Soluci´on natural

It means spontaneous or induced termination of pregnancy before the foetus is viable. Normally, the foetus becomes viable after 20 weeks of pregnancy. But sometimes, children born before 20 weeks of pregnancy have also survived. With better medical facilities available now, it is possible to save premature babies more easily and more often. ‘Abortion’ usually refers to expulsion of fertilised ovum within 3 months of gestation. If expulsion occurs between 4–7 months of pregnancy, it is called ‘miscarriage’. Premature baby is defined as a baby who comes out before full-term but usually after 7 months of pregnancy. It takes about 7–10 days for fertilised ovum for implantation. Up to 9th week, the fertilised ovum is called ‘embryo’ thereafter, it is called ‘foetus’.

CLASSIFICATION OF ABORTION

Abortion is classified into following categories: 1. Natural Abortion: It is called ‘spontaneous

abortion’ too and commonly occurs within 3 months of pregnancy. About 10–15 per cent of all pregnancies are aborted within 3 months of pregnancy.

The following are the common causes of natural abortion:

(a) Acute systemic infections like respiratory or abdominal infections.

(b) Hypertension, diabetes mellitus and systemic diseases.

(c) Blood disorders like anaemia, Rh incompatibility.

(d) Blunt trauma to abdomen.

(e) High anxious states like sudden shock, fear, joy, sorrow or emotional set-up.

(f) Acute infection of vagina, uterus or ovaries. (g) Congenital malformation of uterus, fibroids,

etc.

(h) Genetic abnormalities of foetus. (i) Idiopathic.

2. Induced Abortion: It may be of following types:

(a) Therapeutic abortion: This abortion is done by a medical practitioner under the ambit of Medical Termination of Pregnancy Act 1971 at a place duly authorised by law. Under the Act, a pregnancy can be legally terminated on following grounds:

(i) Therapeutic grounds: It applies when the continuation of pregnancy would endanger the life of the woman, or would cause grave injury to her physical or mental health. In this case, pregnancy can be terminated at any stage.

(ii) Eugenic: Eugenic grounds involve the risk of child being born with serious physical or mental abnormalities like

Abortion and Medical Termination of Pregnancy 145

anencephaly, big head, Turner’s syndrome, Down syndrome, etc.

(iii) Humanitarian: If the pregnancy has

been caused by rape, it can be terminated under humanitarian grounds.

(iv) Social grounds: Social grounds apply for termination in case of a married woman where:

– Pregnancy has resulted due to failure of contraceptive methods adopted. – Continuation of pregnancy can cause

injury to physical or mental health of the woman by changing social or economic environment.

The termination of pregnancy has to be done at a government hospital or any nursing home or hospital duly authorised by government authorities. If the duration of pregnancy is less than 12 weeks, one registered medical practitioner can terminate it. But if the pregnancy is above 12 weeks but less than 20 weeks, two medical practitioners are required for termination. No pregnancy above 20 weeks can be terminated except when warranted to save the life of the woman (under therapeutic grounds). The registered medical practitioners conducting the termination of pregnancy must be registered with medical council and be duly competent to conduct abortion. A medical practitioner with M.D. degree in obstetrics and gynaecology or diploma in gynaecology and obstetrics or MBBS degree holder who has assisted in at least 25 cases of medical termination of pregnancy under supervision is competent to perform abortion under the Act.

The place where termination is done should be well equipped with facilities for the operation and administration of anaesthesia and should be recognised by competent authorities.

Consent: Consent of the woman is

mandatory except when she is minor or

mentally ill. In such cases, consent from parents or guardians can be taken. Consent of the husband of the married woman is not necessary.

Emergency cases: In case of emergency

any registered medical practitioner of any specialty irrespective of obstetrics and gynaecology can terminate pregnancy at any place, irrespective of duration if it is done to save the life of the pregnant woman. (b) Criminal abortion: When the abortion is

not done as prescribed under Medical Termination of Pregnancy Act, it is called ‘criminal abortion’ and is punishable under law.

Most of the criminal abortions are done within first 3 months of pregnancy. In India, female foeticide is very common as some people have a strong desire for male child. They keep on doing female foeticide till the woman is pregnant with a male child. In some communities where dowry demands are quite high, female foeticide is very common. They get to know the sex of the foetus by ultrasound. The sex of the baby is differentiated at 4 months of gestation and can be easily detected by ultrasound. If the foetus is a female, parents opt for abortion. In order to prevent foeticide, the Government of India has banned ultrasound examination for detection of sex under the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of sex selection) Act, 1994.

In poor families, criminal abortion is common as they cannot afford to go to private clinics for abortion, and opt for unskilled health workers for abortion. Although in a government hospital there is no charge for MTP, still abortion by unskilled workers is quite common in India. WHO has defined ‘unsafe abortion’ as abortion not provided through approved facilities and/or persons.

146 Concise Textbook of Forensic Medicine and Toxicology Unsafe abortion is very common in India. Section 312 of the I.P.C. defines ‘causing miscarriage’ as an abortion done is not in good faith and will be punishable with a sentence ranging from 3 to 7 years, even if the abortion is done with the consent of the woman. Section 313 of the I.P.C. states whoever conducts an abortion without consent of the woman may get imprisonment from 10 years to life imprisonment. Section 314 states that if a person causes death of a woman while doing miscarriage without her consent, he can be punished up to life sentence and if he is doing with consent of woman, he can be punished up to 10 years.