Patient’s consent and agreement before giving abortion pills is must or…

Patient can file complaint against Doctor.

Recently there was one medico legal case where a newly married woman filed a police case against a Doctor for giving pills with out consent. She rather made a charge as she was not aware that Doctor was giving her tablets for termination of her pregnancy.

Case was filed against her Husband along with Doctor that both of them used an abortion pills to terminate her pregnancy which she was keen to continue.

In such cases only papers showing the proper consent of patient and record of case paper can only save the Doctor.

Why Abortion Pill fails?

Abortion pills shows variable results if used early, used in inadequate dosages or used with out proper clinical examination.

No proper Clinical Examination -

Sometimes it happens that a Doctor gives abortion pills after taking history. Doctor calculates the days of gestations on account of last menstrual period told by patient. Doctor usually does not perform bimanual examination of uterus.

If the size of Uterus is of more than 10 or 12 weeks then there are chances that patient bleeds vaginally for three four days and then bleeding gets stopped. And in such cases pregnancy may get continued.

Early dosages -

Conscious patients visit Doctors when she misses the period. Many times such patient’s demands abortion pills even if she has missed a date by two or three days. And many times Doctor does give the abortion pills without even confirmation of pregnancy by urine examination. Here also chances of failure are more as pregnancy may be in the tubes only.

Inadequate Dosages -

Some over smart patient take first dose and if minimal per vaginal bleed after 24 hours, she does not turn to Doctor for second dose. In such cases there are likely chances of either continuation of pregnancy or missed abortion or incomplete abortion.

Medical Abortion in India

Is survialence is done by government?

As the use of abortion pills are so commmon way to perform medical abortion...the real serious aspect of it is - Is anyone doing survialence as far as failure rate or other related things as  kept in medical field?

Has health authority is keeping an eye on the use of medical abortion pills?

Is some one is trying to impliment norms for use of abortion pills by medical practioners?

Abortion by pills

Medical abortion

It is known as abortion by using ‘the abortion pill'…a non surgical way of termination of pregnancy in a legal way.

Background:

Background:

Government has taken more liberal stand as far as use of medical abortion pills are concerned.

The general physicians or family physicians are allowed to use it for the termination of pregnancy of their patient having pregnancy up to 9 weeks of gestational period.

Changing Trends:

Changing Trends:

Previously the abortion pills was made available to only doctors having MTP registrations and facilities of MTP approved by government authorities.

Later on it was made freely available to all including family physician and general physicians.

And at present abortion polls are freely available in medical stores on the prescription of any qualified doctor.

Changing Trends:

Changing Trends:

To  edit

Abortion pills are popularized…

Abortion pills are popularized…

Once it’s use was with caution…but with more liberal use the abortion pills are now got the women’s most favorite drug to terminate unwanted pregnancy.

And also became the best choice to all physicians and also to gynecologist.

Changing norms of using Abortion pills:

Changing norms of using Abortion pills:

Norm of using abortion pills is still in changing mode…means not yet final.

Previous norm was to confirm pregnancy by ultrasound…then use abortion pills….and then again ultrasound to reconfirm…weather abortion is complete or not.

But recent trend is no need of ultrasound examination. The vaginal bimanual examination only sufficient to diagnose.

Patient are only referred for ultrasound if they do not give history suggestive of abortion or prolonged bleeding.

And patients are referred to MTP centers if the abortion pills are failed to abort pregnancy,

And patients are referred to gynecologist only if there is history of prolonged bleeding needing to do check curetage.

Dose of drugs and schedule is not fixed.

Dose of drugs and schedule is not fixed.
Previous dose advised was one tablet of mifipristol ( 200mg)…followed by two tablets of Misopristol ( 400 micro gm )
Till today there is no standard dose
Dose mifipristol ranges from 200 mg to 600 mg…
Dose misopristol ranges from 400 microgram to 800 microgram.
Oral route or Vaginal route of misopristol is flexible…and according to choice of patient and doctors…

Dosage

Dosage of Abortion pills:

1.One tablet of Mifipristole ( 200 mg )

orally on day One.

