{"id":640,"date":"2020-02-17T20:37:53","date_gmt":"2020-02-17T15:07:53","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=640"},"modified":"2020-02-17T20:37:53","modified_gmt":"2020-02-17T15:07:53","slug":"medical-termination-of-pregnancy","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/medical-termination-of-pregnancy\/","title":{"rendered":"Medical Termination of Pregnancy"},"content":{"rendered":"\n<p><strong>Medical Termination of Pregnancy<\/strong><\/p>\n\n\n\n<p>MTP Act 1971 and 2002 amendment<\/p>\n\n\n\n<p><strong>Legal abortions :<\/strong><\/p>\n\n\n\n<ul><li>Termination done for conditions and within the gestation prescribed by the Act with the consent of women.<\/li><li>Termination done by a medical practitioner approved by the Act.<\/li><li>Termination done at a place approved under the Act.<\/li><li>Gestational age \u00e0 Up to 20 weeks of gestation, with the consent of the woman,<\/li><li>If the woman is below 18 years or is mentally ill, then with consent of a guardian.<\/li><li>The opinion of a RMP has been formed in good faith, under certain circumstances.<\/li><li>Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks<\/li><\/ul>\n\n\n\n<p><strong>Indications :<\/strong><\/p>\n\n\n\n<ul><li>Risk to the life or grave injury to the physical or mental health of woman<\/li><li>Substantial risk of physical or mental abnormalities in the fetus.<\/li><li>Pregnancy caused by rape (presumed grave injury to mental health)<\/li><li>Contraceptive failure in married couple (presumed grave injury to mental health)<\/li><\/ul>\n\n\n\n<p><strong>Contraindications<\/strong><\/p>\n\n\n\n<ul><li>suspected ectopic pregnancy,<\/li><li>intrauterine device in place,<\/li><li>anemia, some hemorrhagic disorders,<\/li><li>anticoagulant therapy,<\/li><li>chronic adrenal failure, long-term corticosteroid therapy, inherited porphyrias, and inability to comply with the regimen or lack of access to emergency care in the case of a complication<\/li><\/ul>\n\n\n\n<p><strong>Medications used for first-trimester medication abortion<\/strong><\/p>\n\n\n\n<p><strong>Mifepristone<\/strong> \u2014<\/p>\n\n\n\n<ul><li>The progesterone receptor antagonist<\/li><li>was approved by the US Food and Drug Administration (FDA) in 2001 as a 600 mg dose, but 200 mg is now commonly used.<\/li><li>A meta-analysis of four randomized trials demonstrated 200 mg is equally effective for pregnancy termination as the originally approved 600 mg dose<\/li><li>results in some <strong>softening and dilation of the cervix.<\/strong><\/li><li>Mifepristone&#8217;s primary effect in mifepristone-misoprostol medication abortion is to <strong>increase the sensitivity of the uterine and cervical muscle to the effect of misoprostol, r<\/strong>esulting in greater success in pregnancy expulsion as compared with misoprostol alone<\/li><\/ul>\n\n\n\n<p><strong>Misoprostol \u2014<\/strong><\/p>\n\n\n\n<ul><li>a synthetic prostaglandin E1<\/li><li>widely available and can be stored at room temperature, making it an ideal prostaglandin complement to mifepristone for first-trimester medication abortion.<\/li><li>Misoprostol is the <strong>sole prostaglandin approved by the FDA for use for medication abortion<\/strong>, and the FDA requires that misoprostol be used in conjunction with mifepristone for medication abortion.<\/li><li>Misoprostol given alone, whether by the vaginal or the buccal route, is less effective than when given in combination with mifepristone<\/li><\/ul>\n\n\n\n<p><strong>Methotrexate-based regimens<\/strong> \u2014<\/p>\n\n\n\n<ul><li>Prior to FDA approval of mifepristone, methotrexate (50 mg\/m2) followed by vaginal misoprostol (800 mcg) three to seven days later was used for medication abortion.<\/li><li>However, a methotrexate\/misoprostol regimen is less effective and requires a longer time to complete abortion compared with mifepristone\/misoprostol.<\/li><li>Another disadvantage to the methotrexate regimen is the prolonged interval from treatment to complete abortion associated with this regimen.<\/li><\/ul>\n\n\n\n<ul><li><strong>The two drugs approved for use in India are Mifepristone and Misoprostol. <\/strong><strong><\/strong><\/li><\/ul>\n\n\n\n<ul><li><strong>In India, use of these drugs (Mifepristone and Misoprostol) for termination of pregnancy is approved up to <u>nine weeks.<\/u>&nbsp;<\/strong><strong><\/strong><\/li><\/ul>\n\n\n\n<p><strong>First-trimester medication abortion<\/strong><\/p>\n\n\n\n<ul><li>method of pregnancy termination with use of medications rather than a surgical procedure.