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Medical Termination Of Pregnancy (Mtp)

  1. Medical method for first trimester MTP
    It is now officially allowed in India up to 9 weeks (63 days) of gestation.
    Method: combination of RU486 followed by PGE1.

Mifepristone, also known as RU-486, is an anti-progesterone compound

  1. It acts preferentially on target cells of the endometrium and deciduas, counteracting the effect of progesterone, which is essential for establishment and maintenance of pregnancy.
  2. It affects the pituitary gonadotropic cells, producing a remarkable decrease of LH secretion, leading to luteolysis.
  3. It causes softening and ripening of the cervix and produces increased contractibility of the myometrium.
  4. It causes a marked increase in sensitivity of the uterus to exogenous PGs.

Misoprostol (PGE1)


It acts by (a) enhancing uterine contraction and thus helping expulsion of the products of contraception and (b) causing cervical ripening or priming. It IS used orally as tablets and vaginally as a suppository. Success rate of this combination is 96%.


Fewer than 5% of women undergoing medical methods of abortion will need surgical intervention (check curettage) for incomplete abortion.

For the medical abortion up to 9 completed weeks since last menstrual period, mifepristone plus PGs are used; the dosage regimens recommended by World Health Organization are as follows:


200 mg mifepristone followed after 36-48 h by:

  1. 800μg vaginal misoprostol
  2. 400μg oral misoprostol

Contraindications (due to medical reasons) for medical method of abortion:

  1. Smoking> 35 years
  2. Hemoglobin < 8 g%
  3. Confirmed/ suspected ectopic pregnancy/ undiagnosed adnexal mass
  4. Coagulopathy or patient on anticoagulant therapy
  5. Chronic adrenal failure or current use of systemic corticosteroids
  6. Uncontrolled hypertension with BP >160/100mmHg
  7. Certain cardio-vascular diseases
  8. Severe renal, hepatic or respiratory diseases
  9. Glaucoma
  10. Uncontrolled seizure disorder
  11. Allergy or intolerance to mifepristone /misoprostol or other prostaglandins
  12. Lack of access to 24 hours emergency services.
  1. Surgical Technique (Suction Evacuation/Manual Vacuum Evacuation)
    It is allowed up to 12 weeks of gestation.

Complications of MTP

  1. Uterine hemorrhage: It occurs in 1-4% cases.
  2. Pelvic infection: It ranges from 0.1 % to 1.5%. It is due to incomplete evacuation and improper aseptic technique.
  3. The incidence can be reduced to a great extent by prophylactic use of antibiotic.
  4. Cervical injury: This complication occurs in 0.01-1 % cases.
  5. Uterine perforation: This is the most dangerous complication, but fortunately it happens very rarely in 0.1- 0.28% cases.

When perforation occurs or is suspected, the patient should be kept under observation and antibiotic should be started. Usually she can be discharged in 24 h time. If there is strong suspicion or actual diagnosis of injury to the intestines or omentum, or if hemorrhage occurs, laparotomy should be performed followed by necessary steps.


Retained products: Incomplete abortion happens in 24% cases.


Continuation of pregnancy: In about 1 % cases.

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