Transcript
Medical Termination of Pregnancy (MTP),sterilization and birth control
Content Questions
Q. Define and categorize abortion. Q. Enumerate the complications and sequele of abortions.Q. Describe the condition, person and place covered under MTP act 1971Q. Explain the male and female terminal methods of contraceptive procedures with their complicationsQ. Describe the various miscellaneous methods of birth control
05/03/2023 2
• Abortion = Termination of pregnancy before the foetus becomes viable.
Category:- Spontaneous: “ Natures method of birth control”- Induces: deliberately done legally or illegally
Abortion facts
• Out of 210 m pregnancies, 80 m are unintended• 2008: 21.6 m unsafe abortions causing 47,000 deaths• 14 unsafe abortions/ 1000 women (15-44 yrs)• Developing countries, its 16 per 1000 women
• India: ICMR study documented safe 6.1 and unsafe 13.5 per 1000 pregnancies
• 2/3rd takes place outside authorized health service
Complications and sequelae
Early complications:- Haemorrhage - Shock- Sepsis- Uterine perforation- Cervical injury- Thromboembolism - Anaesthetic and
psychiatric
Late sequelae - Infertility - Ectopic gestation- sed risk of
spontaneous abortion- Reduced birth weight
Medical termination of pregnancy act 1971
Coverage under MTP act 1971
1. Conditions under which preg can be terminated
2. Person/s who can perform
3. The place – terminations are performed
1. Conditions under which pregnancy can be terminated
Five- Medical: continuation might endanger mothers life- Eugenic: risk of the child being born handicap- Socio-economic: could lead to mothers health injury- Humanitarian: pregnancy is the result of rape- Failure of contraception: anguish caused by
unwanted pregnancy causing grave mental injury to the mother
Medical termination of pregnancy (MTP) act 1971 (contd.)
2. The Person/s who can perform abortion
• The act authorises only Registered Medical Practitioner having experience in Gynaec. and obs. (preg < 12 wks)
• 12wks – 20 wks: Opinion of two RMPs is necessary
Medical termination of pregnancy (MTP) act 1971 (contd.)
3. The place where abortion is performed
• NGOs may also take up – licence from dist. CMO
Medical termination of pregnancy (MTP) act 1971 (contd.)
Strategies of safe MTP centres and service providers
At community level:a. Spread awareness regarding availability of safe MTPb. Access to confidential counselling: train ANMs, AWW,
ASHAc. Provide post abortion care
At the facility level: d. To provide manual vaccum aspiration facilitye. Provide comprehensive & high quality services at FRUsf. Encourage private and NGO sectors to establish
Terminal methods
Sterilization Male Sterilization: 10-15% of sterilization in India though it is
simpler, safer & cheaper than female sterilization (85%)
Guidelines for sterilization1) Age of husband should not be <25 yrs or >50 yrs2) Age of wife should not be<20 yrs or >45 yrs3) Motivated couple must have 2 living children4) If the couple has 3 or more children the lower age limit of
couple can be relaxed by surgeon5) Acceptor declares having obtained consent of his/her spouse to
undergo sterilization
Female sterilization
• Postpartum/ at time of abortion
• 2 procedures: – Laparoscopy, – Mini-laparotomy (pomeroy)
Laparoscopic female sterilization
• Abdominal approach, specialized instrument called “laparoscope”
• Abdomen inflated with gas• Falope rings (clips) applied to occlude the tubes• Specialists availability ensured prior operation• Short operating time, short hospital stay, small scar
Complications: Puncture of large vesselsPatient selection: Not advisable postpartum for 6 wks
Minilaparotomy
• Modification of abdominal Tubectomy
• Simpler procedure requiring a smaller abdominal incision of only 2.5 – 3cm under LA
• Minilap/ Pomeroy technique
• Suitable technique at PHC for mass campaigns
• Suitable for post partum period.
Male sterilization (vasectomy)
• Simpler, faster, less expensive than tubectomy in terms of instruments, hospitalization and doctor’s training
• Cost wise ratio: 5 vasectomy to 1 tubal ligation
Procedure:• Acceptor is not immediately sterile after operation
usually until 30 ejaculations have taken place
• Remove at least 1 cm vas after clamping
Complications of male sterilization
• Operative : Pain, haematoma, wound infection (3%)
• Sperm granules (7mm)• Spontaneous recanalization• Autoimmune response• Psychological
Post – operative advice• Pt should be told that he is not sterile immediately after
operation, at least 30 ejaculations may be necessary before seminal examination is negative
• Use contraceptives until aspermia has been established
• Avoid taking bath for at least 24 hrs after operation• Wear T-bandage / scrotal support for 15 days• Avoid cycling/heavy wt. lifting for 15 days• To have stitch removed on 5th day after operation
No Scalpel Vasectomy (NSV)
• New technique that is safe, convenient & acceptable to males
• Accepted by NHFWP• Availability of this new technique at the
peripheral level will increase the acceptance of male sterilization
• Project is being funded by UNFPA
Miscellaneous methods of birth control
1) Abstinence 2) Coitus interruptus3) Safe period (rhythm method)
4) Natural methods: a) Basal body temperature method b) Cervical mucus method c) Symptothermic methodi. Breast-feedingii. Birth control vaccines
Safe period (Rhythm method)
• Calendar method• First day of fertile period:
Shortest cycle – 18 days• Last day of fertile period:
Longest cycle – 10 days• Eg
Safe period (contd.)
• Drawbacks:– Woman’s menstrual cycle is not regular– To be used by educated & responsible couples
with high degree of motivation– Compulsory abstinence of sexual intercourse for
nearly half of every month– Not applicable during post natal period– High failure rate: 9 per 100 HWY
• Complications:– Ectopic pregnancy– Embryonic abnormality
Natural family planning methods
a) Basal body temperature method (BBT) :– Rise of body temp by 0.3 – 0.5 degree C at the time of
ovulation – Intercourse restricted to post-ovulatory infertile period
b) Cervical mucus method– Billings method/ ovulation method– At the time of ovulation, cervical mucus becomes watery
clear resembling raw egg white, smooth, sleepery – After ovulation mucus thickens (progesterone)
c) Symptothermic method (combines temp. cervical and calender technique
Miscellaneous methods (Contd.)
• Breast feeding:– Lactational amenorrhoea
• Birth control vaccine– Prepared from B subunit of hCG– Research phase
Summary
05/03/2023 25
‘THANKS FOR THE ATTENTION’REVISE IT Today
05/03/2023 26
top related