BIOLOGY INVESTIGATORY

PROJECT
MEDICAL TERMINATION OF
PREGNENCY
(MTP)

SUBMITTED BY:
. Gunal.S Xll A1
. GUG

.
J
 Certificate of Authenticity

This is to certify that Gunal.S a student of class 12th has successfully

completed the research product on the topic “MTP” under the guidance of
Mythili ma’am.

This project is absolutely genuine and does not indulge in plagiarism of

any kind. This reference taken in making this project has been declared at
the end of this project.

Signature (subject teacher) Signature (examiner)

 Acknowledgement

I f e e l p r o u d to p r e s e n t my i n v e s t i g a t o r y project in Biology on the “ “MTP”

This project would not have been feasible without the proper rigorous guidance of biology teacher
Ma’am Mythili. Who guided me throughout this project in every possible way. An investigatory
project involves various difficult lab experiments, which have to obtain the observations and
conclude the reports on a meaningful note. Thereby, I would like to thanks Ma’am Mythili for
guiding me on a systematic basis and ensuring that in completed all my research with ease. Rigorous
hard work has put in this project to ensure that it proves to be the best. I hope that it proves to be
the best. I hope that this project will prove to be a breeding ground for the next generation of
students and will guide them in every possible way.
 Introduction
Abortion is the ending of pregnancy by removing a foetus 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 foetus could potentially survive outside the womb is known as a "late
termination of pregnancy”, “post viability 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.
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 area’s
abortion is legal only in special cases such as rape, problems with the foetus,
poverty, risk to a woman's health, or incest. In many places there is much debate
over the moral, ethical, and legal issues of abortion. Those who are against
abortion largely claim that an embryo or foetus is a human with a right to life and
may compare it to murder. Supporters point to a woman's right to decide over her
own body and to human rights in general.
 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.
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 time.
According to Soranus' 1st or 2nd century CE work Gynaecology, one party of
medical practitioners banished all abortive 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 health.

Aristotle, in his treatise on government Politics (350 BCE), condemns infanticide

as a means of population control. He preferred abortion in such cases, with the
Okrestriction "[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 19th century. Islamic tradition has traditionally permitted abortion until a
point in time when Muslims believe the soul enters the foetus, 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.
The practice of induced abortion-the deliberate termination of pregnancy
Has been known since ancient times various methods have been used to
perform or attempt abortion, including the administration of abortifacient
herbs, the use of sharpened implements,the application of abdominal
pressure, and other techniques. The term abortion, or more precisely
spontaneous abortion, is sometimes used to refer to a naturally occurring
condition that ends a pregnancy, that is, to what is popularly called a
miscarriage. But in what follows the term abortion will always refer to as
Induced abortion
Abortion laws and their enforcement have fluctuated through various eras.
In much of the Western world during the 20th century, abortion-rights
movements were successful in having abortion bans repealed. While
abortion remains legal in most of the West, this legality is regularly
challenged by anti-abortion groups. The Soviet Union under Vladimir
Lenin is recognized as the first modern country to legalize induced elective
abortion care.
19th-century medicine saw tremendous advances in the fields of surgery,
anaesthesia, and sanitation. Social attitudes towards abortion shifted
in the context of a backlash against the women's rights movement.
Abortion had previously been widely practiced and legal under common
law in early pregnancy (until quickening), and it was not until the 19th
century that the English-speaking world passed laws against abortion.

There were a number of factors that contributed to this shift in opinion about
abortion in the early 19th century. In the United States, where physicians
were the leading advocates of abortion criminalization laws, some of them
argued that advances in medical knowledge showed that quickening
was neither more nor less crucial in the process of gestation than any
other step, and thus if one opposes abortion after quickening, one should
oppose it before quickening as well.
Practical reasons also influenced the medical field to impose anti-abortion
laws. For one, abortion providers tended to be untrained and member
of medical societies. In an age where the leading doctors in the nation were
attempting to standardize the medical profession, these "irregulars" were
considered a nuisance to public health.

Types Of Abortions
There are 2 kinds of induced abortions: surgical and chemical.

Surgical Abortion Procedures

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 foetus 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. Suction pulls apart the foetus’ body and out the uterus. After
suction, the doctor and nurses must reassemble the foetus’ 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
foetus and placenta. Then the abortionist inserts a curette (a loop-shaped knife)
into the uterus. The abortionist uses the curette to scrape any remaining foetal parts
and the placenta out of the uterus.

4. D & E (Dilation and Evacuation): within 13-24 weeks after last

menstrual period
The foetus literally doubles in size between the 11th and 12th weeks of pregnancy.
Soft cartilage hardens into bone at 16 weeks, making the foetus 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 foetal size. The abortionist then both tears and cuts the
foetus 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 foetus 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
foetus’ lungs absorb the salt solution, it begins to suffocate. It may struggle and
may even have convulsions. The saline also burns off the foetus outer layer of
skin. Saline abortion can take one to six hours before the foetus is no longer viable.
The woman begins labour 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 labour 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 labour) replaces saline.
Prostaglandin activates contractions. It can cause overly painful or intense labour;
there have been cases in which the violence of the contractions 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 caesarean 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.”
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 labour. As the woman labours, 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 foetus
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
labour and expels the dead foetus. 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

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 foetus) to
die. Misoprostol empties the foetus from the uterus by causing the uterus to
contract and push the foetus 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.
The Indian MTP Act
To avoid the misuse of induced abortions, most countries have enacted laws
whereby only qualified Gynaecologists 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.
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.
(ii) Where the continuation of pregnancy could lead to substantial risk to the
new-born 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.
⮚ A consent assures the clinician performing the abortion that she:
⮚ Has been informed of all her options.
⮚ Has been counselled about the procedure, its risks and how to care
for herself after she chosen the abortion of her own free will.

Person or persons who can perform MTP

⮚ Physicians qualified to do MTP are:
⮚ Any qualified registered medical practitioner who has assisted in 25 MTPs.
⮚ A house surgeon who has done six months post in Obstetrics
and Gynaecology.
⮚ A person who has a diploma /degree in Obstetrics and Gynaecology.
⮚ 3 years of practice in Obstetrics and Gynaecology for those doctors
registered before the 1971 MTP Act was passed.
⮚ 1 year of practice in Obstetrics and Gynaecology 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:
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 haemoglobin estimation.
⮚ Blood group and Rh factor.
 BIBLIOGRAPHY
The matter taken for the above project was taken
from the following sites: -

⮚ https://www.health.harvard.edu/

⮚ https://americanpregnancy.org/
⮚ https://www.acog.org/
⮚ https://en.wikipedia.org/
⮚ https://rationalwiki.org