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  1. Introduction
    The MTP Act refers to the Medical Termination of Pregnancy Act which was passed by Parliament in 1971.Under this Act, the considerations for termination of pregnancy include:
    1. Therapeutic when the continuation of the pregnancy endangers the life of the woman
    2. Eugenic when there is a risk of the child being born with serious physical or mental handicap.
    3. Humanitarian when pregnancy has been caused by rape.
    4. Social when pregnancy has resulted from contraceptive failure or there is a risk to the other due to environmental conditions.​
Pregnancy can only be terminated by a qualified registered medical practitioner possessing prescribed experience after obtaining written consent from the woman. If the period of pregnancy is between 12-20 weeks two doctors must concur that there is an indication. The law does not permit MTP beyond 20 weeks.

Hospitals approved/maintained by Govt.
  1. MTP Rules & Regulations 2003
    The MTP rules of 1975 have been repealed by these rules of 2003 which states the following:
    1. A committee should be constituted at the district level comprising of 1 gynaecologist / surgeon/ anaesthetist, and a person from local medical professional body, NGOs, PRI & one of them should be a women.
    2. Person who can carry out MTP should be having experience of 3 years in Obs & gynae or who has obtained PG degree or diploma in Obs & gynae or who has completed 6 months residency in gynae. Such person can carry out MTP upto 20 wks.
    3. Any person who has assisted a RMP in performance of 25 cases of MTP of which at least 5 have been performed independently in a hospt established or maintained or a training institute approved for the purpose by the Govt can perform MTP upto 12 wks.
    4. Approval of the place where MTP can be carried out must be given by the Committee on recommendation of the CMO of the district after inspection. Certificate of approval can be cancelled or suspended any time by the Committee if the facilities are found to be inadequate at any stage. The owner can apply for the review of the order within a period of 60 days.
    5. In the case of termination of early pregnancy upto 7 wks using RU 486 with Misoprostol can be prescribed by the RMP at his clinic provided such an RMP has access to a place approved for MTP if such a need arises.
  2. Important Points
    1. Conventional contraceptives
      Contraceptives needing action at or just prior to the intercourse are called conventional contraceptives. Physical and chemical barrier contraceptives generally belong to this category.
    2. Equivalent Sterilization
      This is an index of overall family planning performance calculated by adding the number of sterilizations performed over a period of time, one third the number of IUD insertions, one eighteenth the number of conventional contraceptive users and one ninth the number of oral contraceptive users. These weights are derived from an assessment of the number of births averted by different contraceptive methods in India.
    3. Crude Birth rate defined
      Crude birth rate refers to the number of live births which occurred in the population of a given geographic area during a given year among the mid-year total population of the same area during the same period. It is expressed as per 1000 population. The crude birth rate in India is 25 per 1000 population.
    4. Sex ratio
      The number of females per 1000 males is called the sex ratio. Biologically, female of the species is stronger and has a higher life expectancy and therefore there should be more females per 1000 males. In India the sex ratio is 940 females per 1000 males which is an adverse sex ratio and indicates discrimination agonist women.
    5. IMR.
      It is defined as the number of infant deaths (0-12 months) per 1000 live births in a country. It is a sensitive indicator of the level of health services in a country.
The common causes of IMR in India are
  1. Low birth weight         – Acute respiratory infections
  2. Diarrheal dehydration – Early weaning and lack of breastfeeding
  3. Congenital anomalies  – Birth injury
  4. Prematurity
  1. < 5 Mortality Rate defined
    The total number of deaths among children less than 60 months of age per 1000 live births is defined as Under Five Mortality Rate.
  2. Neonatal Mortality Rate
    This is defined as the number of deaths less than 28 days of age per 1000 live births. Most of these deaths occur due to prenatal or natal causes.
  3. Perinatal Mortality Rate
    This is defined as deaths of fetus after 28 weeks of gestation till the first 7 days of post natal life per 1000 live births.
  4. Low birth weight
    Low birth weight is defined as a baby weighing less than 2500 grams at birth. In India the Indian Academy of Pediatrics has suggested at infants born with weight less than 2000 grams should be considered as low birth weight because Indian babies are smaller. However, for all international comparisons weight less than 2500 grams is considered as low birth weight.
  5. Maternal mortality (AIIMS May’08)
    The causes of maternal mortality can be categorized as follows:

A.  Obstetric causes: These account for more than 50% of deaths

i.   Puerperal sepsis


– Hemorrhage

ii.  Rupture of uterus

– Accidents during labor


B.  Non-obstetric causes

i.   Anemia

– Heart Disease

– Kidney disease

ii.  Malignancies

– Hypertension

– Diabetes

iii. Jaundice

– TB

– Accidents ,etc.

C.  Social causes

i.   Early marriage

– Early childbirth

– Large no. of pregnancies

ii.  Frequent pregnancies

– Malnutrition

– Poverty

iii.  Illiteracy, etc.

  1. High risk pregnancy
    1. A high risk pregnancy is one where the mother suffers from causes which are detrimental to her health or the fetal health. Some of these important factors are:
      1. Age over 35 years
      2. Elderly primi
      3. More than 5 previous pregnancies
      4. History of past stillbirths
      5. History of neonatal deaths
      6. Previous Caesarian section
      7. Hemorrhage
      8. Placenta previa
      9. Short stature – below 140 cms
      10. Young primi - < 16 years
      11. PET
      12. Systemic diseases – Hypertension, RHD, Diabetes, Renal disease, etc.
      13. TB
    2. Pearl Index (AIIMS Nov’08)
      1. Failure rate / 100 women year
      2. Contraceptive effectiveness

        Total accidental pregnancy
        ------------------------------     X 1200
        Total months of exposure

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