What is First Trimester MTP? - Purpose, Procedure and Method

Abortion is legal in India. You do not need anyone's consent to opt for an abortion. Therefore, you must have all the necessary detail about abortion if you are considering one. The alternative name for Abortion is Medical Termination of Pregnancy (MTP). 

The first trimester of a pregnancy, which offers a range of abortion alternatives, is when a pregnancy is in its earliest stages. If the pregnancy is fewer than twelve weeks, early abortions can be carried out surgically or chemically (measured from the first day of the last menstrual period.) This blog covers information about MTP during the first trimester of pregnancy.

First trimester MTP is Medical Termination of Pregnancy or abortion performed in the first trimester of pregnancy (1-12 weeks). The abortion is carried out during a pregnancy up to 13 weeks. The doctor prescribes medications to women within 12 weeks of pregnancy. It is also known as the abortion pill. The pills comprise two drugs (Mifepristone and Misoprostol) that enable the womb to expel the developing foetus. When medical abortion fails, a surgical abortion is usually performed.

Medical abortion is a personal decision and may be done for several reasons. A woman may opt for MTP because of one or more reasons. She wants to end an unwanted pregnancy due to any of the following reasons:

1. A known risk of inherited or congenital disease
2. To end an early miscarriage
3. She has health complications that could prove fatal to her or the baby.
4. Rape victim

A woman can go for an abortion as soon as possible once she finds out she is pregnant. The doctor will use an ultrasound to confirm if the woman is pregnant and for how long she is pregnant. If the pregnancy duration is more than nine weeks, other options exist to end the pregnancy. The doctor will further discuss the possibilities, and one can decide which would be the best option.

Medication or surgery can induce an early abortion in the first trimester. Abortion through medical or surgical means is often secure and successful. Patients can discuss choices and decide which is best for them with their doctors. 

1. Medical abortion: The doctor will give the pregnant woman two medicines (Mifepristone & Misoprostol) that are either taken in the doctor's office or at home. 
2. Surgical abortion: The doctor will surgically remove the embryo from the womb. Some reasons a woman might need a surgical abortion are a personal choice, failed medical abortion, or being too far along in the pregnancy.

First trimester MTP is either performed medically or surgically. But there are procedures that need to be followed before the procedure. The doctor will perform an examination that includes:

1. A physical exam to confirm the pregnancy
2. Blood and urine tests to determine the length of pregnancy and confirm that it is not an ectopic pregnancy (the baby grows outside the womb, typically in the fallopian tube).
3. Monitor the foetal heart rate 
4. Ultrasound to confirm the pregnancy and gauge the possible delivery date
5. Explain to the woman the procedure, side effects, and risks.

A gynaecologist will first The woman may undergo any of the following procedures after a detailed discussion with her gynaecologist:

1. Medical abortion:
   Medical abortion involves taking medication via the oral or vaginal route. A combination of two drugs is used to end the pregnancy. Mifepristone and Misoprostol are used to induce an abortion. Mifepristone blocks the progesterone, the uterine lining becomes thin without progesterone, and the embryo detaches from the womb. After 24 - 48 hours, when the woman takes misoprostol, the womb contracts and bleeds, and the embryo comes out. The pregnancy is, therefore, ended.
2. Aspiration:
   In the aspiration process, the doctor opens the cervix (the womb's opening) with metal dilators or laminaria (a porous plant that softens and opens the cervix in the presence of moisture). Usually, before planning the abortion process, laminaria are placed one to two days before. During the abortion process, the doctor attaches a tube to a suction machine and puts the tube into the womb. The suction tube pulls the embryo out by creating a vacuum and detaches the placenta from the uterus wall. The placenta and the foetal parts are collected in a container attached to the suction tube and discarded.
3. Dilation and Curettage:
   This process is less safe than suction, and that is why it is not commonly used. The doctor dilates the cervix, and a curette or loop-shaped metal is inserted into the womb to remove the foetus and detach the placenta from the uterus wall. Further, the doctor then scrapes out all the remaining foetal parts and membranes from the womb.

In the case of medical abortion, around 95-97% of the woman successfully responds to medicines. In the case of surgical abortion, 98% of abortions are successful.

After a medical abortion, women usually experience heavy bleeding for several hours and bleed for around two weeks. Many women also experience intense cramps and nausea till full recovery takes place.

After the surgical abortion, women usually have light bleeding for around two weeks. Many women may experience cramps during or after the procedure. But it is a painless procedure as it involves the use of anesthesia. 

MTP is typically safe. However, as with any medical procedure, the following complications or risks may arise after the procedure:

1. In Medical Abortion:
   1. There is around a 3-8% chance that the abortion may fail. It may be due to incomplete abortion, infection, allergic reaction to medicines, etc.
   2. After taking the second medicine (misoprostol), heavy bleeding, cramping, and passing large blood clots may last for up to four weeks, and vomiting, nausea, diarrhoea, dizziness, or weakness can last up to 24 hours (Note: If exceeds more than a day it may get serious, therefore contact your doctor). 
2. In Aspiration:
   1. The metal rods can damage the cervix, which can cause extreme bleeding that may require surgical repair. The uterus and nearby organs may get torn or punctured due to abortion instruments.
   2. In addition, perforation of the womb may lead to hysterectomy (removal of the womb). Scarring of the uterine lining may occur after the abortion due to the instruments, which may cause miscarriage in future pregnancies and can also be the reason for infertility.
   3. Complications due to a perforated uterus and a damaged cervix are rare, but one should immediately contact the doctor if one notices any of the following symptoms:
      1. Pain
      2. Fever
      3. Prolonged or heavy bleeding or blood clots
      4. Foul-smelling discharge from the vagina
      5. Abdominal tenderness
3. In D&C:
   1. The cervix may get damaged or torn due to surgical instruments, leading to heavy bleeding, and need surgical repair. 
   2. D&C may result in scar tissue development in the womb and a rare condition known as Asherman's Syndrome (which occurs when D&C is done after a miscarriage).
   3. The uterus and nearby organs may get torn due to the instruments used for abortion. In addition, perforation of the womb may need additional repair surgery, including a Hysterectomy.
   4. A rare complication may occur due to a torn cervix or perforated uterus. Contact the doctor if any of the following symptoms occur:
      1. Fever
      2. Pain
      3. Prolonged or heavy bleeding or blood clots
      4. Abdominal tenderness
      5. Foul-smelling discharge from the vagina

Having read about MTP, its various options, and what you can expect after the abortion, you can take an informed decision about opting for it or not. You can share this article with loved ones and help them in this difficult time by sharing accurate information and helping them make up their mind.

HexaHealth is here for you if you're seeking an abortion or just want to learn more about pregnancy and abortion. Our helpful team of medical professionals at HexaHealth provides total assistance and makes sure you receive the necessary care at the appropriate facility. You can contact a professional at any moment by visiting our website.