Presented by- Subhansee Sahu.

3rd prof.Bams
Guided by- Dr.Swapna Swayamprabha
Ma’am
Dr.Niroj Kumar Suna Sir
 Abortion

• Expulsion or extraction from its mother

of an embryo or foetus weighing 500g
or less when it is not capable of
independent existence.
• The 500g foetal development is
attained approximately at 22 weeks.
Etiology –
• Chromosomal .endocrine
• Infection . Anatomic
• Immunological .Thrombophilic
• Environmental .Others
Natural Abortion – Also known as
spontaneous abortion (miscarriage).
Classification-
• Threatened Abortion
• Inevitable Abortion
• Complete Abortion
• Incomplete Abortion
• Septic Abortion
 Artificial Abortion

1. Legal or therapeutic ( MTPAct)

Abortion:-
• Abortion is justifiable only when it is
done in good faith to save the life of
woman,if it is materially endanger
by the continuation of pregnancy.
MTP Amendment Act,2021
• The MTP act,2021 has came into
force with effect from 24th
sept,2021.

• The MTP Rule 2021 was notified on

12 th Oct,2021.
 Indications
• Therapeutic- when the period of
pregnancy endangers the life of
woman or may cause serious injury
to her physical or mental
health.The indications are very
limited.
1 ) cardiac disease
. 2) psychiatric illness with
the
Advice of a
• Eugenic- when there is risk of
being child born with severe mental
retardation.(measles,TORCH,small
pox,drugs).

• Humanitarian—when pregnancy has

been caused by rape.

• Social-when pregnancy has

resulted from the failure of
contraceptive methods in case of a
married woman, which is likely to
cause serious injury to her mental
 AIMS OF MTP
• Aims to improve maternal health
scenario by
preventing large number of unsafe
abortions
and consequent high incidence of
maternal
Mortality & morbidity.

• Legalizes abortion services.

• Promote access to safe abortion services

to women
MTP Act,2021-8 sections
1)Sec 1-Short title, extent and
commencement.
2) Definitions
3)When pregnancy can be
terminated.
4)Places where MTP can be done.
5) Sections 3 & 4 when not to apply.
6) Power to make rules.
7) Power to make regulations.
8) Protection of actions taken in
good faith.
Rules Of MTP:
 Who is authorised to do MTP ?
a)Qualified RMP possessing pg
degree or diploma in ob & G
(MD/DGO).

b)RMP who has assisted in

performing 25 cases of MTP.

C)RMP +6 month experience as

• MTP Amendment Act,2014 allows
Ayurvedic & homeopathic
practitioners to conduct MTP.
Consent-
• Consent of Pregnant
woman>18 year.

• <18 year mentally ill of

any age –Guardian written consent.

• Consent of husband is not

necessary.

• Abortions can not be performed by

the request of her husband, if the
• Places where the MTP can be
conducted?

1. A hospital established or maintained

by Government.

2. A place approved for the purpose of

this act by a District level committee
(DLC) Constituted by the government
with
Chief medical health officer as a
chairperson.
• Duration of pregnancy vs who is
authorised to do MTP ?

• A/c to MTP act 1971,

1) If the period of pregnancy is less
than12 weeks, it can be
terminated by a single doctor.

2) If the period of pregnancy is

between 12 & 20 weeks, two
doctors must agree that there is
an indication.
• In an emergency, pregnancy can be
terminated by a single doctor,even
without required training without
consulting a single doctor, in private
hospital which is not recognised.
A/c to act 2021,
• One RMP for termination of
pregnancy up to 20 weeks of
gestation.

• 2 RMP for termination of pregnancy

up to 20 to 24 weeks of gestation.
(Form E)

• State level medical board is essential

for a pregnancy to be terminated
after 24 weeks.
Upper gestation limit up to 24
weeks:
• In MTP act,2021 the upper
gestationional limit increases from
20 to 24 weeks.
(Sec 3(2 C& D).
Punishments:-

The termination of pregnancy,

1.) by a person who is not recognised

medical practitioner.

2.)or in an unrecognised hospital

should be punished with rigorous
imprisonment .(2 -7 years)
• Confidentiality:-
• S.5A-Not to reveal name of woman
or any other particulars of woman.

• Punishment : Imprisonment upto

1year or fine or both.

• Miscarriage without consent of

woman Imprisonment upto 10 years
( 313 IPC).
Special category of woman for MTP
upto 24 weeks:-Sec 3(2 b)
• Survivors of sexual assault or
rape or incest.
• Minors
• Change of marital status during
the ongoing pregnancy.
• Woman with physical disabilities.
• Mentally ill woman including
mental retardation.
• Foetal malformation.
• Woman with pregnancy in
humanitarian settings or disaster
or emergency situations as
declared by the government.
First trimester termination of pregnancy
(Up to 12 weeks)-
Medical method-
• Mifeprestone and misoprostol(PGE1)
• Mifepristone 200-600 mg orally
followed in 48 hours by misoprostol
200-600 microgram orally or 400-800
microgram bucally, sublingually or
vaginally.
• Methotrexate (50 mg/M2)IM ( before 56
days of gestation) & misoprostol (7
days later 800 microgram.
• Letrozole & misoprostol.
Surgical methods of 1st trimester abortion-
• Vacuum Aspiration-
• Done during 1st 3 months.
• Cervix is dilated & cannula is introduced into
uterine cavity.(8-12 weeks – 9mm.cannula).
• A negetive pressure of 0.4 -0.6 kg/sq.cm is
produced in the uterine cavity for evacuation
of contents.

