No one was very forthcoming with answers to the questions that I put on my blog about the Partial Birth Abortion a week or so ago.
I did find the article from the American Medical Association on it and I am going to share some parts that I thought were very interesting.
http://jama.ama-assn.org/cgi/content/full/280/8/744
Rationale for Banning Abortions Late in Pregnancy
M. LeRoy Sprang, MD; Mark G. Neerhof, DO
JAMA. 1998;280:744-747.
Intact D&X came to the forefront of public awareness in 1995 during a congressional debate on a bill banning the procedure. During this debate, opponents of the ban asserted that the procedure was rarely performed (approximately 450-500 per year) and only used in extreme cases when a woman’s life was at risk or the fetus had a condition incompatible with life.1-2 Following President Clinton’s April 1996 veto of a congressionally approved ban, conflicting information surfaced. Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, had stated in November 1995 that “women had these abortions only in the most extreme circumstances of life endangerment or fetal anomaly.”3 However, he later admitted that his own contacts with many of the physicians performing intact D&X procedures found that the vast majority were done not in response to extreme medical conditions but on healthy mothers and healthy fetuses.3
In newspaper interviews, physicians who use the technique acknowledged performing thousands of such procedures a year. One facility reported that physicians used intact D&X on at least half of the estimated 3000 abortions they perform each year on fetuses between 20 and 24 weeks’ gestation.3 In another report, Dayton, Ohio, physician Martin Haskell, MD, who had performed more than 700 partial-birth abortions, stated that most of his abortions are elective in that 20- to 24-week range and that “probably 20% are for genetic reasons, and the other 80% are purely elective.”4 The late James T. McMahon, MD, of Los Angeles, Calif, detailed for the US Congress his experience with more than 2000 partial-birth abortion procedures. He classified only 9% of that total as involving maternal health indications (of which the most common was depression), and 56% were for “fetal flaws” that included many nonlethal disorders, some as minor as a cleft lip.5
Conflicting information about intact D&X and its frequency catalyzed prominent medical organizations to evaluate the procedure. In 1996, the American College of Obstetricians and Gynecologists (ACOG) convened a special committee to review it. According to the ACOG panel, intact D&X has been defined to consist of 4 elements9: (1) the deliberate dilation of the cervix, usually over a sequence of days; (2) instrumental conversion of the fetus to a footling breech; (3) breech extraction of the body, excepting the head; and (4) partial evacuation of the intercranial contents of a living fetus to effect vaginal delivery of a dead but otherwise intact fetus.
An ACOG policy statement emanating from the review declared that the select panel “could identify no circumstances under which this procedure . . . would be the only option to save the life or preserve the health of the woman” and that “an intact D&X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman’s particular circumstances can make this decision.”9 However, no specific examples of circumstances under which intact D&X would be the most appropriate procedure were given.
Maternal Considerations
There exist no credible studies on intact D&X that evaluate or attest to its safety. The procedure is not recognized in medical textbooks nor is it taught in medical schools or in obstetrics and gynecology residencies. Intact D&X poses serious medical risks to the mother. Patients who undergo an intact D&X are at risk for the potential complications associated with any surgical midtrimester termination, including hemorrhage, infection, and uterine perforation. However, intact D&X places these patients at increased risk of 2 additional complications. First, the risk of uterine rupture may be increased. An integral part of the D&X procedure is an internal podalic version, during which the physician instrumentally reaches into the uterus, grasps the fetus’ feet, and pulls the feet down into the cervix, thus converting the lie to a footling breech. The internal version carries risk of uterine rupture, abruption, amniotic fluid embolus, and trauma to the uterus. According to Williams Obstetrics, “there are very few, if any, indications for internal podalic version other than for delivery of a second twin.”10
The second potential complication of intact D&X is the risk of iatrogenic laceration and secondary hemorrhage. Following internal version and partial breech extraction, scissors are forced into the base of the fetal skull while it is lodged in the birth canal. This blind procedure risks maternal injury from laceration of the uterus or cervix by the scissors and could result in severe bleeding and the threat of shock or even maternal death. These risks have not been adequately quantified.
Fetal Considerations
The majority of intact D&X procedures are performed on periviable fetuses. When infants of similar gestational ages are delivered, pain management is an important part of the care rendered to them in the intensive care nursery. However, with intact D&X, pain management is not provided for the fetus, who is literally within inches of being delivered. Forcibly incising the cranium with a scissors and then suctioning out the intracranial contents is certainly excrutiatingly painful. It is beyond ironic that the pain management practiced for an intact D&X on a human fetus would not meet federal standards for the humane care of animals used in medical research.13 The needlessly inhumane treatment of periviable fetuses argues against intact D&X as a means of pregnancy termination.
Most clinicians would argue for maintaining the option of late pregnancy termination to save the life of the mother, which is an extraordinarily rare circumstance. Maternal health factors demanding pregnancy termination in the periviable period can almost always be accommodated without sacrificing the fetus and without compromising maternal well-being. The high probability of fetal intact survival beyond the periviable period argues for ending the pregnancy through appropriate delivery. In a similar fashion, the following discussion does not apply to fetuses with anomalies incompatible with prolonged survival. When pregnancy termination is performed for these indications, it should be performed in as humane a fashion as possible. Therefore, intact D&X should not be performed even in these circumstances.
. Among the immediate complications of abortions, the incidence of hemorrhage, laceration of the cervix, and uterine perforation is 1.2% at 8 weeks’ gestation but increases to 3.6% at 15 weeks and beyond.26 The risk of uterine perforation and resultant visceral injury also increases as gestation advances.27 The risk of complications requiring hospital admission increases from 5.5% for abortions performed before 14 weeks’ gestation to 11.2% for abortions performed subsequent to 14 weeks.28
Dilation and evacuation procedures commonly used in induced midtrimester abortion may lead to cervical incompetence, which predisposes to an increased risk of subsequent spontaneous abortion, especially in the midtrimester.26, 32-33 Cervical incompetence is more prevalent after midtrimester termination of pregnancy than first trimester termination because the cervix is dilated to a much greater degree.34
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