1

Acknowledgement

First and foremost, we would like to thank our Pro Vice Chairman Sir and
Director Ma'am of our school for having provided us with the essential
platform needed for the completion of this project.

We also extend our sincere gratitude to our Principal, Mr. Naveen Katwal,
for his support and motivation during the process of our project work.

We wholeheartedly express our deep sense of indebtedness and

appreciation to our English Teacher, Mrs. Mamta Rai , for her assistance,
guidance and constant encouragement for the successful completion of
the task.

We also acknowledge with a deep sense of reverence, our gratitude

towards our Parents, Friends, and other Faculty Members of our school for
their valuable suggestions in completing the project.
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INDEX

sl content pg no.
no.
1. Introduction 3
2. history 5
3. Types of abortion 7
4. The Indian MTP Act 12
5. Place where MTP can be 16
performed
6. Bibliography 17

Teacher’s
remarks:
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Introduction
Abortion 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.
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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.
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History
Induced 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.

( 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)

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
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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 healthAristotle,
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 19 th
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.
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Types Of Abortions
There are 2 kinds of abortion : surgical and chemical
Surgical Abortion Procedure

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.
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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'
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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
thecontractions 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."

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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
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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.
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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.
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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.
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(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.
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 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 people who can perform MTP

 Physicians qualified to do MTP are:

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 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:
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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.

Bibliograpy
The sources that helped me finish this investigatory project are as follows
:-

 https://www.wikipedia.org
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 https://www.scribd.com
 class 12 ncert book of biology.