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The reproductive rights of women with intellectual disability (WID) are a matter of concern for all stakeholders, including the woman herself, caregivers, guardians and her treating physicians. The judicial system often calls upon psychiatrists to opine regarding the “capacity to consent” of a WID to procedures such as medical termination of pregnancy and permanent sterilisation. Apart from physical and obstetric examinations, assessment of mental status and intelligence quotient (IQ) are also carried out to facilitate an understanding of the above issue. The Rights of Persons with Disabilities Act, 2016, (RPwD) and the Mental Healthcare Act, 2017, elucidate what constitutes free and informed consent as well as how to assess capacity. The assessment process of “capacity to consent” to reproductive system procedures among WID is important and can guide clinicians. Before assessing capacity, the treating physicians should educate a WID with appropriate information on the proposed procedure, its risks and benefits through various means of communication and then evaluate the “capacity to consent” to the procedure. This article summarises the provisions of the existing legislations on the reproductive rights of WID and puts forward guidance for clinicians on how to approach the issue.
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Background: MTP (is common procedure done by obstetrician under certain circumstances as per MTP rules and guideline, but it has certain complication and data about complication are not fully available. The aims of this study are to analyse various complication and causes of this complication following MTP presenting at our hospital.Methods: This study was conducted in 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical college, Udaipur attending OPD (including emergency OPD) and IPD during August and September 2019 after MTP. This Study also included maternal mortality among all women participated in the study.Results: A total of 100 cases included in study attended OPD (including emergency OPD) and IPD during study period. All cases were eligible for inclusion in the study. Medical method of abortion (MMA) was the most common method of termination of pregnancy adopted by patient. Prolonged bleeding, anaemia and Incomplete abortion was the common complication related to MTP and manual vacuum aspiration was done in majority of cases to manage incomplete abortion in our hospital setting.Conclusions: The high rate of MTP related morbidity is due to induced abortion continue to be done at inappropriate places using inappropriate methods by person not eligible to do so.
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Background: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security.
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Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.
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Background: India is going to be highest populous country within less than a decade. To stabilize population growth as well as to reduce maternal mortality and morbidity resulting from unwanted pregnancy, greater utilization of the spacing methods is essential. In spite of several decades of effort the popularity of Cu-T among the Indian woman is not high. Aim of the study was to find out the profile of the Cu-T acceptor after medical termination of pregnancy (MTP).Methods: It was a retrospective study. Socio-demographic data of the woman accepting Cu-IUCD after MTP was collected from family planning operation theatre record book.Results: The majority of the participants were from rural area. The mean age of the acceptor was 27.28±4.78. The maximum number of woman was para two 74 (44.3%). The number of woman with LCB 2 years or less than 2 years was 96 (57.5%) and that of woman with LCB more than two years was 71 (42.5%).Conclusions: A significant number of woman use Cu-T after a long gap of two years after last child birth. Woman found to be inclined to use Cu-T after having at least one male child.
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Background: The adoption of the Medical Termination of Pregnancy (MTP) Act has allowed for abortion on the grounds of medical and social reasons since 1972.The aim of the present study is to establish the demographic of women seeking abortion care services and to determine the role of different factors in the timing of seeking an abortion.Methods: A retrospective hospital record-based study was carried out among pregnant women seeking an MTP in a tertiary care hospital in Mumbai. The records of women seeking MTP over a 5-year period from January 2012 to December 2016 were accessed and data pertaining to their demographic and obstetric history was recorded. Statistical tests of significance and analysis were done.Results: A total of 803 women underwent an MTP from January 2012 to December 2016. The number of deliveries during the same time period was 13735. The most common age group was 25-30 years. Stratification in terms of the educational backgrounds showed that 45.7% had received only secondary school education while 12.7% had no schooling. Majority of the women (74.8%) availed an MTP in the first trimester, out of which, most of them (36.9%) had 2 previous pregnancies. Most women coming in the second trimester (43.6%) hadn’t conceived before.Conclusions: Education didn’t seem to be a significant factor in determining the timing of seeking an MTP. School education did not necessarily include exposure to sexual education. Experience in terms of parity was more relevant in identifying signs of pregnancy and seeking appropriate services in a timely manner.
