OG20.1 | Medical Termination of Pregnancy — Summary & Reflection

KEY TAKEAWAYS

Medical Termination of Pregnancy in India is governed by the MTP Act 1971 as amended by the MTP (Amendment) Act 2021 and MTP Rules 2021. The key gestational tiers are: (1) ≤20 weeks — one RMP's opinion sufficient; (2) 20–24 weeks — two RMPs + specified category (rape/incest survivors, minors, foetal anomaly, marital-status change, disability, humanitarian); (3) >24 weeks — State Medical Board for substantial foetal abnormality only. Pre-procedure assessment must confirm intrauterine pregnancy, gestational age by ultrasound, blood group (Rh-negative women need anti-D), haemoglobin, and absence of contraindications. First-trimester MTP uses mifepristone 200 mg + misoprostol 800 mcg (medical, up to 9–10 weeks) or MVA/EVA (surgical, up to 12–14 weeks). Second-trimester MTP uses mifepristone + high-dose misoprostol or D&E. Complications include incomplete abortion (managed by re-evacuation or additional misoprostol), haemorrhage (uterotonics — note ergometrine contraindicated in hypertension, carboprost in asthma), septic abortion (IV antibiotics + evacuation), and uterine perforation (surgical review). Follow-up at 2 weeks is mandatory after medical MTP.

REFLECT

Recall the woman from the opening scenario who requested MTP at 8 weeks after contraceptive failure. You now know the law permits this with a single RMP's opinion, and the mifepristone-misoprostol protocol is the appropriate method. Reflect on how the non-directive counselling approach — explaining her options without judgment — aligns with the ethical principle of patient autonomy. How would you counsel a woman at 22 weeks who has just received a prenatal diagnosis of a lethal foetal anomaly? What are the emotional, legal, and practical steps you would walk through with her? Write a brief counselling script for this scenario.