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As abortion-restricting laws roll into place in at least 18 states after the Supreme Court’s June 24 decision to overturn Roe v. Wade, people took to social media to wonder if the decision would limit access to treatment for ectopic pregnancies.
A facebook Publish asserted that “the treatment for an ectopic pregnancy is abortion”.
Ectopic pregnancies occur when a fertilized egg implants outside the uterus. This can cause life-threatening bleeding.
We found that although in some cases there is some overlap in how ectopic pregnancies are treated and how pregnancies are electively terminated through abortion, this overlap appears to be small.
The larger question is whether health care providers interpret restrictive abortion laws as limiting their ability to treat patients with potentially life-threatening ectopic pregnancies.
Providers’ response could depend on how “abortion” is defined in state laws.
Ectopic pregnancies are not viable
Ectopic or ectopic pregnancies occur when the egg travels down the fallopian tube to meet the sperm but does not reach the uterus. In 90% of ectopic cases the fertilized egg attaches to the fallopian tube. In other cases, it may attach to the cervix or to the scar of a cesarean section. Out of approximately 1,000 pregnancies in the United States eight are ectopic.
“As the pregnancy develops, the tube can burst,” which can lead to life-threatening internal bleeding, according to the American College of Obstetricians and Gynecologists.
These pregnancies are not viable and cannot be re-implanted into the uterus. Accordingly, the pregnancy must be terminated.
Symptoms of an ectopic pregnancy are similar to those of a normal pregnancy: lower back pain, mild cramps, and missed periods.
Termination of pregnancy is the treatment for an ectopic pregnancy.
There are different treatment options for an ectopic pregnancy. These depend on the stage of the pregnancy. All treatments result in termination of pregnancy.
In most cases, ectopic pregnancies are treated as soon as possible to prevent the patient’s fallopian tubes from rupturing – a condition that could otherwise lead to life-threatening blood loss.
An ectopic pregnancy can be detected by a pelvic exam, blood test, and ultrasound. And if detected early enough, it can be treated with prescribed medication. In this case, a doctor gives one or more injections of a medicine called methotrexate. This drug stops cell growth, terminates the pregnancy, and dissolves existing cells.
Research shows that when it comes to elective abortions, methotrexate can be used alongside another drug, misoprostol, to terminate viable first-trimester pregnancies. But methotrexate’s price and possible side effects make it less likely to be used in such abortion procedures, according to Amy Addante, OB-GYN and colleague with Physicians for Reproductive Health.
A combination of mifepristone and misoprostol is the more common diet for induced abortion.
If an ectopic pregnancy is more advanced or causes the fallopian tubes to burst, the patient will need to undergo operation to terminate the pregnancy. This can be done through a laparoscopic procedure in which a doctor makes a small incision and uses a thin tube with a camera lens and light to perform the surgery.
Depending on the patient’s condition, it may be necessary to remove the fallopian tube.
If the ectopic pregnancy causes heavy bleeding, emergency surgery may be needed. For this, a doctor will make an incision in the patient’s abdomen.
None of these procedures are performed as part of a surgical abortion.
According ACOG, there are three procedures for an abortion, the procedure used depends on the stage of the pregnancy. The first involves an aspirator, where a tube is inserted into the cervix and attached to a suction pump to terminate the pregnancy. The second is a dilation and curettage where the cervix is dilated and instruments are used to remove the pregnancy tissue. The third, is a dilation and evacuation, similar to a dilation and curettage, the cervix is dilated but larger instruments are used with a suction device.
None of these procedures would be used for an ectopic pregnancy in the fallopian tube.
However, if the ectopic pregnancy is located in the cervix or on scar tissue from a C-section, the treatment could be the same as an abortion, according to Addante.
Medical and legal definitions of “abortion”
The definition of an abortion varies according to the medical source or the expert consulted. Lawyers tend to approach the issue differently than those in the medical community – the patient’s intention to terminate treatment is key to this discussion.
In medical terms, abortion is widely considered a procedure undertaken to terminate a pregnancy.
The National Institutes of Health defines an abortion as a procedure “to terminate a pregnancy”.
Harvard Medical School describes it as a “removal of pregnancy tissue, products of conception, or the fetus and placenta (after birth) from the uterus”. Harvard clarifies that other terms for abortion include “elective abortion, induced abortion, termination of pregnancy, and therapeutic abortion.”
The Mayo Clinic clarifies that the treatment of an ectopic pregnancy is not a medical abortion, which he defines as “a procedure that uses drugs to terminate a pregnancy”. He adds that a medical abortion can be used “to complete an early miscarriage or end an unwanted pregnancy.”
In terms of the legal definition, however, what constitutes an “abortion” is often dictated in part by whether the patient has made a conscious decision to terminate the pregnancy.
According to Cornell Law School Institute for Legal Information an “abortion is the intentional termination of a pregnancy”.
Abortion laws across states have used similar definitions. A Ohio Law includes “the voluntary termination of a human pregnancy by any person”. A law in North Dakota defines it as “the use or prescription of any substance, device, instrument, medicine or drug to intentionally terminate the pregnancy of a person known to be pregnant”.
Most of the medical experts we spoke to made it clear that they do not consider ectopic treatment an abortion.
The lack of consensus on the definition of an abortion makes defining the treatment of an ectopic pregnancy confusing and may have real-world implications.
“I think the reason it’s happening right now is because of the vague wording in so many of these laws, and I think that’s what the general public, clinicians, and lawyers are all dealing with,” he said. said Addante. “As a doctor, I would not have, until a week ago, considered the treatment of an ectopic pregnancy as an abortion.”
Abortion laws could delay treatments for ectopic pregnancy
Health care experts told PolitiFact that even if the treatment of an ectopic pregnancy is not classified as an abortion, patients could still be put at risk due to laws prohibiting or restricting abortions.
All 18 states supposed to ban abortion following the reversal of Roe v. Wade have exceptions for the life of the patient or a medical emergency.
Even so, experts say the vagueness of these laws could lead to complications with access to treatment for ectopic pregnancies.
“These laws will have a chilling effect on clinicians because they don’t want to be accused of committing a crime,” said Daniel Grossman, professor of obstetrics, gynecology and reproductive sciences at the University of California. in San Francisco. “They can wait until the clinical presentation progresses to the point where it’s really clear that the person’s life is in danger, for example, waiting until the fallopian tube has ruptured before intervening. That would be very poor medical care. .”
The New England Journal of Medicine reports that has already been the case for healthcare providers in Texas, where a restrictive abortion law, with an exception for the life of the mother, went into effect in September 2021.
“It’s very, very important that people understand that for political reasons, people misrepresent biological events and medical treatments,” said Wendy Chavkin, co-founder of Global Doctors for Choice and professor of obstetrics and gynecology. at Columbia University. “And there’s something called the standard of medical care, and that’s what people should be getting.”
Most pregnancy-related care is extremely urgent, especially when dealing with an ectopic pregnancy.
“When people don’t know what these laws mean and you’re talking about heavy penalties for doctors, you know, loss of license, jail time, felony charges,” Addante said. “The delays that are happening as they seek legal clarity to make sure they can legally do what they know is medically correct, it’s really dangerous for this patient.”