ABORTION IN MUMBAI

Abortion is the process of terminating a pregnancy voluntarily because of certain circumstances that might occur. These can include undesired pregnancy despite the usage of protection, underage sex and so on. There are generally two methods of abortion and both of their own pros and cons. Abortion can be successfully conducted in one day, so the person getting it does not have to stay overnight in order to get it.

Abortion for Unwanted pregnancy in India

Duration of pregnancy

The number of days or weeks since the first day of the woman’s last normal menstrual period (LMP) in women with regular cycles. For women with irregular cycles, the gestational age may need to be determined by physical or ultrasound examination. In India, abortion (MTP) is permitted up-to 20 weeks of pregnancy.

There are two methods by which abortion can be done

1. Medical Abortion -Non-surgical abortion in which medicines are used to induce abortion

2. Surgical Abortion - Use of transcervical procedures for terminating pregnancy, including vacuum aspiration, and dilatation and evacuation (D&E).

Medical Abortion

Medical abortion in India is approved only up-to 7 weeks (49 days) of pregnancy.

Medical abortion can be done up-to 9 weeks (≤63 days) according to WHO – World Health Organization.

Advantages of Medical Abortion

Avoids surgery. Controlled by the woman and may take place at home. No need for admission to the Hospital. Usually well tolerated by women if properly counselled and motivated. No need to take leave from work, as bleeding can be manged with menstrual pads even while in office or at work.

Disadvantages of Medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Method of Medical Abortion

Mifepristone (200 mg) is always administered orally at first visit.Then Misoprostol (4 tablets = 800mcg) administered by different routes, including oral, vaginal, buccal and sublingual. Vaginal route is preferred as chances of success is much higher and lowest rate of side effects; as compared to other routes. For women having medical abortion, routine use of prophylactic antibiotics is not recommended.

When to seek medical attention during medical abortion

1. Prolonged or heavy bleeding (soaking more than two large pads per hour for two consecutive hours);

2. Fever lasting more than 24 hours;

3. Feeling generally unwell more than 24 hours after misoprostol administration.

Surgical abortion

It can be performed upto 12 weeks of pregnancy either by Vacuum aspiration or by Dilatation and evacuation (D&E).

Advantages of Surgical Abortion

Quick procedure. Complete abortion easily verified by evaluation of aspirated products of conception. Takes place in a Hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled.

Disadvantages of Surgical abortion

Requires instrumentation of the uterus. Small risk of uterine or cervical injury. Timing of abortion controlled by the Doctor and Hospital. Anaesthesia wneeds to be administered. Most doctors perform this procedure under short general anaesthesia. Woman needs to be in the Hospital for at least 6 hours. Effect of sedation will be there through out the day.

All women having surgical abortion, regardless of their risk of pelvic inflammatory infection, should receive appropriate prophylactic antibiotics pre- or peri-operatively.

Choice between Medical Abortion and Surgical Abortion

• If pregnancy is <= 7 weeks; medical Method with Mifepristone with misoprostol is favourable as success rate is as high as 97%.
• If pregnancy is between 7-12 weeks; surgical abortion is the only option.
• If pregnancy is beyond 12 weeks – 20 weeks, then woman needs to be hopsitalized and will be given either Mifepristone followed by Misoprostol tablet or only misoprostol tablets and woman will then abort like a miscarriage in the Hospital. If any products are remaining then it will be evacuated surgically.
• Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.
• If a woman fulfills the criteria for selecting either method i.e. (Before 7 weeks), final choice to be given to the woman.

Summary of Choice between Medical abortion and Surgical abortion in India

<= 7 weeks - Medical method or Surgical method 7-12 weeks - Surgical abortion 12 – 20 weeks – Medicines with or without surgical procedure in Hospital.

Laboratory and other investigations

The following tests, when available, may be performed on the basis of individual risk factors, findings on physical examination, and available resources:

1. pregnancy test if pregnancy is unconfirmed;

2. Haemoglobin (Hb) for suspected anaemia;

3. Rhesus (Rh)-testing, where Rh-immunoglobulin is available for Rh-negative women;

4. HIV testing/counselling;

5. Other laboratory tests as indicated by medical history (kidney or liver function tests, etc.);

6. Ultrasound, if indicated, to confirm pregnancy dating or the location of the pregnancy.

Side-effects and complications

Pain, Bleeding, Fever, Nausea and vomiting, Diarrhoea, Pelvic infection

Follow-up care

• Medical Abortion - There is no medical need for a mandatory routine follow-up. Women should be able to have a follow-up visit if they desire. If a follow-up visit is scheduled, it should be between 7 and 14 days.
• The use of clinical signs and symptoms with bimanual examination, human chorionic gonadotrophin (hCG) levels or ultrasonography (if available) can confirm abortion completion.
• If a woman reports ongoing symptoms of pregnancy and/or has only minimal bleeding or persistent bleeding after 14 days or excessive bleeding after taking the abortifacient medications it is better completed by surgical method

"Authored By Dr.Niraj Mahajan"