Describe medical termination of pregnancy — its aetiology, clinical features and management.

Definition

Medical termination of pregnancy (MTP) is the legally permitted, deliberate termination of pregnancy by a registered medical practitioner under the provisions of the MTP Act, 1971 (amended 2021) in India.

Legal Gestational Limits (india)

• Up to 20 weeks — on the opinion of one registered medical practitioner.
• 20–24 weeks — on the opinion of two practitioners, for specified categories (e.g. Survivors of rape, minors, change in marital status, fetal abnormality, disability).
• Beyond 24 weeks — only for substantial fetal abnormality, on the approval of a Medical Board.

Indications

Risk to the life or physical/mental health of the woman, substantial fetal abnormality, pregnancy from rape/incest, and contraceptive failure (for any woman and her partner).

Methods

• Medical — mifepristone followed by misoprostol (up to about 9 weeks).
• Surgical — suction evacuation / manual vacuum aspiration (up to ~12–14 weeks), and dilatation and evacuation later.

Complications

• Immediate — haemorrhage, uterine perforation, cervical injury and anaesthetic complications.
• Delayed — incomplete abortion, pelvic infection/sepsis, and failed termination with a continuing pregnancy.
• Remote — cervical incompetence, intra-uterine adhesions and (with repeated procedures) menstrual disturbance.

Pre-requisites

The procedure requires the informed written consent of the woman, performance by a registered medical practitioner with the prescribed training, at a government-approved place, with maintenance of the woman's confidentiality.

A Note on WHY the MTP Act Exists — and What It Prevents

A useful point is understanding why India legalised abortion, and what the law is actually for. Before the MTP Act (1971), abortion was illegal, so women who needed one resorted to unsafe abortion at the hands of untrained persons — and septic abortion, with its haemorrhage, sepsis, renal failure and uterine perforation, became one of the leading causes of maternal death. The Act's purpose was therefore not to encourage abortion but to make it safe: by permitting it, under defined conditions, to be performed by a registered medical practitioner at an approved place. That framing explains its provisions: the grounds (risk to the woman's life or of grave injury to her physical or mental health; substantial risk of serious fetal abnormality; pregnancy resulting from rape — presumed to cause grave mental injury; and failure of a contraceptive device, which extends the law to any woman with an unwanted pregnancy); the limit (extended by the 2021 Amendment to 24 weeks for specified categories, with no upper limit where a Medical Board diagnoses substantial fetal abnormality); and the requirement for the woman's consent alone (not her husband's; a guardian's if she is a minor or mentally ill). Crucially, the Act also protects confidentiality — and does not permit abortion for sex selection, which is separately prohibited by the PCPNDT Act.

MTP Act 2021 permits termination up to 24 weeks in specified categories.

• The MTP Act (1971; amended 2021) legalised abortion to make it safe — unsafe abortion was a leading cause of maternal death.
• Grounds: risk to the woman's life or grave injury to physical/mental health; substantial risk of serious fetal abnormality; rape; contraceptive failure.
• Limits: up to 20 weeks (one doctor's opinion); 20–24 weeks for specified categories (two doctors); no upper limit for substantial fetal abnormality (Medical Board).
• Consent: only the woman's consent is required (a guardian's if she is a minor or mentally ill) — not the husband's; confidentiality is protected.
• Methods: medical (mifepristone + misoprostol, up to 9 weeks) or surgical (suction evacuation; D&E later). Sex-selective abortion is forbidden (PCPNDT Act).