गर्भपात

आचतुर्ाभत् ततो मासात् प्रस्रवेद्

गर्भववच्युवत : ।
तत: स्थर्रशरीरस्य पात:
पन्चमषष्ठ्यो : ॥
सु.सं.वि. ८/१०
, मा.वि. ६४/२
अर्ाभत् चतुर्भ मास तक गर्भ ववच्युवत (
स्वथर्ाि से अलग हो कर वगरिा) होिे
 DEFINITIONS
• Medically, abortion is expulsion or
extraction from its mother of an
embryo or fetus weighing 500 g or
less, when it is not capable of
independent survival ( WHO).
• This 500 gm of fetal development is
attained at about 22 weeks of
gestation.
• Legally , abortion means expulsion of
product of conception from the uterus
at any period before full term.
• Abortus : the non viable product of the
abortion.
• Abortifacient : any agent that induces
abortion.
• Some authors use the term abortion as
expulsion of ovum within first 3 months of
pregnancy.
• Miscarriage as expulsion of fetus from 4th
-7th months; and premature delivery , the
delivery of baby after 7 months of
pregnancy and before full-term.
Classification of Abortion
Abortion
Natural / Induced /
spontaneous Artificial
Threatene
d Legal / Illegal
Justifiable (Criminal)
Inevitable
Complete
Missed
Septic
 NATURAL / SPONTANEOUS
ABORTION
• Incidence : 10-20% of all pregnancy.
• Most frequent within first 3 months,
owing to weak attachment of ovum to
uterine wall ( 75% abortions occur
before 16th week and out of these,
75% before 8th week of gestation.
• Abortion occurs without any induction
procedure and usually coincides with
menstrual flow.
Causes
 Genetic
• Majority of early abortions are due to
chromosomal abnormality.
• Autosomal trisomy is commonest cause
(50%)and most common is trisomy 16 ( 30
%).
• Monosomy and chromosomal aberration (
including deletion, duplication,
translocation and inversion) constitutes
20% and 2-4 % of all abortions
respectively.
 Anatomic
• Cervico-uterine factors usually cause
second trimester abortions.
• Cervical incompetence.
• Congenital malformation of uterus, e.g.
hypoplasia, bicornuate / septate uterus or
duplication of upper part of uterus.
• Uterine fibroid.
 Endocrine and metabolic
abnormalities.
• Diabetes mellitus
• Hypo- or hyperthyroidism
• Luteal phase defect
• Deficient progesterone secretion from
corpus luteum.
 Infections
• Viral : Rubell, cytomegalovirus, vaccinia,
variola or HIV.
• Bacterial : Ureaplasma, Chlamydia or
Brucella
• Parasitic : Toxoplasma or malaria.

Immunological
Both autoimmune and alloimmune factors
can cause miscarriage.
 Others
• Maternal illness : Cyanotic heart disease
or hemoglobinopathies .
• Anti-fetal antibodies.
• Blood group incompatibility :
incompatible ABO and Rh group.
• Premature rupture of the membranes.
• Environmental Factors : Cigarette
smoking ,drugs, chemicals , noxious
agents, in situ contraceptive agents , X-ray
exposure and antineoplastic drugs.
Artificial or Induced Abortion
• It means willful termination of pregnancy
before viability . It can be :
• Legal or justifiable : when it is done in
good faith to save the life of the woman
and performed within the legal
provision of MTP Act.
• Criminal : Induced destruction and
expulsion of fetus from womb
unlawfully. It is induced before the 3rd
month, and cause infection and
 Criminal Abortion
• Legal aspect : Dealt under section 312-316 IPC
• Sec.312 IPC : whoever voluntarily causes criminal
abortion with the consent of the patient is liable for
imprisonment upto 3 years / or fine , and the woman is
quick with child imprisonment may extend upto 7
years.
• Sec 313 IPC : if miscarriage is caused without consent
imprisonment upto 10 years and fine.
• Sec 314 IPC : if pregnant woman dies from this act
imprisonment upto 10 years and fine.
• Sec 315 IPC : Any act done with intend to prevent the
child being born alive or cause its death before birth is
punished with imprisonment upto 10 years/ or fine.
• Sec . 316 IPC : Any act which cause death of quick
unborn child amounts to culpable homicide and
imprisonment upto 10 year and fine.
 Methods for inducing
Criminal Abortion
• 1. Abortifacient drugs
• 2. General violence
• 3. Local Violence
 Abortifacient drugs
• Most of them have no effect on uterus or
fetus , unless given in toxic doses and
often sold to exploit distressed woman.
Usually used in 2nd month of pregnancy.
1.Ecbolics : They increase uterine
contractions, e.g. ergot preparation ,
synthetic estrogen, strychnine and quinine.
2. Emmanagogues : they produce or
increase the menstrual flow. They acts as
abortifacient when given in large and
repeated doses. The chief of these are
• 3. GIT irritants : these cause irritation of
the uterus e.g. purgative like castor or
croton oil , senna , Magnesium sulphate .
• 4. Genito- urinary irritants : they
produce reflex uterine contraction e.g.
cantherides, oil of terpentine etc.
• 5. Drugs having systemic toxicity :
• Inorganic irritants , e.g. lead, copper, iron
and mercury.
• Organic irritants : e.g. Abrus precatorius ,
Calotropis , Seeds of Cutard apple and
carrots and unripe fruit of papaya etc.
 General Violence
• Any act directly on the uterus or indirectly
to produce congestion of pelvic organs or
hemorrhages between uterus and
membranes.
• Resorted to upto end of the first month .
• It is likely to cause injury then the abortion.
• It can be intentional or accidental.
 Intentional
1. Severe pressure on abdomen by kneeling,
blows, kick, tight bandage and massage of
uterus through abdominal wall.
2. Violent exercises, like horse riding
,cycling, skipping or jumping from height.
3. Cupping : A mug is turned mouth
downwards over a light wick and placed on
hypogastrium and mug is pulled , which result
in partial separation of the placenta. This is
usually practiced in advanced pregnancy.