2.Followed by four tablets of Misopristol ( 800 micro gram ) on day Three…keep in vagina… deep in posterior fornix…

preferably by using sim’s speculum… to avoid accidental expulsion of tablets…

Gynecologist are benefited:

Gynecologist are benefited:

After confirmation of safety of drugs, gynecologists are more comfortable to use the drugs…

Apart from use as abortion pills…it is more convenient for them is to use misopristol…for initial dilatation of cervix prior to perform surgical abortion of pregnancy having 12 +/- 1 weeks pregnancy.

In many big set up or Institution abortion pills are used to do legal abortions up to 20weeks…No more ethacredene lactate is used now a days…

What is Legal in India?

What is Legal in India?

Though in many countries the use of abortion pills is up to 9 weeks of gestational period…in India it is restricted to 7 weeks that is 49 days of gestational period.

Registered medical doctor including family physician is the authorized for using abortion pills according to amendment in MTP act.

The required only condition is that the family physician should make provision of nearest MTP center for further treatment required and should inform regarding same to the patient and or her relatives.

He is suppose to provide details of same in written format to patient or relative.

He is suppose to display such information mentioning details like address and phone number of whom she is suppose to contact in case of emergency.

Contraindications...

Do not use abortion pills in following cases:

1. HB less than 8 gm %
2. Patient complaining Pain in abdomen…suspected /confirmed ectopic pregnancy / undiagnosed adnexal mass
3. coagulopathy or patient on anticoagulant therapy
4. chronic adrenal failure or current use of systemic corticosteroids
5. uncontrolled hypertension…more than 160/100 mmHg
6. cardio-vascular diseases such as angina, valvular heart diseases, arrhythmia
7. severe renal, liver or respiratory diseases
8. glaucoma of eye.
9. uncontrolled seizure disorder…epilepsy.
10. History of allergy or intolerance to mifepristone / misoprostol or other prostaglandins
11. lack of access to 24-hours emergency services.
12. Irresponsible or un co operative patient
13. Not willing to wait or anxious patient..
14. Not willing for surgical abortion in case of failure
15. Refusing to give consent in writing.
16. Patient moving to some other place …within 30 days.
17. Unknown person or woman…demanding tablets to take at home…she may misuse the tablets.
18. as an emergency contraceptives…to avoid pregnancy.
19. unconfirmed pregnancy…only menses are delayed and urine pregnancy test is negative.
20. Pregnancy with history of copper T of which position is not confirmed…or even if position is in situ.

Supportive therapy:

Supportive therapy:

1.Prescribe antispasmodics…

2. Prescribe prophylactic antibiotics if the procedure of abortion is delaying more than 3 to 5 days…

3.Advise check curettage or refer to specialist if bleeding is off & on and prolonged with history of pain in abdomen.

Ten Things which are must before using Abortion pills:

Ten Things which are must before using Abortion pills:

1.Detail History

2.General Examination.

3.Systemic Examination

4.Basic Investigations

5.Per vaginal bimanual examination

6..Counsilling of patient and relatives

7.To tell regarding likely complications.

8.To tell regarding likely failure and likely chances of abortion by surgical way.

9.To take proper consent in written format.

10.To explain need of follow ups.

PATIENT AGREEMENT FOR MEDICAL ABORTION

PATIENT AGREEMENT FOR MEDICAL ABORTION

1. Doctor answered all my questions and told me about the risks and benefits of using medical abortion pills / tablets to end my pregnancy.

2. I believe I am no more than 49 days (7 weeks) pregnant.

3. I understand that I will take one tablet in Doctor’s clinic (Day 1).

4. I understand that I will attend his clinic for second dose two days after I take first dose (Day 3).

5. Doctor gave me advice on what to do if I develop heavy bleeding or need emergency care due to the treatment.

6. Bleeding and cramping do not mean that my pregnancy has ended. Therefore, I must return to Doctor’s clinic in about 2 weeks (about Day 14) after I take tablets to be sure that my pregnancy has ended and that I am well.

7. I know that, in some cases, the treatment will not work. This happens in about 5 to 8 women out of 100 who use this treatment.

8. I understand that if my pregnancy continues after any part of the treatment, there is a chance that there may be birth defects. If my pregnancy continues after treatment with Medical abortion pills / tablets , I will talk with Doctor about my choices, which may include a surgical procedure to end my pregnancy.

