BIOLOGY INVESTIGATORY PROJECT

MEDICAL TERMINATION OF PREGNANCY

Name: Mari Sree. A

Class: Ⅻ
 CERTIFICATE
This is to certify that MARI SREE.A, a student of Grade XII, has completed the

Biology project titled "[MEDICAL TERMINATION OF PREGNANCY]"

under the guidance of Ms.SUMATHI, our school's Biology teacher during the

academic year 2024-25.

The project work is original and has been executed at Vel’s Vidhyalaya Senior

Secondary School as part of the CBSE curriculum requirements for Grade 12

biology.

INTERNAL EXAMINER EXTERNAL EXAMINER

PRINCIPAL
 ACKNOWLEDGEMENT
I thank the Almighty God who helped me to choose this project wisely.

I thank our respected Correspondent Mr. M. V. M. Senthil Prakash and Principal

Mrs. S. Murugeswari for their encouragement, help and service in performing the

project.

I gratefully acknowledge my sincere thanks to my respected biology teacher Mrs.

Sumathi her remarkable guidance throughout the project.

And I extend my sincere appreciation to everyone who contributed to this

project's success,

MARI SREE.A

GRADE: XII

ROLL NO:
 INTRODUCTION
Medical termination of pregnancy or (MTP) is a medical procedure
to end the pregnancy. It is also known as Medical Abortion. The
pregnancy is terminated either by taking medicines or by
performing a surgical procedure.

Most abortions are carried out before 24 weeks of pregnancy. It

can be ended medically if the pregnancy is 7-9 weeks old or
earlier, otherwise, a surgery is required. Medical abortion is
permitted in India if the pregnancy has not exceed 20 weeks.
Legally, approval of only the pregnant woman is required for a
pregnancy termination.
 ABORTION VS MISCARRIAGE
There is often confusion in understanding miscarriage vs.
abortion.

While both involve the termination of a pregnancy, there are

some key differences between the two.

The main difference between abortion and miscarriage is that

abortions are induced, while miscarriages occur naturally. In other
words, an abortion is a planned termination of a pregnancy, while
a miscarriage is an unplanned one.

WHAT IS MISCARIAGE?(SPONTANEOUS
ABORTION):
Miscarriage is the ending of the pregnancy naturally before the 20th week.
Miscarriages are also called spontaneous abortions. The majorities of
miscarriages are unavoidable and happen when the fetus stops developing.
Miscarriages are very common in the first trimester of pregnancy. The most
common signs of miscarriage include bleeding of tissues and clots,
abdominal cramps and lower back pain.
WHAT IS INDUCED ABORTION?(DELIBRATE
ABORTION ) :
Abortion is a legal procedure by which a woman can end her
pregnancy deliberately. It can be done till the 24th week of
gestation. A pregnant woman can abort her pregnancy using
medicines or surgery if she doesn't want to deliver the baby.

It is better to abort in the early stages of pregnancy to reduce

risks. As it involves going through emotional turmoil, the patient
must consider carefully and take the advice of specialists before
going ahead with the procedure.
TYPES OF MISCARRIAGE:
Bleeding with closed cervix but no
1.THREATENED evidence of fetal demise on
ultrasound scan ; 50% chance of
complete miscarriage
Open cervix but products of
2.INEVITABLE conception not yet expelled. Almost
all progress to complete miscarriage
Products of conception partially
3.INCOMPLETE expelled. All progress to complete
miscarriage.
All products of pregnancy are
4.COMPLETE expelled.

Ultrasound scan sows fetal demise

5.MISSED but products of conception remain in
uterus. Can be asymptomatic. All will
progress to complete miscarriage.
Rare. Often result from pelvic
6.SEPTIC instrumentation (i.e., non sterile
 conditions)

Induced abortion (Legal):

FIRST TRIMESTER TERMINATION:
In the first trimester, options for abortion commonly include
medical abortion or vacuum aspiration.

A person can usually access medical abortion until about 7-9

weeks after their last period. It involves taking two types of
medication.

Surgical options, such as vacuum aspiration and dilation and

evacuation, are more common between 6 and 14 weeks of
pregnancy

SECOND TRIMESTER TERMINATION:

In the second trimester, a pregnant person may undergo dilation
and evacuation (D&E). Doctors typically perform this between
weeks 12 and 24.

In the third trimester, a pregnant person may undergo labor

induction abortion.
However, this is very rare

CONDITION OF ALLOWANCE:
 If a woman's health is under danger because of pregnancy.
 If a woman is pregnant because of rape.
 If it is known that the fetus will be unwell or handicapped
after birth.
 Pregnancies that happen despite contraception.
 If a girl under the age of eighteen or a 'lunatic' (a person
who is not in his/her senses) is pregnant

PLACES WHERE MTP CAN BE DONE:

 It is considered illegal to perform MTP unless it is conducted in either of
the following places. A hospital which is under the government. Any
other place which is approved by the government to work according to
the MTP Act. Medical abortion can be performed at a clinic, but the
doctor needs to be attached to the government approved MTP center.

