Medical Termination of Pregnancy

Discovering that one is pregnant can be a cherished time for the parents-to-be. But sometimes, the pregnancy may have to be terminated because of a threat to the mother’s health, risk of complications, or other reasons.

The termination can be done via medications or surgery. In the initial stages, termination through medication is a safer option than surgical means. If, however, the pregnancy period has crossed 9 weeks, a surgical termination (Dilation and Curettage – D & C) must be considered to safeguard the mother’s health.

What is Medical Termination of Pregnancy (MTP)?

Abortion is the common term used for the procedure to end a pregnancy so that it does not result in the birth of a child. It is also called ‘termination of pregnancy.’ When abortion is done using certain medicines it is called medical termination of pregnancy (MTP).

The most common medications used for this purpose are two pills of mifepristone and misoprostol. Mifepristone blocks the hormone required for pregnancy (progesterone) while misoprostol induces cramping and bleeding to empty the uterus contents.

Usually, a gynaecologist will recommend this if the pregnancy is up to the first trimester. Beyond the first trimester, medical termination of pregnancy or surgery (Dilation and Curettage – D & C) is recommended.

What are the reasons for doing MTP?

MTP may be done for specific reasons including,

• Pregnancy posing risk to the mother’s life or High-risk pregnancy
• Presence of foetal or genetic abnormalities
• Completion of a miscarriage
• Unwanted pregnancy

The situation leading up to termination is different for everyone. Getting an abortion is a major decision that can affect the mother’s mental and physical health. Consult your doctor and talk to trusted friends or family members before taking the big step.

How Is Abortion (Both Medical & Surgical) Done?

Abortion or MTP may be done in two different ways, depending on the gestational age:

Medical Abortion—This procedure is done early in the pregnancy (before 9 weeks), where you are advised to use certain medicines for termination. You will be given an MTP kit with oral medications. After a week of taking the MTP tablet, your doctor will do a detailed examination to ensure a complete abortion.

Surgical Abortion—When the pregnancy has gone beyond 9 weeks, it may be terminated through surgery. There are two types of surgical abortion:

• Suction Method, which can be done up to 15 weeks which takes about 5-10 minutes from start to end.
• Dilatation and Evacuation (D & E) Method, which can be carried out after 13 weeks of pregnancy weeks which takes about 15-30 minutes from start to end.

What Happens During a Medical Abortion?

A medical abortion involves taking pills either by mouth or vagina. The first medication to be taken is Mifepristone which terminates the pregnancy and the other one is Misoprostol which empties the uterus.

The drug Mifepristone acts by blocking the hormone progesterone. The blockage of progesterone causes thinning of the uterus lining. This ensures that the foetus does not attach to the uterus.

The drug Misoprostol causes contraction and bleeding of the uterus. Ideally, Misoprostol must be taken within 24 to 48 hours of taking Mifepristone.

A lot of people start noticing the effects of both medicines shortly after taking misoprostol. The common effects include:

• Heavy cramps and bleeding
• Blood clots
• Low grade fever or chills that last for more than a day
• Tiredness
• Nausea
• Diarrhea
• Dizziness.

What Is An MTP kit?

An MTP kit is a kit used for medical termination of pregnancy within 7–9 weeks of gestation. The kit contains oral medications mifepristone and misoprostol. The combined action of the two medicines blocks the progesterone needed for pregnancy and induces contraction of uterus to assist in the abortion.

Some of the side-effects of MTP kit include: nausea, abdominal pain, vomiting, and vaginal bleeding.

Who Can Conduct An Abortion?

The MTP procedure can be carried out according to law by,

• A registered medical practitioner, who has done at least 25 pregnancy terminations
• A surgeon trained in obstetrics/gynaecology
• A obstetrician or gynaecologist with minimum three years of experience

Who is eligible to undergo MTP?

• Women who want to abort an unwanted pregnancy and are in the early stages (up to nine weeks) can undergo MTP.
• In special circumstances that are prescribed under the law in India, women can get an abortion up to 24 weeks.

Who Shouldn’t/Cannot Undergo MTP or Medical Abortion?

Although medical abortion is legal and can be performed under medical supervision, it is still not recommended in certain cases. Before going for an abortion, it is important to discuss your medical history with your healthcare provider.

