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1. Legal Framework (MTP Act 2020 Amendment)
- Gestational Limits
- Up to 20 weeks: Requires opinion of one Registered Medical Practitioner (RMP)
- 20 to 24 weeks: Requires opinion of two RMPs for specific categories.
- Beyond 24 weeks: Only for substantial fetal abnormalities; requires approval from a four-member State-level Medical Board.
- Special Categories (20–24 weeks)
- Survivors of sexual assault, rape, or incest.
- Minors (under 18).
- Change of marital status during ongoing pregnancy (widowhood/divorce).
- Women with physical or mental disabilities.
- Contraceptive Failure
- Applicable to both married and unmarried women (a major change from the 1971 Act).
- Limit: Strictly up to 20 weeks.
- Confidentiality
- The name and particulars of the woman must not be revealed except to a person authorized by law. Punishment includes imprisonment up to 1 year.
- Mifepristone (RU-486)
- Action: Anti-progestogen; detaches the embryo by blocking progesterone receptors.
- Dose: 200 mg orally (Day 1).
- Misoprostol (PGE1 Analogue)
- Action: Prostaglandin; causes cervical ripening and uterine contractions.
- Dose: 400 mcg or 800 mcg (Day 3) via oral, sublingual, or vaginal route.
- Eligibility
- Medical MTP is generally highly effective up to 9 weeks (63 days) of gestation.
- Vacuum Evacuation (Standard for 1st Trimester)
- MVA (Manual Vacuum Aspiration): Uses a 60 mL syringe; effective up to 12 weeks.
- EVA (Electric Vacuum Aspiration): Requires 600 mmHg pressure.
- Dilation and Evacuation (D&E)
- Preferred for 13–15 weeks (Early 2nd trimester).
- Key Instruments
- Cusco’s/Sim’s Speculum: To visualize the cervix.
- Hegar’s Dilators: To dilate the cervical os.
- Karman Cannula: Flexible tube for suction (Size in mm ≈ Gestational age in weeks).
- Ovum Forceps: Spoon-shaped, no catch/lock to prevent uterine injury.
4. Nursing Responsibilities & Complications
- Pre-Procedure
- Confirm Written Informed Consent (Woman's consent only if >18 years; Guardian if <18 or mentally ill).
- Ensure Ultrasound (USG) is done to rule out ectopic pregnancy.
- Assess Rh status; if Rh-negative, prepare Anti-D Immunoglobulin (50 mcg for <12 weeks; 300 mcg for >12 weeks).
- Intra-Procedure
- Monitor for the "Uterine Cry" (grating sensation) signifying the cavity is empty.
- Watch for vasovagal shock (bradycardia, fainting).
- Post-Procedure & Complications
- Perforation: Most common site is the fundus; monitor for sudden abdominal pain.
- Incomplete Abortion: Most common cause of post-MTP primary hemorrhage.
- Sepsis: Indicated by fever, foul discharge, and pelvic tenderness.
- Follow-up: Mandatory visit on Day 15 to ensure complete evacuation.
- Standard follow-up for medical MTP: 14–15 days.
- Consent for MTP: Only the woman's consent is needed if she is an adult.
- Rh-Negative Mother: Anti-D must be given within 72 hours of the procedure.
- Best time for MTP: 8–10 weeks (safest window).
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