are inserted hours before the
procedure and allowed to slowly absorb water and expand, thereby
dilating the cervix. Once the cervix is dilated, the abortionist inserts tubing
into the uterus and attaches the tubing to a suction machine. Suction pulls
apart the fetus’ body and out the uterus. After suction, the doctor and
nurses must reassemble the fetus’ dismembered parts to ensure they have
all the pieces.

3. D & C (Dilation and Curettage):within first 12 weeks

The cervix is dilated. A suction device is placed in the uterine cavity to

remove the fetus and placenta. Then the abortionist inserts a curette (a
loop-shaped knife) into the uterus. The abortionist uses the curette to
scrape any remaining fetal parts and the placenta out of the uterus.

4. D & E (Dilation and Evacuation):within 13-24 weeks after last

menstrual period

The fetus literally doubles in size between the 11th and 12th weeks of
pregnancy. Soft cartilage hardens into bone at 16 weeks, making the fetus
too large and strong to pass through a suction tube. The D & E procedure
begins by inserting laminaria a day or two before the abortion, opening the
cervix wide to accommodate the larger fetal size. The abortionist then both
tears and cuts the fetus and uses the vacuum machine to extract its
remains. Because the skull is too large to be suctioned through the tube, it
must be crushed by forceps for removal. Pieces must be extracted very
carefully because the jagged, sharp pieces of the broken skull could easily
cut the cervix.

5. Saline:after 15 weeks of pregnancy

This procedure is conducted in the same manner as amniocentesis (a
prenatal test used to diagnose a fetus’ potential chromosomal
abnormalities). A long needle is inserted into the woman’s abdomen,
directly into the amniotic sac. It is at this point that a saline abortion and
amniocentesis differ. In a saline abortion, amniotic fluid is removed from
the woman and replaced by a strong saline (salt) solution. As the fetus’
lungs absorb the salt solution, it begins to suffocate. It may struggle and
may even have convulsions. The saline also burns off the fetus’ outer layer
of skin. Saline abortion can take one to six hours before the fetus is no
longer viable. The woman begins labor after approximately 12 hours, and
she may take up to 24 hours to deliver. Because the procedure is often
quite long, many times the woman is left to labor alone.

6. Prostaglandin:after 15 weeks of pregnancy

This procedure is conducted in the same manner as a saline abortion,

except prostaglandin (a hormone that causes the woman to start labor)
replaces saline. Prostaglandin activates contractions. It can cause overly
painful or intense labor; there have been cases in which the violence of the
contractions ruptured the mother’s uterus.1 This type of abortion is not
preferred by abortionists because there is a 40% higher chance of a live
birth.

7. Hysterotomy:after 18 weeks

This procedure is the same as a cesarean section (in which the doctor cuts
through the abdomen and uterus to deliver the baby), except that in a
hysterotomy, no medical attention is given to the baby upon delivery to
help it survive. Most often, a wet towel is placed over the baby’s face so it
can’t breathe. Sometimes the baby placed in a bucket of water. The goal is
to have a baby that won’t survive.

8. D & X (Dilation and Extraction):from 20 weeks after last menstrual

period to full term. Also called “partial birth abortion.”
This procedure takes three days. During the first two days, the woman’s
cervix is dilated. She is given medication for cramping. On the third day, she
receives medication to induce labor. As the woman labors, the abortionist
uses an ultrasound to locate the baby’s legs. The abortionist then grasps a
leg with forceps and delivers the baby up to its head. Next, using a scissors,
the abortionist creates an opening in the base of the baby’s skull. A suction
catheter is inserted into the skull opening, and the baby’s brains are
suctioned out. The skull collapses, and the rest of the baby’s body is
delivered through the birth canal.

Chemical Abortion Options

1. RU-486 (Mifepristone):within 4-7 weeks of the last menstrual period.

Also called “the abortion pill.”

This drug interferes with levels of progesterone, a hormone that keeps the
fetus implanted in the wall of the uterus. The woman is prescribed
progesterone and then returns to the clinic two days later to receive a
prostaglandin drug that induces labor and expels the dead fetus. A third
visit may be required if the baby is not expelled, at which time a woman has
a 5-8% likelihood of needing a surgical abortion to complete the process.
RU-486 is documented to be unsafe for women.2

2. Methotrexate and Misoprostol

Methotrexate is used for treatment of cancer, and Misoprostol is used for

ulcer treatment. In a chemical abortion, these two drugs are used in
combination. Methotrexate causes cells in the placenta (the organ that
nourishes the fetus) to die. Misoprostol empties the fetus from the uterus
by causing the uterus to contract and push the fetus out. Methotrexate is a
drug used in chemotherapy and has the potential for serious liver toxicity.

3. “Morning After” Pill:sometimes used in rape cases

Up to 72 hours after intercourse, a woman is administered large doses of
birth control pills (or levonorgestrel, also known as Plan B) to prevent the
embryo from implanting in the uterus wall. Twelve hours after the first
dose, a second dose is given. Large doses of birth control pills work to
prevent ovulation and hinder sperm motility.
 The Indian MTP Act
To avoid the misuse of induced abortions, most countries have enacted
laws whereby only qualified Gynecologists under conditions laid down and
done in clinics/hospitals that have been approved can do abortions. The
Medical Termination of Pregnancy Act was enacted by the Indian
Parliament in 1971 and came into force from 01 April, 1972. The MTP act
was again revised in 1975.

The MTP Act lays down the condition under which a pregnancy can be
terminated, the persons and the place to perform it.

The reasons for which MTP is done, as interpreted from the Indian MTP
Act, are:

(i) Where a pregnant woman has a serious medical disease and

continuation of pregnancy could endanger her life like:

 Heart diseases.
 Severe rise in blood pressure.
 Uncontrolled vomiting during pregnancy
 Cervical/ breast cancer.
 Diabetes mellitus with eye complication (retinopathy).
 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.
 Rubella (German measles) viral infection to mother in first three
months.
 If previous children have congenital abnormalities.
 Rh iso-immunisation. link
 Exposure of the foetus to irradiation.

(iii) Pregnancy resulting of rape.

(iv) Conditions where the socio-economic status of the mother (family)

hampers the progress of a healthy pregnancy and the birth of a healthy
child.

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. Husband’s 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.

Person or persons who can perform MTP

  Physicians qualified to do MTP are:
 Any qualified registered medical practitioner who has assisted in 25
MTPs.
 A house surgeon who has done six months post in Obstetrics and
Gynecology.
 A person who has a diploma /degree in Obstetrics and Gynecology.
 3 years of practice in Obstetrics and Gynecology for those doctors
registered before the 1971 MTP Act was passed.
 1 year of practice in Obstetrics and Gynecology for those doctors
registered on or after the date of commencement of the Act.
 Whenever the pregnancy exceeds 12 weeks but is below 20 weeks
opinion of two registered medical practitioners is necessary.

Place where MTP can be performed:

Any institutions licensed by the Government to perform MTP. The
certificate issued by the Government should be conspicuously displayed at
a place easily visible to persons visiting the place.

Methods of Induced Abortion:

Abortion can be induced by different methods depending on the weeks of

pregnancy completed.

Tests to be done:

 A thorough medical examination including blood pressure and

weight
 An internal examination to confirm the duration of pregnancy.
 Urine test for confirmation of pregnancy.
 Routine urine analysis.
 Routine blood counts including hemoglobin estimation.
 Blood group and Rh factor.
 At times, an ultrasound may be required.
Bibliography
- www.google.com
- www.embibe.com
- www.ncert.com
- Ncert text book