A medical abortion is not safe in the following cases, if:

• The pregnancy is beyond 20 to 24 weeks.
• The pregnant woman is allergic to certain medications.
• The pregnancy is developing outside of the uterus, that is ectopic pregnancy.
• The pregnant woman is using long-term corticosteroids.
• An intrauterine device (IUD) is in place.
• The pregnant woman has a blood clotting disorder, anaemia, or chronic adrenal failure.
• Those who have blood disorders, anaemia and seizures
• Those women whose pregnancy is too far along (above 20 weeks)
• Women with ectopic pregnancy
• Those who have high blood pressure, heart or kidney diseases
• Women using an intrauterine device (IUD)

What are the Benefits of Medical Abortion? 

Medical abortion is safe and effective to terminate pregnancy up to 9 weeks. With a medical abortion: 

• You can terminate a pregnancy in early stages with mild pain.
• Termination of pregnancy will feel natural as compared to a surgery.
• You can terminate the pregnancy at home.
• You can have people around you to support during your tough time. 

What are the Risks of Medical Abortion?

Generally, medical abortions are safe and effective. It is, however, important to take your medications as per doctor’s prescription. Skipping a dose or two may pose certain health risks:

• Retained pregnancy tissue and failure to terminate pregnancy.
• Heavy and continuous bleeding.
• Digestive pain.
• Diarrhoea.
• Allergic reactions to medications
• Vaginal infection including vaginal odour lasting for more than 24-48 hours.

Recovery after MTP

Mifepristone and Misoprostol are effective up to 98% with fewer complications. The recovery, however, may vary for people. Most of people start to feel better after the bleeding stops. Normal activities can be resumed once your bleeding stops completely. But, make sure to take a lot of rest following the procedure.

Consult your gynaecologist if there is severe vaginal bleeding, fever, vomiting or other symptoms.

If you have undergone a medical/surgical abortion, ensure you take lots of rest following the procedure. Consult your gynaecologist if there is severe vaginal bleeding, fever, vomiting, or other symptoms.

What to Expect After a Medical Abortion?

One of the major side effects of medications are vaginal bleeding and cramping. The bleeding may occur for several days and may continue for days similar to mensuration. In general, the bleeding starts reducing from 2nd to 3rd week.

In some cases, the healthcare provider may schedule a follow-up appointment within 2-5 weeks or even conduct an transvaginal ultrasound scan (TVS) to confirm whether the medical abortion is complete.

Is Medical Abortion Legal in India?

Yes, abortion is legal in India and is governed by the Medical Termination of Pregnancy (MTP) Act that was passed by Parliament in August 1971.

The Government of India has laid down certain regulations to govern medical abortion in India. According to the Medical Termination of Pregnancy (MTP) Act, 1971, the use of medications, that is Misoprostol and Mifepristone is approved up to the 9 weeks of pregnancy.

The MTP Act permitted abortion under stipulated circumstances up to a gestational period of 20 weeks, and based on expert medical opinion. Under the provisions of this Act, medical termination of pregnancy maybe allowed when,

• Going ahead with the pregnancy may endanger the life of the pregnant woman;
• Continuing with the pregnancy may cause significant risk to the physical and mental well-being of the woman;
• The infant born out of this pregnancy may be at risk of physical or mental anomalies;
• The pregnancy is a result of rape, as alleged by the woman; or a result of failure of contraceptive method used by the pregnant woman or her husband.

Abortion can be done by a registered medical practitioner when the pregnancy does not exceed 12 weeks and up to a gestational period of 20 weeks, under the supervision of two registered medical practitioners.

In all circumstances, the abortion has to be conducted with the consent of the pregnant woman.
In 2002, an amendment was made to the 1971 Act to allow the usage of abortion pills after advice of a doctor.

Under the MTP (Amendment) Act, 2021, the upper limit for abortion was increased from 20 to 24 weeks. But this will be allowed only under specific circumstances.

What Is The Cost Of Medical Termination Of Pregnancy (MTP)?

To know more about the cost of a medical termination of pregnancy (MTP) Click here. However, the MTP cost may vary from person to person or case to case based on several factors.

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