GUIDELINE FOR STERILIZATION
Age of husband >25---<50yrs
Age of wife >20---<45yrs
Must have 2 living child
If > 3 child the lower limit of age restriction can be relaxed
Ready to give informed consent
Sterilization :female sterilization and male vasectomy are permanent method of contraception and highly effective
28% of reproductive age women undergo tubal ligation and 10% of men undergo vasectomy.
Sterilization methods include:
1- Vasectomy in males.
2- Tubal Ligation in females .
Surgical procedure performed on a woman
Fallopian tubes are cut, tied, cauterized mechanically blockage of both fallopian tube to prevent the sperm reaching and fertilizing the oocyte
sterilization performed by laparoscopically(under GA) or through a suprapubic “mini-laparotomy”
Failure rates vary by procedure, from 0.8%-3.7%
Advantages:
• intended to be permanent• highly effective• safe• quick recovery• lack of significant long-term side effects• cost effective
Disadvantage:
•Complication:A women may experienced anesthetic problem or may be
damage to intra-abdominal during the procedure.
NOTE: ectopic pregnancy can be a late complications and any sterilized women who misses her period and has
symptom of pregnancy should seek medical advice.
• difficult to reverse
• future pregnancy could require assisted reproductive technology (such as IVF)
• more expensive than vasectomy
Male sterilization procedure
Vasectomy involve division of the vas deferens on each side to prevent the release of sperm during ejaculation.
No-scalpel technique available
Faster and easier recovery than a tubal ligation
Failure rate = 0.1%, more effective than female sterilization
Usually done under local anesthesia.
Disadvantages:
• reversal is difficult, expensive, often unsuccessful
• not effective until all sperm cleared from the
reproductive tract (may take up to 12 w)
• no protection from STDs
Immediately bleeding, wound infection and hematoma may occur.
At the cut of vas deferens small lump will appear as a result of a local inflammation response this is called sperm granuloma it needs surgical excision.
some men develop anti-sperm antibody following vasectomy
TERMINATION OF PREGNANCY BEFORE THE FOETUS BECOMES VIABLE…(ADMINISTRATIVELY 28TH WEEK AND WEIGHT 1000 gm)
Early complication::: hge, shock, sepsis uterine perforation, thromboembolism.
Late complication::: Infertility, ectopic
NEED TO LEGALISED
Abortions are termed legal only when all the following conditions are met: Termination done by a medical practitioner
approved by the Act Termination done at a place approved under the
Act Termination done for conditions and within the
gestation prescribed by the Act
MTP Act - an enabling act which Aims to improve the maternal health scenario by
preventing large number of unsafe abortions and consequent high incidence of maternal mortality & morbidity
Legalizes abortion services Promotes access to safe abortion services to women De-criminalizes the abortion seeker Offers protection to medical practitioners who
otherwise would be penalized under the Indian Penal Code (sections 315-316)
MTP Act [1971] lays down when & where pregnancies can be
terminated Grants the central govt. power to make rules
and the state govt. power to frame regulations MTP Rules[1975]
lays down who can terminate the pregnancy, training requirements, approval process for place, etc.
MTP Regulations lays down forms for opinion, maintenance of
records custody of forms and reporting of cases
1. Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental health of woman. [MEDICAL]
2. Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped. [EUGENIC]
3. Pregnancy caused by rape (presumed grave injury to mental health). [HUMANITARIAN]
4. Contraceptive failure in married couple (presumed grave injury to mental health).
5. Socio economic condition if leads to injury to the mother.
Up to 20 weeks gestation
With the consent of the women. If the women is below 18 years or is mentally ill, then with consent of a guardian
With the opinion of a registered medical practitioner, formed in good faith, under certain circumstances
Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks
A hospital established or maintained by
Government
or
A place approved for the purpose of this Act
by a District-level Committee constituted by
the government with the CMHO as Chairperson
A medical practitioner (RMP) who has a recognized medical qualification as
defined in clause (h) of section 2 of Indian Medical Council Act, 1956
Whose name has been entered in a State Medical Register and
Who has such experience or training in Gynecology and Obstetrics as prescribed by Rules made under the Act
For termination up to 12 weeks:
A practitioner who has assisted a registered
medical practitioner in performing 25 cases of MTP
of which at least 5 were performed independently
in a hospital established or maintained or a training
institute approved for this purpose by the
Government
For termination up to 20 weeks
A practitioner who holds a post-graduate degree or diploma in Obstetrics and Gynecology
A practitioner who has completed six months house job in Obstetrics and Gynecology
A practitioner who has at least one-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities on or after date of commencement of the act
A practitioner who has at least three-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities before date of commencement of the 1971 MTP act
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