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Is Abortion Medically Necessary?
Published in Nicholas Colgrove, Bruce P. Blackshaw, Daniel Rodger, Agency, Pregnancy and Persons, 2023
Abortions performed in the first trimester of pregnancy are divided into medication abortions and aspiration abortions. Medication abortions involve the administration of drugs: typically the antiprogesterone drug mifepristone, which causes decidual necrosis, myometrial contraction, and the detachment of the early fetus from the womb, is followed by the prostaglandin analogue, misoprostol, to expel the contents of the uterus (Bartz and Blumenthal 2021; Chen et al. 2014). In aspiration abortions, the cervix is mechanically dilated, and a cannula attached to an aspirator is inserted into the uterus to evacuate its contents (Shie and Wallace 2021). Second-trimester abortions can be performed by induction abortion or by dilation and evacuation. Induction abortion requires the administration of the same drugs as a medication abortion, often preceded by a feticidal injection (Hammond 2021a). Dilation and evacuation entails emptying the uterine contents with suction, forceps, and curettage (Hammond 2021b), not usually preceded by feticidal injection (Sfakianaki et al. 2019). Abortions performed in the late second or third trimester are performed using one of these two techniques, usually the former.
Birth control
Published in Frank J. Dye, Human Life Before Birth, 2019
Partial-birth abortion (PBA) sounds gruesome and is. More properly termed intact dilation and evacuation, this procedure is usually performed between 4 and 7 months of pregnancy. The cervix is dilated, and the fetus is pulled out feet first. A cannula is inserted into the base of the fetus's skull, and the brain is sucked out, causing the head to collapse and pass out of the cervix and vagina more easily. One does not have to be pro-life to find this procedure repugnant. So why is it done? It is done to protect the life or health of the mother.
Contraception and abortion
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
After 14 weeks, the surgical technique of choice is dilation and evacuation. In skilled hands, this procedure has a low complication rate and is highly acceptable to women. It is widely used in North America, but is less common in Europe. It is necessary to achieve good cervical dilation before the procedure (up to 20 mm) in order to remove larger fetal parts. This is achieved using one or a combination of either osmotic dilators (hygroscopic sticks placed in the cervix several hours preprocedure that absorb fluid from surrounding tissues, causing them to swell and bring about cervical dilation), or misoprostol (vaginal or sublingual) or mifepristone (oral). At surgery, the cervix is then further dilated using graduated dilators and the contents of the uterus removed by a combination of aspiration and extraction of fetal tissue using appropriate instruments; ultrasound is performed to confirm complete evacuation.
Intrauterine Fetal Demise Associated with Vascular Malperfusion and Multiple Uterine Leiomyomata: A Report of Two Cases
Published in Fetal and Pediatric Pathology, 2023
Tess E. K. Cersonsky, Megan Lord, Halit Pinar
The patient was counseled on options for uterine evacuation. Pelvic examination confirmed the presence of a large uterine leiomyoma in the lower uterine segment, and it was unclear if the fetus would be able to pass through the pelvis. A hysterotomy for uterine evacuation would likely require incision into the contractile portion of the uterus. Given the size and location of the leiomyoma, there was also concern for uterine atony following hysterotomy, potentially resulting in hysterectomy. At the time of admission, attempted dilation and evacuation (D&E) in the operating room was not felt to be feasible given the patient’s advanced gestational age. Mildly elevated blood pressures were noted during induction on hospital day 2; serum creatinine and other end-organ laboratory values were normal at this time. The patient was mildly febrile and was started on gentamicin and clindamycin for possible intraamniotic infection.
Prenatal genetic diagnosis of Neu-Laxova syndrome
Published in Journal of Obstetrics and Gynaecology, 2018
Amber M. Wood, Amy T. Mottola, Eleanor H. Rhee, Jeffrey A. Kuller
The 18-week ultrasound revealed a thickened nuchal fold and facial oedema. There was no apparent cavum septum pellucidum. Minimal foetal movement was noted, concerning for foetal akinesia. The upper extremities appeared short and fixed, with contracted hands and the lower legs were also fixed in a crossed position. A significant growth lag and microcephaly was noted, with foetal measurements 3 weeks behind expected. Genetic analysis from the CVS returned at this time and the foetus was found to be homozygous for the familial variant c.399 G > A in the PHGDH gene, consistent with a diagnosis of NLS1. The pregnancy was terminated by dilation and evacuation. Autopsy was not performed.
Surgical termination of pregnancy for fetal anomaly: what role can an independent abortion service provider play?
Published in Journal of Obstetrics and Gynaecology, 2019
Helen Callaby, Jane Fisher, Patricia A. Lohr
At BPAS, a surgical termination is undertaken as a day-case procedure with either electric or manual vacuum aspiration to approximately 14 weeks of gestation after which the method used is dilation and evacuation. Procedures under a vacuum aspiration may be performed with an oral analgesia and a cervical anaesthesia, intravenous conscious sedation with low-dose midazolam and fentanyl, or general anaesthesia with intravenous propofol and fentanyl without intubation. All dilation and evacuation procedures are performed under a general anaesthesia, as described. The use of cervical preparation under 14 weeks of gestation is left to the discretion of the surgeon. The regimen, if used, is misoprostol 400 mcg vaginally for 3 h or sublingually for 1 h. After 14 weeks of gestation, cervical preparation is undertaken in all cases. The routine regimens are misoprostol 400 mcg vaginally for 3 h from 14 to 17+6 weeks of gestation, osmotic cervical dilators (Dilapan) with or without misoprostol for 4 or 4 h pre-procedure, respectively, from 18 to 21+6 weeks of gestation, and Dilapan inserted the day prior to surgery with or without adjunctive misoprostol 400 mcg sublingually for 2 h pre-procedure from the 22nd to 24th weeks of gestation. Immediate and delayed complications of abortion procedures are reported by clinical staff on incident reporting forms and coded before being entered into a database maintained at BPAS Head Office. Staff in clinics identify adverse events at the time they occur, during in-person assessments or from communication with the client or another care provider (e.g. General Practitioner or hospital) indicating a treatment-related adverse event occurred. BPAS’ standard practice is to obtain discharge summaries from hospitals or letters from GPs when possible to accurately record any diagnoses or interventions.