9. I understand that if the medicines I take do not end my pregnancy and I decide to have a surgical procedure to end my pregnancy, or if I need a surgical procedure to stop bleeding, Doctor will do the procedure or refer me to another Doctor l. I have that provider’s name, address and phone number.

10. I have Doctor's name, address and phone number and know that I can call if I have any

questions or concerns.

11. I have decided to take Medical abortion pills / tablets to end my pregnancy and will follow my provider’s advice about when to take each drug and what to do in an emergency.

12. I will do the following:

- contact Doctor right away if in the days after treatment I have a fever of 100.4°F or higher

that lasts for more than 4 hours or severe abdominal pain.

- contact Doctor right away if I have heavy bleeding (soaking through two thick full-size

sanitary pads per hour for two consecutive hours).

- contact Doctor right away if I have abdominal pain or discomfort, or I am “feeling sick”,

including weakness, nausea, vomiting or diarrhea, more than 24 hours after taking abortion pills.

- return to Doctors clinic about 14 days after beginning treatment to be sure that my

pregnancy has ended and that I am well.

Patient Signature: ____________________________________

Patient Name:______________________________________Date:_________________

The patient signed the PATIENT AGREEMENT in my presence after I counseled her and answered all her questions.

Doctor’s Signature: ________________________________________

Name of Doctor : ______________________________________Date: _________________

One copy to the patient before she leaves the clinic and put one copy in file of her medical record.

PATIENT AGREEMENT FOR MEDICAL ABORTION

One copy to the patient before she leaves the clinic and put one copy in file of her medical record. 

Keep Records

it is importatant...
CASE PAPER FOR
MEDICAL (PILLS) TERMINATION OF PREGNANCY

Date -..............

Name of Patient - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 厖厖厖...

Age of Patient (completed years) - . . . . . . . . . . . . 厖厖厖... . .......

Name of Husband - . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .,.......................

Age of Husband (completed years) - . . . . . . . . .. ..................................

Full Address-....................................... Village/Town.................
Post office-. . . . . . . . . . . . . . . . Taluka- . ...................... .. District-. . . . . . . . . . . . . . . . .

History -

Chief complaints - .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Married / Unmarried / widow, age - . .... . Completed years.
Obstetric History - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1......................... .2. .........................3. ........................ .4..........................

Total children (sex & age) .. . . . . . . . . . . . . . . . . . . . . . . . ... ................:.......
LMP - . . . . . . . . . . . . . . . . . . . Date of last delivery - . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Past illness - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Particular Family history - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .

Particular Personal history - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

History of drug or other allergies - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Examination - Weight in kg'-. . . . . . . . . .

Pulse - . . . . / minute. Blood Pressure' . . . . . . . . / . .. mm hg. Temperature - . . . . deg. F

General condition - . . . . . . . . . . . . . . . . . . . . . . .. Nutritional condition - . . . . . . . . . . . . .

No pallor, no ecterus, no pedal edema, / . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heart sounds - . . .,........ Respiratory system - . . . . . . . . .......................

Per abdominal - . . . . . . . . . . . . . . . . . . L - . . . . . . . . . . . S - . . . . . . . . . . . K - . . . . . . . . .

Other examination - . . . . . . . . . . . . . . . . . . . . . . .

P. V. examination - . . . . . . . . . . . . . . . ........ . Per Speculum exam - . . . . . . . . . . . . .

Any other - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Investigations - HB - . ...... .gm%, Blood group - .................Urine routine -. . . . . .

Any other - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical Abortion Therapy Details -

Day-l (Date - ...............) -................................

Day - 3 (Date - ....................) - ................................

Day-7 (Date - ....................) - .................................

Day – 15 ( Date - ……………) - …………………..

Confirmation of complete abortion is done by - clinical exam / ultrasound.
Advise given - ………………………………………

If case referred then

Name of Doctor in case of complication - ……………………………………

MTP center in case of failure - ……………………………

Final Remark -............................................... ........................ .......

Signature -........................... Date -.............................

Name of Doctor ………………………………….

Place - ……………………………………

Keep Records

Keep Records

1.All Details like examination and investigations

2.Records of follow up till next menses.

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