Who should not get medical abortion?:

Medical abortion is not a safe option for those who:

* Are too far along in the pregnancy.

* Have a pregnancy outside of the uterus (ectopic pregnancy).

* Have a blood clotting disorder or significant anemia.

* Have chronic adrenal failure.

* Use long-term corticosteroids.

* Have an intrauterine device (IUD).

* Have an allergy to the medications used.

* Do not have access to emergency care.

* Can't return for a follow-up visit.

It is important to discuss your medical history with your

healthcare provider before a medical abortion procedure

Who can perform MTP?:

Physicians qualified to MTPs are:

Any qualified registered medical practitioner having postgraduate

training in obstetrics and gynecology and having special training
in MTP.

For termination up to 12 weeks of gestation opinion of one

medical practitioner is enough.

In case of second trimester MTP opinion 2 medical practitioners is

essential.

Methods recommended for MTP:

The world health organization (WHO) recommends three safe
abortion methods for terminating early pregnancies. The choice of
each method depends on pregnancy length and the patient’s
medical condition.
These are:

1. The medical abortion method

2. Vacuum aspiration abortion method
3. Surgical abortion method

First Trimester Termination of Pregnancy:

Medical methods:
Mifepristone (RU 486) and Misoprostol:
 Mifepristone (200mg) an analog of
progestin(norethindrone) act as an antagonist,
blocking the effect of progesterone.
 Addition of low dose prostaglandins(800mg)
(PGE1) improves the efficiency of first trimester
abortion. It is effective up to 63days and is
highly successful when used within 49 days of
gestation.
Methotrexate and Misoprostol:
 Methotrexate 50mg/m2 IM (before 56days of
gestation) followed by 7days later misoprostol
800µg vaginally highly effective.
 Misoprostol may have to be repeated 24 hours
if it fails.
 Methotrexate and Misoprostol regimen is less
expensive but takes longer time than
mifepristone and misoprostol
Surgical method of first trimester abortion:

MENSTRUAL REGULATION:

 It is the aspiration of endometrial cavity within

14days of missed period in a woman with previous
normal cycle.
 The operation is done as an out patient or an office
procedure.
 It is done with aseptic precautions.
 After introducing the posterior vaginal speculum, the
cervix is steadied with an Allis forceps.
 Cervix may be gently dilated by using 4 or 5mm size
dilators
 The cannula is rotated, pushed in and out with gentle
strokes.
 The operator should examine the aspirated tissue by
floating it in a clear plastic dish over a light source.
 This will help to detect failed abortion, molar
pregnancy or ectopic pregnancy.
 5-6 mm suction cannula (Karman's) is then inserted
and attached to the 50 mL syringe for suction.
 The procedure is contraindicated in the presence of
pelvic
Inflammation.
Manual vacuum aspiration (MVC):
Done up to 12 weeks with minimal cervical dilatation
 It is performed as an outpatient procedure using a
plastic disposable Karman's cannula (up to 12 mm
size) and a 60 mL plastic (double valve) syringe.
 It is quicker (15 minutes), effective (98-100%), less
traumatic and safer than dilatation, evacuation and
curettage.
 The procedure may be manual vacuum aspiration
(MVA) or electric vacuum aspiration (EVA).
 Hand operated double valve plastic syringe is
attached to a cannula.
 The cannula is inserted transcervical into the uterus
and the vacuum is activated.
 A negative pressure of 660 mm Hg is created.
 Aspiration of the products of conception is done
Dilation and Evacuation:
(D+E) and (D+C):
The operation consists of dilatation of the cervix and evacuation
of the product conception from the uterus