• Dilatation of the cervix and evacuation of

uterus by curettage.
(Vacuum Aspiration)
Midtrimester termination of pregnancy
(13-24 weeks)-
Medical methods-
Prostaglandins & their analogs
• Misoprostol
• Mifepristone & misoprostol
• Dinoprostone(PGE2 analog)

• Amniotic fluid replacement therapy .

• Surgical Methods-
• Dilatation & evacuation
• Hysterectomy
Criminal Abortion
• A criminal Abortion is the induced
destruction & expulsion of foetuses
from the womb of the mother
unlawfully i.e., When there is no
therapeutic indication for the
operation.

• It is mostly resorted to widows &

unmarried woman.
1. Abortifacient Drugs-
• Most of them have no effect on uterus
Unless given in toxic doses .
• Usually used in 2 month of pregnancy.

Echbolics- They increase uterine

contractions.
Eg-Ergot
preparations,Strychnine,quinine,
Synthetic oestrogen,pitutary extracts.

Emmenagogues- These drugs initiate or

increase menstrual flow.eg-
GIT Irritants- These causes irritation of
uterus.eg-Purgatives likes castor or croton
oil,julap,Senna & Mgso4.

Genitourinary irritants- They produce reflex

uterine contractions.eg-canthraides,oil of
turpentine or pennyroyal.

Inorganic irritants- lead,cupper,iron,

mercury.
Organic irritants- Arbus
precatorius,calotropis,Seed of custard apple
& carrot, unripe fruit of papaya.
General violance –
• Any procedure acting directly on uterus
or indirectly to produce pelvic congetion
Or haemorrhage between uterus &
membranes.
• Usually done upto 1st month.
• Can be intentional or accidental.

Intentional-
• Severe pressure on abdomen by
kneading,blows,
. Kicks, jumping,tight lancing , massage of
uterus
• Cupping
• very hot & cold hip bath alternatively.
Local Violance
• Usually employed in 3 rd -4 th month
when other methods have failed.

1. Syringing- The ordinary enema syringe

with a hand bulb is used to inject fluid
into uterus.the hard nozzle insert into
cervix.
• The suction valve is placed in a bowl of
fluid & pressure applied on the bulb.the
fluid detaches part of amniotic sac,and
placenta from uterine wall followed by
(Higginson's
Syringe)
Vacuum aspiration- The cervix is dilated &
a tube attached to a suction pump extracts
the foetus.

Rupturing of membrane - The membranes

are ruptured by Introduction of an
instrument like
probe,stick,Catheter,pencil,pen holder,
hairpin.

Dilatation of cervix – Foreign bodies are

introduced & left in cervical canal Like
pessaries,laminaria tent,seatangle tent
(Laminaria
tent)
Abortion Stick-
• It is a wooden or bamboo stick ,12-18 cm
long Cotton wool or piece of cloth &
soaked With juice of marking nut,
calotropis,or paste made of arsenous
oxide or lead.
• It introduced into vagina and retained
there till contraction starts.
Air insufflation - Air is introduced into
vagina & uterus by various means.

Electric current - An electric current of

110 v
With negetive pole applied to posterior
vaginal wall and positive to lumbosacral
region.
Evidence of Abortion –
In the living victim –
• Breast show pigmentation.
• Secretion of milk or colostrum from
the nipple
• Linea nigra/albicans May be Present.
• In advanced pregnancy, the uterus
may be palpable even after abortion.
• Congestion of labia majora or minora
often present.
• Ulceration of vagina or cervix may be
noted.
• A swab may be taken from the
In the dead victim-
• Undergarments may show blood clots,and
fragments of POC.
• Perforation of pelvic organ may be noted.
• Uterus may show marked
instrumentation.
• Vaginal fluid should be collected for
chemical analysis.
• Swab should be taken for microbiological
investigation.
Medico legal Questions –
• Whether the woman was pregnant or
not (proof of pregnancy) is required
for actual Abortion, but not for
attempt to do it.

• Fabricated abortion- when a woman is

assaulted,she may try to exaggerate
the offence by alleging that it caused
her to abort.
she may acquire a human or animal
foetus to
Supply the charge.
Woman in either case, punishment is
by life imprisonment.

• Whether death of the child was

caused by the act of Abortion.

• Whether death of the woman was

due to the abortion or its attempt.
In instrumental Abortion –
1) Has any instrument been used,
and if so when?

2) What kind of instrument was

used?

3) How many injuries present be

interpreted?

4) Was instrumentation self induced

or assisted?
Medico legal importance of
placenta?
• It gives an idea of the length of
gestation.

• In criminal Abortion often pieces

are retained in the uterus.

• The transfer of poisions, bacteria,

antibodies,etc across placenta
may result in death, disease,
abnormalities of foetus.
Case presentation
We report the case of a woman, over the
age of 18 years, who presented to the
hospital holding her dead fetus wrapped in
a towel. The placenta was still in her uterus.
Complete expulsion of the placenta
occurred at the hospital on the same day.
During the consultation, the woman
explained that she had been involved in a
car accident and, as a consequence of the
impact, had aborted her fetus. Since there
was suspicion of an illegal abortion, the
forensic pathologist and the gynaecologist
 woman revealed no traumatic injuries,
such as bruising, haematoma or
lacerations. The gynaecologist
performed a speculum examination of
the cervix revealing two lesions of the
uterine cervix, which were bleeding
despite being cleaned with gauze These
injuries were attributable to fetal
expulsion through the pinching of the
cervix with surgical forceps. An
ultrasound examination revealed the
absence of maternal and uterine disease
or intracavitary pouring. Therefore, it
was clinically evident that there was no