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Induced – Abortion

  1. Upto POG 20 weeks
  2. Done by Gynecologist / who has done 25 MTPS under supervision / who has 6 months experience in OBS & GYNAE.
    (Period of viability in India is > 28 weeks POG, weight >500gms)



Methods of Medical Termination of Pregnancy


First Trimester (Up to 12 Weeks)

Second Trimester (13-20 Weeks)


1. Mifepristone

2. Mifepristone and Misoprostol (PGE1)

3. Methotrexate and Misoprostol

4. Tamoxifen and Misoprostol


1. Menstrual regulation

2. Vacuum Aspiration (MVAIEVA)

3. Suction evacuation and/or curettage

4. Dilatation and evacuation:

 - Rapid method

 - Slow method

1. Prostaglandins PGE1 (Misoprostol), 15 methyl PGF2α (Carboprost), PGE2 (Dinoprostone) and their analogues (used-intravaginally, intramuscularly or intra-amniotically)

2. Dilation and evacuation (13-14 weeks)

3. Intrauterine instillation of hyperosmotic solutions

a. Intra-amniotic hypertonic urea (40%), saline (20%)

b. Extra-amniotic-Ethacrydine lactate, Prostaglandins (PGE2, PGF2α)

4. Oxytocin infusion high dose used along with either of the above two methods

5. • Hysterotomy (abdominal) -- less commonly done

Extra Edge:


Menstrual regulation – within 42 days of LMP (6 mm Karman canula attached with 50ml syringe)


Suction evacuation / MVA – Upto 12 weeks of gestation (pressure required is 60-70 cms of Hg)


End point:

  1. no more material sucked out.
  2. Gripping of cannula
  3. Grating sensation
  4. Appearance of bubbles in cannula

Intrauterine instillation of hyperosmotic solutions – Done after 16 weeks gestation.


Prostaglandins – Method of choice for MTP in second trimester (after 12 weeks)

Medical Abortion

FDA approved protocol


- 600mg of Mife on day 1 followed by 400 μg of Miso on day 3.


- Effective upto 49 days

Recent protocol


- 200mg of Mife on day 1 followed by 800 μg of Miso on day 3.


- Effective upto 63 days

Role of Mif

  1. Mife blocks progesterone receptors in the endometrium which leads to disruption of the embryo, production of prostaglandins and a decrease in HCG levels.
  2. The success rate is dependent on the length of pregnancy – the more dependant the pregnancy is on progesterone from the corpus luteum, the more likely that the progesterone antagonist, mife will result in abortion.
  3. The production of prostaglandins leads to softening of the cervix as well.

Septic abortion


It is any abortion associated with clinical evidences of infection of the uterus and its contents is called Septic abortion.

Criteria for Septic abortion:

  1. Abortion is considered septic when:
  2. Rise of temperature is at least 100.4 degree F for 24 hours or more.
  3. Presence of offensive or purulent vaginal discharge.
  4. Presence of other evidence of pelvic infection such as lower abdominal pain and tenderness.
  5. In majority of the cases the infection occurs following illegal induced abortion but may occur following spontaneous abortion.
  6. Infection is polymicrobial from the normal flora of genital tract and is due to gram positive, gram negative and anaerobic pathogens.
  7. Patients will present with fever, abdominal pain, purulent offensive vaginal discharge and vomiting.

On per vaginal examination:

  1. Offensive purulent discharge present.
  2. Cervix feels soft with an open os.
  3. Fornices are tender.
  4. Uterus is tender.
  5. In case a pelvic abscess is formed, a soft boggy mass may be felt (in addition to spiky rise in temperature and mucus diarrhea).
  6. There may be signs of uterine perforation or bowel injury.


  1. Uterine infection i.e. endomyometritis (M/C manifestation), parametritis, peritonitis, septicemia
  2. ARDS
  3. DIC
  4. Acute renal failure


  1. Chronic pelvic pain
  2. Tubal block and infertility
    "The most common cause of death in patients with this condition is respiratory insufficiency secondary to ARDS."
    "With severe sepsis syndrome, acute respiratory distress syndrome or ole may develop and supportive care is essential

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