Procedure:-
1.Vaginal examination is done to note the size and
position of the uterus and to note the state of cervix. USG
should be performed when there is any doubt about the
gestational age.
2. Posterior vaginal speculum is introduced and an
assistant is asked to hold it.
3.The anterior lip of the cervix is to be grasped by an Allis
forceps
4. The cervix may have to be dilated with smaller size
graduated metal dilators up to one size less than that of
the suction cannula. Feeling of "snap" of the endocervix
around the dilator is characteristic. Instead laminaria tent
12 hours before (osmotic dilator) or misoprostol (PGE1)
400 µg given vaginally 3 hours prior to surgery produces
effective dilatation.
5. Intravenous methergine 0.2 mg is administered.
6. The appropriate suction cannula is fitted to the suction
apparatus by a thick rubber or plastic tubing. The cannula
is then introduced into the uterus; the tip is to be placed
in the middle of the uterine cavity.
7. The pressure of the suction is raised to 400–600 mm
Hg. The cannula is moved up and down and rotated
within the uterine cavity (360°) with the pressure on. The
suction bottle is inspected for the products of conception
and blood loss. The suction is regulated by a finger
placed over a hole at the base of the cannula
The end point of suction is denoted by:
a. No more material is being sucked out
b. Gripping of the cannula by the contracting smaller size
uterus
c. Appearance of bubbles in the cannula or in the
transparent tubing.
8. After being satisfied that the uterus is remaining firm,
and there is minimal vaginal bleeding, the patient is
brought down from the table after placing a sterile vulval
pad.
Second trimester termination of pregnancy:
MEDICAL METHODS:
Prostaglandin:
 They act on the cervix and the uterus.
 The PGE (dinoprostone, sulprostone, gemeprost,
misoprostol) and PGF (carboprost) analogues are
commonly used
 PGEs are preferred as they have more selective
action on the myometrium and less side effects.
1. Misoprostol (PGEı analogue)
 400-800 µg of misoprostol given vaginally at an
interval of 3-4 hours is most effective as the
bioavailability is high.
 Alternatively, first dose of 600 µg misoprostol given
vaginally, then 200 µg, orally every 3 hours are also
found optimum.
 Recently 400 µg misoprostol is given sublingually
every 3 hours for a maximum of five doses.
 This regimen has got 100% success in second
trimester abortion.
2. Gemeprost (PGEı analogue):
 1 mg vaginal every 3-6 hours for five doses in 24
hours has got about 90% successes.
 The mean induction-abortion interval was 14-18
hours

3. Mifepristone and prostaglandins:

  Mifepristone 200 mg oral, followed 36-48 hours later
by misoprostol
 800 µg vaginal; then misoprostol 400 µg oral every 3
hours for 4 doses is used.
 Success rate of abortion is 97% and median
induction delivery interval is 6.5 hours.
 Pretreatment with mifepristone reduces the
induction- abortion interval significantly compared to
use of misoprostol alone.

4. Prostaglandin F2 (carboprost): -
-250mg IM every 3 hours for a maximum 100 dose can be
used
Oxytocin:
 High dose oxytocin as a single agent can be used for
second trimester abortion.
 It is effective in 80% of cases.
 It can be used with intravenous normal saline along
with any of the medications used either intra-
amniotic or extra-amniotic space in an attempt to
augment the abortion process.

Mode of action:
 Myometrial oxytocin receptor concentration
increases maximum (200-300-fold) during
labor
 Oxytocin acts through receptor and voltage
mediated calcium channels to initiate
myometrial contraction.
Surgical Methods:
It is difficult to terminate pregnancy in the second
trimester with reasonable safety as in first trimester.

Between 13-15:
Dilation and Evacuation in the mid trimester is less
commonly done.
 Pregnancies at 13 to 14 menstrual weeks are
evacuated.
 In all mid trimester abortion cervical preparation
must be used (WHO 1997) to make the process easy
and safe.
 Intracervical tent (Laminaria osmotic dilator),
mifepristone or misoprostol are used as the cervical
priming agents.
 The procedure may need to be performed under
ultrasound guidance to reduce the risk of
complications.
 Simultaneous use of oxytocin infusion is useful.
Between 16-20 weeks:
 Intra-amniotic
 Extra-amniotic
Intra-amniotic:
Intra-amniotic instillation of hypertonic saline (20%) is
less commonly used now. It is instilled through the
abdominal route.
  Mode of action: There is liberation of prostaglandins
following necrosis of the amniotic epithelium and the
decidua. This in turn excites uterine contraction and
results in the expulsion of the fetus.

Procedure:
 Preliminary amniocentesis is done by a 15 cm 18-
gauge needle.
 The amount of saline to be instilled is calculated as
number of weeks of gestation multiplied by 10 ml.
 The amount is to be infused slowly at the rate of 10
mL/min

Extra-amniotic:
 Extra-amniotic instillation of 0.1% ethacridine lactate
done transcervically through a number 16 Foley's
catheter
 The catheter is passed up the cervical canal for
about 10 cm above the internal os between the
membranes and myometrium and the balloon is
inflated (10 mL) with saline.
 It is removed after 4 hours. The success rate is
similar to saline instillation but is less hazardous.
 It can be used in cases contraindicated for saline
instillation.
 Stripping the membranes with liberation of
prostaglandins from the decidua and dilatation of the
cervix by the catheter are some of the known factors
for initiation of the abortion.
Hysterotomy:
Hysterotomy is an operative procedure of
extracting the products of conception out of the
womb before 28th week by cutting through the
anterior wall of the uterus.
The operation is usually done through the abdominal
route. The operation is rarely done these days for the
purpose of MTP.
Complications:
I Hemorrhage and shock
II Peritonitis
III Intestinal obstruction
Complications of MTP:
IMMEDIATE:
- Injury to the cervix (cervical lacerations)
- Uterine perforation during D and E
-Hemorrhage and shock due to trauma, incomplete
abortion, atonic uterus or rarely coagulation failure
-Thrombosis or embolism

