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