The selection of clients for Medical Termination of Pregnancy (MTP) involves a careful assessment of the woman’s medical, obstetric, and social circumstances to determine eligibility and appropriateness for the procedure.

Get the full solved assignment PDF of MME-302/As-4 of 2024 session now.

MTP services should be provided within the legal and ethical frameworks of the respective country, ensuring respect for women’s reproductive rights, autonomy, and informed decision-making. Here are the general criteria and considerations for selecting clients for MTP:

Contents

Criteria for Selecting Clients for MTP:

Gestational Age:

In most jurisdictions, MTP is legally permissible up to a specified gestational age limit, typically ranging from 10 to 24 weeks of gestation, depending on national laws, regulations, and clinical guidelines.
Gestational age is determined based on the woman’s last menstrual period (LMP), ultrasound dating, or other reliable methods of gestational age assessment.

Medical Indications:

MTP may be indicated for medical reasons to preserve the woman’s health, prevent serious maternal complications, or address fetal anomalies or medical conditions incompatible with life.
Medical indications for MTP may include severe maternal illness, life-threatening conditions, fetal anomalies incompatible with survival, or risks to maternal mental health.

Fetal Viability:

Consideration should be given to the viability of the fetus outside the womb, taking into account gestational age, fetal development, and the potential for fetal survival with appropriate medical intervention.
MTP is generally not performed for non-medical reasons after the point of fetal viability, which is typically around 24 weeks of gestation.

Risk to Maternal Health:

MTP may be indicated when continuation of the pregnancy poses a significant risk to the woman’s physical or mental health, including risks of injury, disability, or exacerbation of pre-existing medical conditions.
Evaluation of maternal health risks should involve a comprehensive assessment of medical history, current health status, and potential risks associated with continuing the pregnancy.

Psychosocial Factors:

Consideration should be given to psychosocial factors affecting the woman’s decision-making, mental health, and well-being, including socioeconomic status, social support, domestic violence, substance abuse, and reproductive coercion.
Counseling and support services should be provided to address psychosocial needs, facilitate informed decision-making, and ensure access to appropriate care and resources.

Informed Consent:

The woman’s informed consent is essential for MTP, ensuring that she understands the nature of the procedure, its potential risks and benefits, and available alternatives.
Informed consent should be voluntary, non-coerced, and based on accurate information provided in a culturally sensitive and linguistically appropriate manner.

Methods of MTP in the Second Trimester:

Medical Methods (Medical Abortion):

Medical abortion in the second trimester involves the administration of medications, typically a combination of mifepristone and misoprostol, to induce uterine contractions and expulsion of the fetus and placenta.
Medical abortion may be performed up to 24 weeks of gestation, although efficacy and safety may vary depending on gestational age and other factors.
Close follow-up and monitoring are required to assess treatment response, manage potential side effects or complications, and ensure completion of the abortion process.

Surgical Methods (Surgical Abortion):

Surgical abortion techniques used in the second trimester include dilation and evacuation (D&E) or dilation and extraction (D&X), depending on gestational age, provider expertise, and local regulations.
D&E involves dilating the cervix and removing the contents of the uterus using suction and instruments, while D&X (intact dilation and extraction) involves intact removal of the fetus through the cervix.
Surgical abortion is typically performed under local or general anesthesia in a clinical setting, with appropriate pre-operative evaluation, monitoring, and post-operative care.

Induction of Labor:

In some cases, MTP in the second trimester may involve induction of labor using medications such as prostaglandins or oxytocin to stimulate uterine contractions and initiate the process of labor and delivery.
Induction of labor may be indicated for medical reasons, fetal anomalies, or maternal health concerns, with careful monitoring of maternal and fetal status throughout the labor process.

Multifactorial Approaches:

Depending on individual circumstances and clinical considerations, a combination of medical and surgical methods, or sequential approaches, may be used to achieve safe and effective termination of pregnancy in the second trimester.
Multifactorial approaches may be tailored to the woman’s preferences, medical indications, gestational age, and available resources, with consideration given to maximizing efficacy, minimizing risks, and ensuring patient-centered care.

The selection of clients for MTP and the choice of method should be guided by evidence-based clinical guidelines, ethical principles, and legal regulations, with a focus on promoting women’s health, autonomy, and rights throughout the decision-making process and provision of care. Access to comprehensive reproductive health services, including MTP, contraception, and post-abortion care, is essential to ensure the reproductive rights and well-being of women and girls worldwide.