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Background: Medical termination of pregnancy (MTP) has been legalized in India since 1971. MTP pills are well effective inthe early weeks of gestation and safe only when used under medical supervision.Aims and Objectives: The aim of the study was to find out the clinical presentations and complications following selfadministration of MTP pills.Materials and Methods: This was a retrospective observational study conducted at SMGS Hospital, Government MedicalCollege Jammu from July 2018 to June 2019. Hundred patients were included in the study. Following factors were studied suchas chief complaints, complications, treatment given, and blood transfusion.Results: Majority (57%) of patients were aged between 30 and 39 years. About 66% were gravid three or more. Only 28% hadtaken the pill within prescribed gestational age limit for MTP, i.e., <7 weeks. Mid-trimester pill intake was encountered in 14%patients. About 41% presented with incomplete abortion. Anemia was present in majority of patients and blood transfusion wasdone in 38% patients. About 24% patients presented with life-threatening shock. Sepsis was present in 5% patients. Emergencylaparotomy was required in 4% cases. Hysterotomy was done in 2% cases. Continuation of pregnancy was noted in 6% patients.Unintended pregnancy and limiting family size were main reasons for abortion 62% and 32%, respectively.Conclusions: Unauthorized over-the-counter availability despite legal ban and ignorance of women have led to increasednumber of unsafe abortions. Increasing awareness among women regarding complications of unsupervised pill intake andeasily availability of safe contraceptive methods can help control this health hazard.
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Background: Emergency contraception (EC) is a safe and cost effective measure, which when used judiciously can avoid unintended pregnancies. This is especially relevant in our country where both population control and unsafe abortions are a serious concern. For any contraceptive to be effective, the general population must have a proper knowledge and a positive attitude towards it. Women who come for medical termination of unwanted pregnancy are the best representatives of this and our study aimed to assess the knowledge and awareness of EC in this group.Methods: It was a descriptive, cross-sectional study conducted using a predesigned questionnaire among 100 women who came for medical termination of pregnancy at G. B. Pant Hospital, Port Blair. Questions were asked to evaluate their awareness, knowledge and attitude towards EC.Results: Out of 100 women, only 26 % had heard about EC, mostly from mass media, and seven of these 26 women had correct knowledge of timing of using EC. Four women had used EC before, whereas among others, fear of menstrual irregularity was the major deterrent. A significant association was found between education level and occupation with knowledge of EC.Conclusions: Although EC is a potent tool to avoid unwanted pregnancies, ignorance and misconceptions regarding EC is unfortunately still prevalent among those who would benefit the most from it. Medical personnel and health workers should be more proactive to propagate benefits of EC and encourage its use, as they are usually the first point of contact to the target population.
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Objective: To compare the outcome of two regimes of mifepristone and misoprostol (oral vs vaginal and sublingual administration of misoprostol) for medical termination of early pregnancy (within 49 days). Study design: A randomized controlled study was conducted. On 75 women undergoing medical termination of pregnancy (MTP) within 49 days of amenorrhea (7 weeks). These women were divided into two groups – Group 1: received tablet mifepristone 200 mg orally followed by tablet misoprostol 600 mcg oral after 48 h. Group 2: received tablet Mifepristone 200 mg orally followed by misoprostol tablet 800 mcg, two tablets administered per vaginum and two tablets advised to be taken sublingually after 12 h. An ultrasonography pelvis was performed on all patients pre-MTP to confirm the location and age of gestation and post-MTP on day 15 to confirm no retained products of conception. Statistical analysis was done by two proportion tests for individual side effect with the null hypothesis. Results: The complete abortion rates in Group 1 were 91.4% as compared to 90% in Group 2. Only 11.4% of women in Group 1 and 12.5% in Group 2 had bleeding for more than 15 days. The duration and amount of bleeding were statistically similar in both groups. Conclusion: We concluded that after 48 h of administration of mifepristone, oral 600 mcg of misoprostol is as efficient as 800 mcg of misoprostol (administered vaginally, 400 mcg and sublingually, 400 mcg) in inducing medical abortion of pregnancy within 49 days of amenorrhea.
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Introduction: Mifepristone and misoprostol are the two drugs which are given at 36-48 h interval for medical abortion. This study was designed to study the efficacy of early administration of misoprostol (24 h after mifepristone) for medical termination of pregnancy less than 9 weeks and to compare this with standard protocol of mifepristone misoprostol combination at 48 h interval. Materials and Methods: Subjects for this single center prospective randomized case-control study were enrolled from the family planning outdoor patient department at our hospital with gestational age of less than 9 weeks. All subjects initially received 200 mg of oral mifepristone and then were randomly assigned to receive per vaginal 400 μg misoprostol at 24 h (study group) and 48 h (control group). They were then followed up after 14 days with transvaginal sonography to confirm completion of expulsion. Treatment was considered failed if surgical evacuation was needed for any indication. Primary outcome measure was success rate of the two treatment regimens. Results: Totally, 200 subjects were randomly allocated to each treatment arm (100 each). Complete expulsion was seen in 94% (94/100) in study group and 95% (95/100) in control group according to intention to treat analysis (P value ns). According to per protocol analysis success rate in study group was 93.6% and 94.3% in control group (P value ns). High failure rate after 7 weeks period of gestation in both the study and control group was found (26.3% and 30.0%; P value ns). Adverse effects were mostly similar in both the groups. Conclusion: Efficacy of mifepristone misoprostol combination at 24 h interval was similar to that at 48 h interval for medical abortion of pregnancy less than 9 weeks without compromising the safety (CTRI No. 2010/091/001422).