AIMMTP

By Abhijeet Gaur

Certificate of Authenticity

This is to certify that “Abhijeet Gaur” a student of class 12th has successfully completed the research product on the topic “MTP” under the guidance of Ma’am Rajani .

This project is absolutely genuine and does not indulge in plagiarism of any kind. This reference taken in making this project has been declared at the end of this project.

Signature {subject teacher} Signature {examiner}

Acknowledgement

I feel proud to present my investigatory project in Biology on the “ MTP ”

This project would not have been feasible without the proper rigorous guidance of biology teacher Ma’am Rajani. Who guided me throughout this project in every possible way? An investigatory project involves various difficult lab experiments, which have to obtain the observations and conclude the reports on a meaningful note. Thereby, I would like to thanks Ma’am Rajani for guiding me on a systematic basis and ensuring that in completed all my research with ease. Rigorous hard work has put in this project to ensure that it proves to be the best. I hope that it proves to be the best. I hope that this project will prove to be a breeding ground for the next generation of students and will guide them in everypossibleway.

IntroductionAbortion is the ending of pregnancy by removing a fetus or embryo from the womb before it can survive on its own. An abortion which occurs spontaneously is also known as a miscarriage. An abortion may be caused purposely and is then called an induced abortion, or less frequently, "induced miscarriage". The word abortion is often used to mean only induced abortions. A similar procedure after the fetus could potentially survive outside the womb is known as a "late termination of pregnancy","postviability abortion","late-term abortion", "later-term abortion", or simply "abortion".

Modern methods use medication or surgery for abortions. The drugs mifepristone and prostaglandin are as good as surgery during the first trimester. While medical methods may work in the second trimester, surgery has lower risk of side effects. Birth control, such as the pill or intrauterine devices, can be started at once after an abortion. When allowed by local law abortion in the developed world is and has long been one of the safest procedures in medicine. Uncomplicated abortions do not cause any long term mental or physical problems. The World Health Organization recommends safe and legal abortions be available to all women. Every year unsafe abortions cause 47,000 deaths and 5 million hospital admissions.

Around 44 million abortions occur each year in the world, with a little under half done unsafely. Abortion rates have changed little between 2003 and 2008, before which they decreased for decades due to better education about family planning and birth control. As of 2008, 40% of the world's women had access to legal abortions without limits as to reason. However, different governments have different limits on how late in pregnancy abortion is allowed.

Since ancient times abortions have been done using herbal medicines, sharp tools, with force, or through other traditional methods. Abortion laws and cultural or religious views of abortions are different around the world. In some areas abortion is legal only in special cases such as rape, problems with the fetus, poverty, risk to a woman's health, or incest. In

many places there is much debate over the moral, ethical, and legal issues of abortion. Those who are against abortion largely claim that an embryo or fetus is a human with a right to life and may compare it to murder. Supporters point to a woman's right to decide over her own body and to human rights in general.

HistoryInduced abortion has long history, and can be traced back to civilizations as varied as China under Shennong (c. 2700 BCE), Ancient Egypt with its Ebers Papyrus (c. 1550 BCE), and the Roman Empire in the time of Juvenal (c. 200 CE). There is evidence to suggest that pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. One of the earliest known artistic representations of abortion is in a bas relief at Angkor Wat (c. 1150). Found in a series of friezes that represent judgment after death in Hindu and Buddhist culture, it depicts the technique of abdominal abortion.

Some medical scholars and abortion opponents have suggested that the Hippocratic Oath forbade Ancient Greek physicians from performing abortions; other scholars disagree with this interpretation, and state the medical texts of Hippocratic Corpus contain descriptions of abortive techniques right alongside the Oath. The physician Scribonius Largus wrote in 43 CE that the Hippocratic Oath prohibits abortion, as did Soranus, although apparently not all doctors adhered to it strictly at the time. According to Soranus' 1st or 2nd century CE work Gynaecology, one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party —to which he belonged— was willing to prescribe abortions, but only for the sake of the mother's health.

Aristotle, in his treatise on government Politics (350 BCE), condemns infanticide as a means of population control. He preferred abortion in such cases, with the restriction "[that it] must be practised on it before it has developed sensation and life; for the line between lawful and unlawful abortion will be marked by the fact of having sensation and being alive." In Christianity, Pope Sixtus V (1585–90) was the first Pope to declare that abortion is homicide regardless of the stage of pregnancy; the Catholic Church had previously been divided on whether it believed that abortion was murder, and did not begin vigorously opposing abortion until the 19th century. Islamic tradition has traditionally permitted abortion until a point

in time when Muslims believe the soul enters the fetus, considered by various theologians to be at conception, 40 days after conception, 120 days after conception, or quickening. However, abortion is largely heavily restricted or forbidden in areas of high Islamic faith such as the Middle East and North Africa.

