OG37.7 | First Trimester MTP and Evacuation Observation — Summary & Reflection

KEY TAKEAWAYS

First-trimester MTP and evacuation of incomplete abortion are among the most commonly performed gynaecological procedures in India, with a direct bearing on maternal mortality reduction. The legal framework — MTP Act 1971 amended 2021 — mandates up to 20 weeks with one RMP, 20–24 weeks with two RMPs for specified categories, and beyond 24 weeks only via State Medical Board for substantial foetal abnormality. The PCPNDT Act 1994 prohibits sex determination at all gestations. Anatomically, the single most important pre-procedure step is establishing uterine axis to prevent perforation. MVA (handheld syringe, up to 12 weeks, portable) and EVA (electric pump, up to 12–14 weeks, OT-based) both use suction evacuation; the technique follows: consent → lithotomy position → cervical priming with misoprostol → tenaculum → Hegar dilatation → cannula insertion with rotational aspiration → gritty end-point. Post-evacuation POC examination looks for feathery chorionic villi and decidua: absent villi mandates immediate exclusion of ectopic pregnancy. Key complications observed include uterine perforation (sudden depth excess + loss of resistance), incomplete evacuation (sparse villi + boggy uterus), and post-evacuation haemorrhage. As an observer, your role is to recognise these decision points and understand the escalation pathway.

REFLECT

Think about the procedure you observed (or will observe) today. Identify one moment where the surgeon paused and made a deliberate clinical decision — for example, checking POC, adjusting instrument direction, or responding to unusual resistance. What information did she or he use to make that decision? How does understanding the anatomy and legal context change what you notice during observation compared with watching without that background? Write a brief reflective note on what you would do differently or watch more carefully in your next observation. (Kolb: Concrete Experience → Reflective Observation → Abstract Conceptualisation → Active Experimentation.)