Here’s the **complete extracted text** from all the uploaded images — clearly formatted and structured for study and note-making 👇 --- ## **MEDICAL TERMINATION OF PREGNANCY** ### **MTP Act & Methods** **Amendments 2021:** * **Congenital anomalies:** up to 24 weeks * **Contraceptive failure:** up to 20 weeks * **Severe congenital anomalies:** no upper limit → should be approved by medical board **Composition of medical board:** * Gynaecologist * Paediatrician * Radiologist * Person assigned by State **Indications:** * Rape * Contraceptive failure * To save life of pregnant female * Prevent grave injury to physical/mental health of female * Substantial risk of fetus with physical/mental abnormalities **Consent:** * Patient ≥18 years old → self * Patient <18 yrs / mentally unstable → guardian **Opinion:** * Up to 20 weeks → single doctor * 20–24 weeks → two doctors **Records:** * Marriage proof & FIR report of rape → *not required* * Records of rape → maintained minimum 5 years **Qualification:** * MD/MS/DGO/DNB in OBG * Registered medical practitioner: * Assisted in 25 MTPs + Primary surgeon in 5 * 6-month house job in OBG * Worked in OBG dept of multispeciality hospital ≥1 year --- ### **Methods of MTP (Based on Technique Used)** | Medical Abortion | Surgical Abortion | | -------------------------------------------- | ---------------------------------------------- | | Non-invasive | Fast procedure | | No surgical/anaesthetic complications | One-time completion | | No surgical expertise needed | One-step procedure | | **Disadvantages:** failure → surgical needed | **Disadvantages:** invasive, anaesthetic risks | --- ## **Based on Gestational Age** | 1st Trimester | 2nd Trimester | | -------------------------------- | ------------------------------------------------- | | Mifepristone + Misoprostol | Misoprostol/Carboprost/Dinoprostone | | Suction evacuation | Oxytocin | | Manual vacuum aspiration (rural) | Extra-amniotic Ethacridine, intra-amniotic saline | | Menstrual regulation (outdated) | Dilatation & evacuation, Hysterotomy | --- ## **1st Trimester Abortions** ### **Medical Abortions** **Management:** OPD basis **Timing:** Up to 9 weeks (63 days) **Drugs used:** * **Mifepristone (oral):** progesterone antagonist → detachment of implanted embryo * **Misoprostol (oral/sublingual/vaginal/rectal):** uterine contraction + cervical ripening → expulsion **Protocol:** * **Day 1:** Mifepristone 200 mg orally * **Day 3:** Misoprostol 800 µg (vaginal > sublingual >> oral) → bleeding after 4–6 hr * **Day 15:** Follow-up **USG in MTP:** not routine **Indications:** unsure LMP, uncertain uterine size, pain, continuous spotting after 15 days --- ## **Suction Evacuation** **Best method:** 9–12 weeks (up to 16 weeks) **Pre-requisites:** 1. Empty bladder 2. PV exam (confirm uterine position) 3. Retract vaginal walls with speculum/retractor **Procedure:** * Dilate cervix using **Hegar’s dilators** * Insert **Karman’s cannula** (plastic, triangular openings) * Attach to suction machine → evacuate POC --- ### **Karman’s Cannula** * Plastic, triangular openings * Size = period of gestation (in mm) * Uses: * Suction & evacuation * Incomplete/missed abortion * Endometrial biopsy (India) * Max number used: 16 * Suction pressure ≥ 600 mmHg --- ### **Anesthesia for S&E** **Paracervical block:** * 1% lignocaine * Sites: 12 o’clock (tenaculum), 4/8/10 o’clock (injection) * Avoid 3/9 o’clock (cervical artery) **End Point:** * ↓ blood loss * Air bubbles in cannula * Grating sensation → gripping uterus --- ## **Perforation during S&E** **Using dilator:** * Stop procedure → wait & watch * Prevention: hold dilator pen-style **Using KC (Karman’s Cannula):** * Identified by: * Loss of resistance * Cannula goes deep * ↑PR, ↓BP → shock * Severe pain **Management:** * Stop, don’t remove KC * Inform senior * Check vitals * Stable → diagnostic laparoscopy * Unstable → resuscitation + laparotomy --- ## **Manual Vacuum Aspiration (MVA) vs Menstrual Regulation (MR)** | Feature | MVA | MR | | ------------ | ------------------------------- | ------------------ | | Significance | Alternative to S&E (rural) | Outdated | | Requirement | MVA syringe, KC, no electricity | MR syringe | | Syringe | Double pinch valve | Single pinch valve | --- ## **2nd Trimester Abortions** ### **Methods** * Medical abortion * Surgical methods: suction (≤16 wks), dilatation & evacuation --- ### **Medical Abortion** **Drug:** Prostaglandins (best) * Misoprostol (PGE₁) – best * Dinoprostone (PGE₂) * Carboprost (PGF₂α) **Dose:** Misoprostol 400 µg q3h (max 5 doses) **In-patient care:** required **Effect:** Mini labor → expulsion **Note:** Mifepristone not used in 2nd trimester abortion --- ### **Surgical Abortion (Dilatation & Evacuation)** **Instrument:** Ovum forceps / Sponge-holding forceps **After procedure:** Blunt curettage **Note:** * Always do blunt curettage in pregnant uterus (except post-molar pregnancy) * If failed misoprostol abortion → do not continue pregnancy (teratogenic → **Moebius syndrome**) --- ✅ **All images and notes fully transcribed (Marrow Obstetrics v1.0 – 2024).** Would you like me to now make **15 high-yield case-based MCQs** on this full topic (MTP + 1st & 2nd trimester abortions) using **HTML, CSS & JS** in one file?