Profile of abortion seekers in the tertiary center of northern hills with review of medical termination of pregnancy act in India

The aim of the present study was to investigate the socio-demographic and obstetric profile of pregnant women, seeking medical termination of pregnancy in accordance with the Medical Termination of Pregnancy (MTP) Act and the reasons for undergoing termination of pregnancy in the tertiary care center of the hilly region of Northern India and to further review the amendments in the Medical Termination of Pregnancy Act 1971 along with its future implications in legalizing abortions in India. Materials and Methods: A registry-based retrospective study was carried out among pregnant women, attending the gynecologic outpatient department for termination of pregnancy at the tertiary care teaching hospital and the referral center for Himalayan foothills in Northern India. The records of women, seeking termination of pregnancy during a 1-year period between October 2020 and September 2021, were reviewed and information on their demographic and obstetric profile, reason for undergoing termination of pregnancy, and acceptance of contraception, following termination of pregnancy was recorded in the data sheet. The information obtained was analyzed using SPSS version 20 (IBM, Chicago, USA) for descriptive statistics. Results: A total of 400 pregnant women underwent Medical Termination of Pregnancy between October 2020 and September 2021. 30.5 % (122/400) women between 26–30 years of age underwent termination of pregnancy, followed by 27.3 % women aged between 31–35 years. Social reasons for termination of pregnancy were more evident in women aged 26 years and above. 84.09 % pregnancies were terminated in the second trimester (>12 weeks) on eugenic ground, while 65.01 % pregnancies were terminated in the first trimester (6–12 weeks) on social grounds. Only 7.75 % (31/400) women opted for sterilization or family planning after MTP, out of which the majority opted for temporary methods of contraception. Conclusion: We conclude from the results of the present study that women in the peak reproductive age (26–30 years) are more likely to seek pregnancy termination and this group of women needs to be the focus of contraceptive counseling and family planning services. Timely ultrasound scans by an expert sonologist may be a step forward towards lowering the rates of late pregnancy termination. There is a need to educate women to avail and use contraceptive methods in an effective manner and to make them aware of utilizing sterilization services, once they complete their families to avoid unwanted pregnancies.

Role of misoprostol 4 hourly versus 6 hourly in medical termination of pregnancy in 2nd trimester.

Objective: To determine efficacy of misoprostol given in 4 hourly versus 6 hourly intervals in second trimester for termination of pregnancy. Study Design: Cross sectional study. Setting: Study was conducted at the department of Obstetrics and Gynecology of Jinnah Medical and Dental College Karachi Allied Hospital. Period: March to August 2020. Material & Methods: Pregnant ladies in second trimester, requiring abortion due to medical reasons, were planned for termination of pregnancy. Two groups were made. Patients in Group-A were given misoprostol 4 hourly and those in Group-B were given misoprostol 6 hourly. Similar dose of drug (200ug) was given in both groups and monitoring was done. If abortion done in 48 hours, it was considered effective abortion and if not happened in 48 hours, it was considered a failed abortion. Consent was taken from all ladies in study group. Ethical approval was taken from ethical review committee. Results: Total 140 cases were studied, 70 cases in each group, A & B. Age range of cases was 16-40 years with mean age of 26.4±3.5 years. Most of the cases were having age between 20-30 years (63.5%). Group-A (N=70) was given misoprostol 4 hourly, where abortion was done in 94.3% cases while abortion failed in 5.7% cases. In Group-B (N=70) misoprostol was given 6 hourly, induced abortion in 82.8% and failed in 17.1% cases. Conclusion: Misoprostol dose of 20ug given via vaginal route is much effective drug for medical termination of pregnancy when given 4 hourly instead 6 hourly, with low failure rate.

Unwanted fertility

This chapter covers unwanted fertility, or abortion. It provides an overview of abortion and the legal aspects surrounding it in the United Kingdom, followed by the nurse’s role in abortion provision. It outlines the pre-abortion assessment process, and then both the methods and timings for the surgical termination of pregnancy (STOP) and the medical termination of pregnancy (MTOP). Finally, complications and risks - including both physical and psychological - associated with abortion are discussed.

