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MTP


MTP

DEF: the indian act permits the willfull termination of pregnancy prior to the age of fetal viability (20weeks of gest. )for well defined indications .  it has to be performed by recognized medical practioners in a recognized place approved by the competent authority under the act

GROUNDS FOR PERFORMING MTP:
1. Medical ground :)
when the countinuation of pregnancy is likely to
~~endanger the life of the pregnant women
~~causes gravious injury to her physical and /or mental health as in cases of severe hypertention.cardiac dis. Diabetes m. Psychiatric illness .breast cancer
EUGENIC GROUNDS :)
 when there is substantional risk of child born with serious physical or mental abnormatities e.g. Hereditary disorders . Congenital malformation in privious peg.with high risk of recurrence in subsequent child birth or Rhisoimmunisation . Teratogenic drugs
HUMANITARIAN GROUNDS :-
when pregnance is caused by rare or incest
SOCIAL GROUNDS :-
when 1. In actual or reasonably forceseeable future her inviroment(social or economic ) might lead to risk to injury to her health   2.peg. Resulting from failure of contraceptive device or method

written content of the pt. On specialy prescribed form is necessary prior to undertaking the procedure

PLACE FOR PERFORMING MTP:)
the act stipulates that no mtp can be performed at any other place than
1. Hospital established and maintained by the govt.
2.place recognized and approved by the govt . Under this act

METHODS OF MTP
these are broadly classified  
METHODS OF FRIST TRIMESTER
~menstrual regulation
~dilatation and station  
  evacuation
~cervical softning prior to  
    d /e
~medical methods

METHODS OF 2 TRIMESTER MTP
~surgical evacuation
~extra outlar instillavion of drugs
~extrauterine methods  

#1st trimester mtp
~#surgical methods
~~#menstual regulation:-)
it consist of aspiration of the contents of the uterine cavity by means of a plastic cannula (karmans cannula)

It has plastic  50ml syringe
capable of creating a vacuum of over 60cm hg

It is effective carried out within 42 days of begining of LMP

complications ~failure . Incomplete evacuation .haemorrhage.cervical laceration. Perforation.infection

VACUUM EVACUATION

~It is most efficient method for termination up to 12 weeks
~undertaken under local anasthetic papacervical block coupled with some sedation
~cervix is dialated to introduce suction cannula of the appropriate size
~a standerd negative suction of 650mm of hg is applied and products are aspirated

MEDICAL METHODS
1. Prostaglandins:-)
   pro. Inj -prostin ,carboprost -prostaglandin F2 alpha  -250 micro gm given i m every 3 hourly

2. MIFEPRISTONE
(Mifegest-RU486)
~It is synthetic steroid a derivative of 19-nortesterone ,with anti progesteronic effect.
~it has also anti gluacocorticoid and weak anti androgenic action
~ACTION~~
It dose not prevent the fertilisation but by blocking the action of proge. No the endometrium ,it causes sloghing and shedding of decidua and prevents implantation


~if used singly effective in only 83% adding prostaglandin increases success rate to 95%

600mg given as single dose
for mtp
CONTRADITIACTIONS
.adrenal failure
.cardiac and asthmatic pt
.haemorrhagic disorder
.glaucoma
.lacting women
COMPLICATIONS
.Adrenal failure
.headache maliase
. Failure to abort
.next menstulatio delayed by10 days

SECOND TRIMESTER MTP
~SURGICAL METHODS
1.D/E
in some countries mtp up to 16 weeks accomplished by slow and deliberate dialatation of cervix with laminaria tents ,p.g. Gel
2. Aspirotomy
involves suction aspiration of liquor amni followed by evacuation of fetal parts in pieces with help of specialy desined instrument aspirotomy forecep

MEDICAL METHODS
1 Extraovvlar instillation of drugs . e. g. Ethacridine lactate
2 . Intra cervical/extraovular instillation of cerviprime
3. Mifepristone and misoprost
4. Prostaglandins
5. Combined methods

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