MEDICAL METHOD OF MTP
1.what is mtp
2.classification
3medical method -regimen
advantage
follow up
adverse effect
4status recently
INTRODUCTION -MTP practice is common but due to surgical intruption and adverse effect most uses medical method for mtp in first trimester,
MTP-Delibrate termination of pregency before viability of fetus
CLASSIFICATION OF MTP- according to method and trimester
A,Method of first trimester
1,Surgical
a.menstural regulation
b.suction evaculation
c.dilatation and evacuation
2;medical method
a.prostaglandins
b.RU486-mifepristone
B;Method of second trimester
1,medical method
a.prostaglandins
2.medical+surgical method
a-extraamniotic method
-ethacridine lactate
-prostaglandins
-simple rubber catheter
b-intra amniotic method
-prostaglandins
-hypertonic saline[20%]
-hypertonic dextrose[50%]
-urea
-mannitol
3Surgical method
a-abdominal hystrotomy
b-aspirotomy
c-dilatation and evacuation
now we will discuss about medical method of mtp in first trimester
MEDICAL METHOD OF MTP--US Food and Drug Administration approved a regimine of mifepristone and misopristol in sepetember 2000.FDA approved protocal upto 49 day after last menstrual cycle i.e. upto 7 wk.this regimen used in India now.
DRUG USED FOR MEDICAL METHOD OF MTP----
1] MISOPROSTOL-
mechanism of action --is synthetic anologue of PGE1.Interact with myometral cell receptor .leading to expulsion of embryonic or fetal tissue. aiso causes cervical softening and dilatation.
MIFEPRISTONE-[RU486]
mechanism of action five times greater affinity for progesteron receptors. bindes to progesterone receptors and blocks progesterone from binding, thus inhibiting its action and ieading to increased uterine contractility.aiso softens and dilates cervix.
METHOTREXATE
mechanism of action - blocks dihydrofolate reductase,thus inhibiting folate production and DNA synthesis.affectes n earrapidly dividing cells first [including trophoblast cells].
REGIMENE USED FOR MTP
1]Mifepristone-Misoprostol---
FDA-approved regimen -orally tablet
DOSES -Mifepristone-200mg tablet-------three tablet stat orally and after 48 hrly later
Misoprostol-200mcg tablet-------two tablet orally
this regimen used for <49 days from last menstrual period
Success rate 98%
LOWER DOSE REGIMENE
DOSES-a] Miferistone-200mg tablet-------one tablet stat orally and after 48hrly later
Misoprostol-200mcg tablet-----two tablet orally
this regimen used for <63day from last menstrual period
Sucess rate 98%
b]Mifepristone 200mg tablet------one tablet stat orally and followed by
Misoprostol 200mcg tablet-----four tablet vaginally.
this reg