Failed tubectomy procedures: a retrospective study

Background: It is difficult to understand the nature of factors leading to failure of sterilization from single institute. Knowing the factors, we can take preventive measures. Those data were of women who filed claims under Family Planning Indemnity Scheme, 2013 (revised 2016). The scheme was not reached at grassroots; therefore, not enough women got the benefit of this scheme. We gave the list of documents as well, which help medical fraternity working in rural area.Methods: Retrospective study of 32 women of failed tubal ligation over a period of four years (from 2016 to 2019). The variables under consideration of study were, parity and age at the time of tubectomy. Time and method of tubectomy. Interval between tubectomy and subsequent pregnancy. Outcome of subsequent pregnancy and further contraceptive acceptance. Descriptive statistics used for frequency analysis.Results: Median age of women was 26 years during tubal sterilization. Seventy two percent women were accepted sterilization on two children. Sixty nine percent of tubal sterilization were performed in puerperium; concurrent with caesarean section and medical termination of pregnancy, while 31% were during interval period. Thirty four percent of women became pregnant within 24 months(2years) of sterilization and cumulative 75% within 60 months (5 years) after sterilization. Sixty nine percent of women had intrauterine pregnancies and 31% ectopic pregnancies. Fifty six percent women accepted medical termination of pregnancy and 53% chosen repeat tubal sterilization. Four women (12%) gave live births. Two of them accepted repeat sterilization and another two intrauterine contraceptive devices. Thirty one percent women had ectopic pregnancy; nine of them came as ruptured ectopic, therefore, exploratory laparotomy with bilateral total salpingectomy were to be performed.Conclusions: Failed tubal sterilization is common when it was performed at younger age and in puerperium. Missed period after sterilization should have high index of suspicion of ectopic pregnancy, which leads to severe maternal morbidity.

The Global Response to Abortion – with Special Focus on India’s Medical Termination of Pregnancy Bill

The 2020 Amendment Act, of Medical Termination of Pregnancy has reinvigorated the discussion with regards to bodily autonomy and reproductive rights in India. This comes at a juncture of time, where the discussion regarding reproductive rights is an important part of the global socio-political narrative. The aim of this paper is to study the developmental trajectory of reproductive rights by gauging how the right to abortion has fared in various countries across the world by analysing specific legislations, judicial precedents and statistical data. We examine how one may secure the reproductive health rights of a woman better by analysing the two functional methods adopted thus far - either through liberal legislations that guarantee full autonomy to the woman or more restrictive laws that permit abortions only in certain circumstances - a major. The second half of this paper focuses on India, a country whose culture is traditionally perceived to be deeply rooted in orthodoxy and conservatives. The Medical Termination of Pregnancy Act was enacted in 1971, and the 2020 Amendment has garnered acclaim for its more progressive outlook and direction. Even though the amendment has addressed some of the major concerns voiced out by reproductive rights’ activists, there are still a few systemic and practical dogmas that are still pervasive in the reproductive rights domain. The paper discusses these prevalent lacunae at play at length and emphasizes on the need for comprehensive and quick solutions. These will contribute to the prevention of unwanted pregnancies while simultaneously reducing the physical and psychological harm that is caused to vulnerable women across the country.

The Medical Termination of Pregnancy (Amendment) Act, 2021: A step towards liberation

Reform of the abortion laws in favour of the well-being of pregnant women is one aspect of the removal of gender discrimination. The Medical Termination of Pregnancy Act (MTP Act) 1971, was a breakthrough legislation in this regard, as it reduced the number of unsafe illegal abortions. With advancements in ultrasonography and genetic technologies, many foetal malformations and genetic disorders were being diagnosed after 20 weeks of gestation. The fact that termination of pregnancy was not legally permitted beyond 20 weeks of gestation caused great distress to such women, and highlighted the need to increase the upper limit of termination of pregnancy. Concurrently, there has been greater awareness around the world on the rights of women to take decisions regarding their own bodies. The MTP Bill, 2020, has come as a breath of fresh air extending the term limit for legal abortions to 24 weeks for certain categories of women, and removing the limit for abortion in the presence of a significant foetal abnormality. The amendments were recently approved by Parliament and the President of India, and have become law as of March 25, 2021. This paper presents the amendments made and their implications for obstetric, ultrasonographic and foetal medical practice. It also presents a critique of the various Acts and suggests further amendments that would enhance the value of the Act.

Uterine arteriovenous malformation treated with selective embolisation of uterine arteries: a case report

Uterine arteriovenous malformation (AVM) is a very rare gynaecological condition, which can potentially lead to life-threatening abnormal uterine bleeding. In most cases uterine AVM is associated with prior pregnancy or pelvic surgery. We present the case of young woman seven weeks after medical termination of pregnancy diagnosed with heavy uterine bleeding due to uterine AVM, which was successfully treated with selective embolisation of uterine arteries.