ABORTION

Abortion is the termination of pregnancy before the period of viability i.e., 20 weeks of gestation or birth weight of 500 grams.

TYPES OF ABORTION:

There are two types of abortion:

1. Spontaneous Abortion
2. Induced Abortion
   
   SPONTANEOUS ABORTION :
   
   It is also known as miscarriages. It occurs spontaneously without the patient’s will. It may occur due to some complications. They are of four types –
   
   a. Incomplete Abortion
   b. Complete Abortion
   c. Threatened Abortion
   d. Inevitable Abortion
   
   INDUCED ABORTION :
   
   It may be legal i.e., MTP or illegal i.e., criminal abortion. Induced abortion is done in order to preserve mother’s health or may be done in case of any foetal abnormality.
   
   THREATENED ABORTION :
   It is the type of abortion in which per vaginal bleeding starts and then stops i.e., remains for a short period of time which is suggestive of possibility of miscarriage but it can be reversed and prevented. The amount of bleeding varies and bleeding is not too heavy. On examination, internal os is closed, uterus and cervix are soft. Patient is advised to take rest, avoid coitus and limit her physical activities for about 2 weeks.
   
   INEVITABLE ABORTION :
   It is a type of abortion in which bleeding occurs to such an extent that pregnancy can’t be now preserved and abortion can’t be prevented. Woman also suffers from painful uterine contractions. On examination, internal os is open and uterus is soft. In this case dilatation and curettage or suction evacuation followed by curettage is carried out if this occurs before 12 weeks of gestation. If it occurs after 12 weeks, mini labour is conducted with the help of oxytocin infusion.
   
   INCOMPLETE ABORTION :
   It is a type of abortion in which products of conception are discharged outside the uterus but discharge is not complete i.e., products of conception are still left inside the uterus. On examination internal os is open. Incomplete abortion can lead to sepsis. Dilatation and evacuation or suction and curettage is performed in case of abortion before 12 weeks. In case of abortion after 12 weeks dilatation and curettage is performed.
   
   COMPLETE ABORTION :
   It is a type of abortion in which products of conception are completely discharged outside the uterine cavity. As soon as all the products of conception is discharged the internal os closes. On performing USG uterus is empty. In this type of abortion no treatment is needed.
   
   MEDICAL TERMINATION OF PREGNANCY (MTP) :
   
   Induced abortion was first legalized in India through Medical termination of pregnancy act of 1971. Induced abortions through MTP are done in following cases –
   • Failure of contraception
   • Case of rape
   • Bad maternal health
   • Child which the lady is bearing is going to have some abnormality
   
   MTP is permitted up to 20 weeks of gestation. For performing MTP consent of spouse is not required. Pregnancy can only be terminated on the written consent of pregnant lady. MTP can only be performed by registered medical practitioners who have assisted at least 25 MTP.
   
   MTP can be performed by both surgical and medical methods. MTP in first trimester can be done by manual vacuum aspiration, suction curettage, dilatation and curettage, Mifepristone, Misoprostal. MTP in second trimester can be done by dilatation and extraction, dilatation and evacuation, conduction of mini labor by oxytocin infusion or prostaglandins
   
   Contributor- Medico Eshika Keshari