REMOTE:
The complications are grouped into:
 Gynecological
 Obstetrical
Gynecological complications include:
I menstrual disturbances
II chronic pelvic inflammation
III scar endometriosis (1%)
Obstetrical complications include:
I ectopic pregnancy (three-fold increase)
II preterm labor
III dysmaturity,
IV rupture uterus

Abortion law of India:

 Although abortion in India has been legal under
various circumstances since the introduction of the
Medical Termination of Pregnancy (MTP) Act in
1971, we look back at the history of various
judgments that were passed and debated to allow
women autonomy over their bodies, or somewhat so
Before 1971 Abortion was illegal in India:
 Illegal abortion to Shantilal Shah Committee, the
1960s
 Until the 1960s, abortion was illegal in India and was
punishable under law. Under Section 312 of the
Indian Penal Code (IPC), a woman could face three
years of imprisonment and a fine. Section 312 of the
IPC criminalizes the intentional causing of
miscarriage if it was not done in good faith for the
purpose of saving the child.
 The discussion of the need for abortion laws started
in India in the mid-1960s when the government set
up the Shantilal Shah Committee headed by medical
professional, Dr Shantilal Shah. The committee was
 assigned with the task of looking into matters of
abortion and whether the country required laws
around the same.
 In 1964, the Committee suggested the liberalization
of abortion laws in India that will help in reducing
unsafe abortions and decrease maternal mortality in
the country. Based on the report of the Shantilal
Shah Committee, a medical termination bill was
introduced in Lok Sabha and Rajya Sabha and was
passed by Parliament in August 1971.
Medical Termination of Pregnancy:
(MTP) Act 1971:
 Came into force in 1972
 Amendments in 1975, 2002 and 2003
Grounds for MTP:
• Therapeutic: risk to pregnant woman
• Eugenic: risk to the child to be born
• Humanitarian: pregnancy caused by rape
• Socioeconomic: pregnancy due to failure of
contraceptive, Unwanted pregnancy with low SE status
• Environmental: no one to help from society
 The Indian abortion laws fall under the Medical
Termination of Pregnancy (MTP) Act, which was
enacted by the Indian Parliament in the year 1971
with the intention of reducing the incidence of illegal
 abortion and consequent maternal mortality and
morbidity. The MTP Act came into effect from 1 April
1972 and was amended in the years 1975 and 2002.
 Recently, the Supreme Court permitted a rape
survivor to terminate her pregnancy at 24 weeks,
which is beyond the permissible 20 weeks limit
prescribed under the Medical Termination of
Pregnancy Act, 1971

 The Indian abortion laws fall under the Medical

Termination of Pregnancy (MTP) Act, which was
enacted by the Indian Parliament in the year 1971
with the intention of reducing the incidence of illegal
abortion and consequent maternal mortality and
morbidity. The MTP Act came into effect from 1 April
1972 and was amended in the years 1975 and 2002.
 Recently, the Supreme Court permitted a rape
survivor to terminate her pregnancy at 24 weeks,
which is beyond the permissible 20 weeks limit
prescribed under the Medical Termination of
Pregnancy Act, 1971
Abortion laws worldwide:
 Abortion is allowed in most countries (97 percent) in order to
save a woman's life. Though the laws vary across the world.
 In 2003 the WHO developed technical and policy guidelines
to help governments pass progressive abortion laws.
 Worldwide, abortion is acknowledged as an important aspect
of reproductive health of women.
 At present, 26 countries including Egypt, Angola, Thailand,
the Philippines, Madagascar and Iraq do not permit abortion.
 39 countries including Brazil, Mexico, Sudan, Indonesia and
Sri Lanka permit abortion when the woman's life is at risk.
 Only some countries like China, Russia, Canada, Australia,
South Africa permit abortion on request mostly up to 12
weeks.
 India will now stand amongst nations with a highly
progressive law which allows legal abortions on a broad
range of therapeutic, humanitarian and social grounds
Bibliography:
1. www.google.com
2. Wikipedia
3. NCERT text book Biology Class 12
4. . D.C. Dutta text book of obstetrics and Gynecology
5. www.health.harvard.edu.
6. www.americanpregnancy.org.