In Europe and North America, abortion techniques advanced starting in the 17th century. However, conservatism by most physicians with regards to sexual matters prevented the wide expansion of safe abortion techniques. Other medical practitioners in addition to some physicians advertised their services, and they were not widely regulated until the 19th century, when the practice was banned in both the United States and the United Kingdom. Church groups as well as physicians were highly influential in anti-abortion movements. In the US, abortion was more dangerous than childbirth until about 1930 when incremental improvements in abortion procedures relative to childbirth made abortion safer. The Soviet Union (1919), Iceland (1935) and Sweden (1938) were among the first countries to legalize certain or all forms of abortion. In 1935 Nazi Germany, a law was passed permitting abortions for those deemed "hereditarily ill", while women considered of German stock were specifically prohibited from having abortions. Beginning in the second half of the twentieth century, abortion was legalized in a greater number of countries. A bill passed by the state legislature of New York legalizing abortion was signed by Governor Nelson Rockefeller in April 1970.

(Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle.)

Types Of Abortions

There are 2 kinds of induced abortions: surgical and chemical.

Surgical Abortion Procedures

1. Manual Vacuum Aspiration: within 7 weeks after last menstrual period

Dilators (metal rods) are used to stretch the cervical muscle until the opening is wide enough for abortion instruments to pass through the uterus. A hand-held syringe is attached to tubing, which is inserted into the uterus. The fetus is suctioned out.

2. Suction Curettage: after 14 weeks from the last menstrual period

The abortionist uses a dilator or laminaria to open the cervix. Laminaria are thin sticks from a kelp species that are inserted hours before the procedure and allowed to slowly absorb water and expand, thereby dilating the cervix. Once the cervix is dilated, the abortionist inserts tubing into the uterus and attaches the tubing to a suction machine. Suction pulls apart the fetus’ body and out the uterus. After suction, the doctor and nurses must reassemble the fetus’ dismembered parts to ensure they have all the pieces.

3. D & C (Dilation and Curettage): within first 12 weeks

The cervix is dilated. A suction device is placed in the uterine cavity to remove the fetus and placenta. Then the abortionist inserts a curette (a loop-shaped knife) into the uterus. The abortionist uses the curette to scrape any remaining fetal parts and the placenta out of the uterus.

4. D & E (Dilation and Evacuation): within 13-24 weeks after last menstrual period

The fetus literally doubles in size between the 11th and 12th weeks of pregnancy. Soft cartilage hardens into bone at 16 weeks, making the fetus too large and strong to pass through a suction tube. The D & E procedure begins by inserting laminaria a day or two before the abortion, opening the cervix wide to accommodate the larger fetal size. The abortionist then both tears and cuts the fetus and uses the vacuum machine to extract its remains. Because the skull is too large to be suctioned through the tube, it must be crushed by forceps for removal. Pieces must be extracted very carefully because the jagged, sharp pieces of the broken skull could easily cut the cervix.

5. Saline: after 15 weeks of pregnancy

This procedure is conducted in the same manner as amniocentesis (a prenatal test used to diagnose a fetus’ potential chromosomal abnormalities). A long needle is inserted into the woman’s abdomen, directly into the amniotic sac. It is at this point that a saline abortion and amniocentesis differ. In a saline abortion, amniotic fluid is removed from the woman and replaced by a strong saline (salt) solution. As the fetus’ lungs absorb the salt solution, it begins to suffocate. It may struggle and may even have convulsions. The saline also burns off the fetus’ outer layer of skin. Saline abortion can take one to six hours before the fetus is no longer viable. The woman begins labor after approximately 12 hours, and she may take up to 24 hours to deliver. Because the procedure is often quite long, many times the woman is left to labor alone.

6. Prostaglandin: after 15 weeks of pregnancy

This procedure is conducted in the same manner as a saline abortion, except prostaglandin (a hormone that causes the woman to start labor) replaces saline. Prostaglandin activates contractions. It can cause overly painful or intense labor; there have been cases in which the violence of the contractions ruptured the mother’s uterus.1 This type of abortion is not

preferred by abortionists because there is a 40% higher chance of a live birth.

7. Hysterotomy: after 18 weeks

This procedure is the same as a cesarean section (in which the doctor cuts through the abdomen and uterus to deliver the baby), except that in a hysterotomy, no medical attention is given to the baby upon delivery to help it survive. Most often, a wet towel is placed over the baby’s face so it can’t breathe. Sometimes the baby placed in a bucket of water. The goal is to have a baby that won’t survive.

8. D & X (Dilation and Extraction): from 20 weeks after last menstrual period to full term. Also called “partial birth abortion.”

