MTP Kit - Medical Termination of Pregnancy

What is the MTP Kit?

Mechanism of Action

• Mifepristone - a synthetic antiprogestin that competitively blocks progesterone receptors. Progesterone is required to maintain the decidua and pregnancy. Blocking it leads to decidual breakdown, cervical softening, and increased uterine sensitivity to prostaglandins.
• Misoprostol - a synthetic prostaglandin E1 analogue that causes uterine contractions and cervical dilation, expelling the products of conception.

Approved Gestational Age

• Up to 9 weeks (63 days) from the last menstrual period (LMP) - standard indication
• Beyond 9 weeks, a different higher-dose regimen or surgical method is required

Standard Procedure / Regimen

Regimen 1 (Recommended - Low Dose)

• Misoprostol can also be given immediately or within 6-8 hours of mifepristone (simultaneous protocol).
• After misoprostol, the patient should rest - cramping and bleeding begin within a few hours and indicate the abortion process has started.
• Mean duration of bleeding: ~17 days.

Regimen 2 (Older/Alternative)

Step-by-Step Clinical Procedure

1. Pre-procedure assessment
   • Confirm intrauterine pregnancy (rule out ectopic)
   • Determine gestational age by LMP and/or ultrasound
   • Check for contraindications
   • Baseline vitals, Hb, blood group, Rh type
   • Counsel patient about expected bleeding, cramping, and follow-up
2. Day 1 - Mifepristone
   • Give 200 mg mifepristone orally under supervision (or at clinic)
   • If vomiting occurs within 30 minutes, another dose may be needed
   • Spotting or light bleeding may begin within 24-48 hrs
3. Day 2-3 - Misoprostol (36-48 hours later)
   • Administer 800 mcg misoprostol vaginally (or buccally/sublingually)
   • Patient should rest afterward
   • Significant cramping and heavy vaginal bleeding begin - this is expected
   • Analgesics (NSAIDs or oral narcotics) can be given for pain
4. Follow-up (~14 days after mifepristone)
   • Clinical examination or ultrasound to confirm complete abortion
   • If products of conception remain (incomplete abortion) or ongoing pregnancy is found - surgical evacuation (MVA/suction evacuation) is recommended
   • Ongoing pregnancy after MTP kit carries a risk of fetal malformation - surgical termination is strongly advised

Contraindications

1. Known allergy/hypersensitivity to mifepristone, misoprostol, or other prostaglandins
2. Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass
3. IUD in place (must be removed first)
4. Chronic adrenal failure
5. Hemorrhagic disorder or concurrent anticoagulant therapy
6. Inherited porphyria
7. No access to emergency medical facilities (for management of incomplete abortion or blood transfusion)

Side Effects

Warning Signs Requiring Immediate Medical Attention

• Soaking more than 2 maxi pads per hour for 2+ consecutive hours
• Fever > 38°C lasting more than 24 hours
• Severe abdominal pain not relieved by analgesics
• No bleeding after misoprostol administration
• Signs of ectopic pregnancy (shoulder tip pain, collapse)

Efficacy

• Up to 7 weeks: ~98% complete abortion rate
• 7-9 weeks: ~95% complete abortion rate
• Failure (ongoing pregnancy): ~1-2% - requires surgical management

Important: The MTP Kit must be used only under the supervision of a registered medical practitioner. Self-administration without medical guidance is unsafe and illegal in India under the MTP Act.

Mandatory Investigations Before MTP (Medical Termination of Pregnancy)

1. Confirm Pregnancy

2. Confirm Intrauterine Location & Gestational Age

USG is the single most important mandatory investigation before MTP. Ectopic pregnancy is a hard contraindication - administering MTP kit in an ectopic pregnancy will NOT terminate it and may cause life-threatening rupture.

3. Hematological Investigations

4. Urine Examination

5. Other Baseline Assessments

Summary Table

Special Note: Anti-D Immunoglobulin

All investigations should be completed, documented, and reviewed before prescribing the MTP kit. The MTP Act (India, 1971, amended 2021) requires that the procedure be performed only at certified facilities by a registered medical practitioner - these investigations form the foundation of safe, legal practice.