Accidental
 Local Violence
• Usually employed in 3rd- 4th month when
other methods have failed .
• Interference may be skilled , semiskilled or
skilled.
 Various methods employed
for Abortion
• 1. Syringing : ordinary enema syringe
with a hand bulb is commonly used to
inject fluid into uterus , the hard nozzle
being inserted into cervix .
• Higginson’s syringe can be used soap
water is often used as injection material ,
• Irritating substances added to water such
as lysol , cresol, alum , KmnO4 or
formaline .
• 2. Syringe Aspiration : Large syringe with
plastic cannula is inserted into cervix ;
develop suction which ruptures early
gestational sac and leads to aspiration and
expulsion of contents.
• 3. Vacuum aspiration : The cervix is
dilated and tube is attached to a suction
pump extracts the fetus.
• 4. Rupturing of membranes : the
membranes are ruptured by introduction
of an instrument , like probe ,stick,
uterine sound, catheter, pencil ,pen holder,
knitting needle and hairpin.
5. Abortion Stick :
• It is a wooden or bamboo stick , 12-18 cm
long , wrapped at one end with cotton ,
wool or piece of cloth and soak with juice
of marking nut, calotropis or paste made of
arsenious oxide or lead.
• It is introduced into the vagina or os by
dais and retained there, till the contraction
starts.
• Instead of this stick , a twig of some irritant
plant , like Plumbago rosea, Calotropis or
Nerium odorum.
6. Dilatation of cervix :
• foreign bodies are introduced and left in
cervical canal , like pessaries , laminaria ( a
dried seaweed) or sea tangle tent which
dilate the cervix , irritate uterine mucosa and
produced marked congestion and uterine
contraction by expulsion of fetus.
• Cervical canal may be dilated by introducing
a compressed sponge into the cervix and
leaving it there . Sponge swells up from the
moisture in the uterine segment with
expulsion of fetus.
• Slippery elm bark (Ulmus fulva) obtained
from tree in central America, is inserted into
cervical canal . They absorb moisture and
within a few minute a jelly like layer is
produced cause dilatation.
• 7. Air insufflations : Air is introduced into
vagina and uterus by various means , like
pumps or syringes leading to abortion.
• 8. Electric current : An electric current of
110v the negative pole is placed over the
cervix in the posterior vaginal vault and
positive over the sacrum or lumbar
vertebrae. When current is passed , uterus
contracts and may expel its contents.
• 9. Pastes : Paste containing iodine and
thymol, potassium iodide ,or mercury or
Fetex paste is introduced in the extra
 Complication of Criminal Abortion
Immediate Delayed Systemic Remote
complication complication

Vagal Septicemia Jaundice , Chronic

inhibition Generalize hepatitis, debility,
Acute renal Chronic pelvic
Air d
failure, pain,
embolism peritonitis Endocarditis, Ectopic
Fat Pyemia Pneumonitis, Pregnancy,
embolism Toxemia Pulmonary Secondary
Hemorrhag Local embolism, infertility,
e Infection Endotoxic Depression
Shock.
Amniotic Tetanus
Fluid
 Medico-legal importance of
placenta
• Gives an idea of the length of
gestation.
• In criminal abortion ,often pieces are
retained in the uterus.
• Transfer of poisons, bacteria,
antibodies across the placenta may
result in death , disease or
abnormalities of fetus.
 Duties of a Doctor in suspected
Criminal Abortion
1. He must ask the patient to make a
statement about the induction of criminal
abortion. If she refuses, he should not pursue
the matter ,but inform the police .
2. Doctor should keep the information
obtained by him as a professional secret.
3. He must consult a professional
colleague.
4. If the woman condition is serious, he
must arrange to record the dying declaration.
5. If the woman dies, he should not issue
the death certificate , but should inform the
police for post-mortem examination.