This procedure takes three days. During the first two days, the woman’s cervix is dilated. She is given medication for cramping. On the third day, she receives medication to induce labor. As the woman labors, the abortionist uses an ultrasound to locate the baby’s legs. The abortionist then grasps a leg with forceps and delivers the baby up to its head. Next, using a scissors, the abortionist creates an opening in the base of the baby’s skull. A suction catheter is inserted into the skull opening, and the baby’s brains are suctioned out. The skull collapses, and the rest of the baby’s body is delivered through the birth canal.

Chemical Abortion Options

1. RU-486 (Mifepristone): within 4-7 weeks of the last menstrual period.

Also called “the abortion pill.”

This drug interferes with levels of progesterone, a hormone that keeps the fetus implanted in the wall of the uterus. The woman is prescribed progesterone and then returns to the clinic two days later to receive a prostaglandin drug that induces labor and expels the dead fetus. A third visit may be required if the baby is not expelled, at which time a woman has

a 5-8% likelihood of needing a surgical abortion to complete the process. RU-486 is documented to be unsafe for women.2

2. Methotrexate and Misoprostol

Methotrexate is used for treatment of cancer, and Misoprostol is used for ulcer treatment. In a chemical abortion, these two drugs are used in combination. Methotrexate causes cells in the placenta (the organ that nourishes the fetus) to die. Misoprostol empties the fetus from the uterus by causing the uterus to contract and push the fetus out. Methotrexate is a drug used in chemotherapy and has the potential for serious liver toxicity.

3. “Morning After” Pill: sometimes used in rape cases

Up to 72 hours after intercourse, a woman is administered large doses of birth control pills (or levonorgestrel, also known as Plan B) to prevent the embryo from implanting in the uterus wall. Twelve hours after the first dose, a second dose is given. Large doses of birth control pills work to prevent ovulation and hinder sperm motility.

The Indian MTP Act

To avoid the misuse of induced abortions, most countries have enacted laws whereby only qualified Gynecologists under conditions laid down and done in clinics/hospitals that have been approved can do abortions. The Medical Termination of Pregnancy Act was enacted by the Indian Parliament in 1971 and came into force from 01 April, 1972. The MTP act was again revised in 1975.

The MTP Act lays down the condition under which a pregnancy can be terminated, the persons and the place to perform it.

The reasons for which MTP is done, as interpreted from the Indian MTP Act, are:

(i) Where a pregnant woman has a serious medical disease and continuation of pregnancy could endanger her life like:

Heart diseases. Severe rise in blood pressure. Uncontrolled vomiting during pregnancy Cervical/ breast cancer. Diabetes mellitus with eye complication (retinopathy). Epilepsy. Psychiatric illness.

(ii) Where the continuation of pregnancy could lead to substantial risk to the newborn leading to serious physical / mental handicaps examples like

Chromosomal abnormalities. Rubella (German measles) viral infection to mother in first three

months. If previous children have congenital abnormalities. Rh iso-immunisation. link Exposure of the foetus to irradiation.

(iii) Pregnancy resulting of rape.

(iv) Conditions where the socio-economic status of the mother (family) hampers the progress of a healthy pregnancy and the birth of a healthy child.

Failure of Contraceptive Device irrespective of the method used (natural methods/ barrier methods/ hormonal methods).

This condition is a unique feature of the Indian Law. All the pregnancies can be terminated using this criterion.

Consent

If married--- her own written consent. Husband’s consent not required.

If unmarried and above 18years ---her own written consent. If below 18 years ---written consent of her guardian. If mentally unstable --- written consent of her guardian. A consent assures the clinician performing the abortion that she: Has been informed of all her options. Has been counseled about the procedure, its risks and how to care for

herself after she chosen the abortion of her own free will.

Person or persons who can perform MTP

Physicians qualified to do MTP are: Any qualified registered medical practitioner who has assisted in 25

MTPs. A house surgeon who has done six months post in Obstetrics and

Gynecology. A person who has a diploma /degree in Obstetrics and Gynecology. 3 years of practice in Obstetrics and Gynecology for those doctors

registered before the 1971 MTP Act was passed. 1 year of practice in Obstetrics and Gynecology for those doctors

registered on or after the date of commencement of the Act. Whenever the pregnancy exceeds 12 weeks but is below 20 weeks

opinion of two registered medical practitioners is necessary.

Place where MTP can be performed:

Any institutions licensed by the Government to perform MTP. The certificate issued by the Government should be conspicuously displayed at a place easily visible to persons visiting the place.

Methods of Induced Abortion:

Abortion can be induced by different methods depending on the weeks of pregnancy completed.

Tests to be done:

A thorough medical examination including blood pressure and weight

An internal examination to confirm the duration of pregnancy. Urine test for confirmation of pregnancy. Routine urine analysis. Routine blood counts including hemoglobin estimation. Blood group and Rh factor. At times, an ultrasound may be required.