\u00a0<\/li><li>Mifepristone\u00a0(a progesterone antagonist), in combination with\u00a0misoprostol\u00a0(a synthetic prostaglandin E1), is approved for this use<\/li><li>Medication abortion and aspiration abortion in the first trimester are both safe and effective procedures for appropriately selected patients.<\/li><li>The choice between medication abortion and aspiration is based upon gestational age, availability, and patient preference.<\/li><li>For women undergoing abortion at &lt;63 days of gestation, medication abortion for women who place value on avoiding surgery or anesthesia and who are willing to accept more discomfort and awareness of the procedure<\/li><li>Women who place a high value on completing the procedure in one visit are more likely to choose aspiration abortion.<\/li><li>\u00a0<\/li><li>The steps of the procedure include<\/li><li>Initial visit and\u00a0mifepristone\u00a0administration \u2013<ul><li>This outpatient visit includes confirmation of pregnancy and<\/li><\/ul><ul><li>medication abortion eligibility,<\/li><\/ul><ul><li>counseling about options and informed consent, and<\/li><\/ul><ul><li>blood typing (and administration of Rh\u00a0immune globulin\u00a0if needed).<\/li><\/ul><ul><li>A <strong>single dose of mifepristone (oral, 200 mg) is administered.<\/strong><\/li><\/ul><\/li><li><strong>Misoprostol\u00a0self-administration<\/strong> \u2013<ul><li>Misoprostol 800 mcg is given to the patient to be self-administered buccally or vaginally at home 24 to 48 hours after taking\u00a0mifepristone.<\/li><\/ul><\/li><li><strong>Follow-up<\/strong> \u2013 Final follow-up to confirm complete abortion is conducted <strong>within two weeks<\/strong><\/li><li>Complete abortion is confirmed by measurement of human chorionic gonadotropin or by transvaginal ultrasound<\/li><li>For women undergoing first-trimester medication abortion, we recommend buccal or vaginal administration of\u00a0misoprostol\u00a0rather than other routes \u00e0 Oral administration of misoprostol is a reasonable option for women at \u226449 days of gestation.<\/li><li>Failed medication abortion is treated with repeat\u00a0misoprostol\u00a0or surgical uterine evacuation.<\/li><li>Side effects following administration of\u00a0mifepristone\u00a0and\u00a0misoprostol\u00a0primarily consist of<ul><li>nausea, crampy abdominal pain, vaginal bleeding, and gastrointestinal discomfort. Potential complications include hemorrhage, infection, incomplete abortion, or unrecognized ectopic pregnancy.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Second-trimester induction abortion<\/strong><\/p>\n\n\n\n<ul><li>Current protocols for second-trimester induction abortion typically include a prostaglandin, usually\u00a0<strong>misoprostol<\/strong>, and may utilize\u00a0<strong>mifepristone\u00a0or\u00a0oxytocin.<\/strong><\/li><li>Prior protocols that <strong>used hypertonic saline have been largely abandoned<\/strong> due to risks such as hypernatremia, coagulopathy, and hemorrhage.<\/li><\/ul>\n\n\n\n<p><strong>ACOG recommends the following protocols for second-trimester induction abortion&nbsp;<\/strong><strong><\/strong><\/p>\n\n\n\n<p>An example of a protocol is\u00a0mifepristone, 200 mg, administered orally followed by either:<\/p>\n\n\n\n<p>\u2022Misoprostol, 800 mcg, administered vaginally, followed by 400 mcg administered vaginally or sublingually every three hours for up to a maximum of five doses.<\/p>\n\n\n\n<p><strong>OR<\/strong><\/p>\n\n\n\n<p>\u2022Misoprostol, 400 mcg, administered buccally every three hours for up to a maximum of five doses also may be used.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Medical Termination of Pregnancy MTP Act 1971 and 2002 amendment Legal abortions : Termination done for conditions and within the gestation prescribed by the Act with the consent of women. Termination done by a medical practitioner approved by the Act. Termination done at a place approved under the Act. Gestational age \u00e0 Up to 20[&#8230;]\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/640"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=640"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/640\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=640"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=640"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=640"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}