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Is Abortion Medically Necessary?
Published in Nicholas Colgrove, Bruce P. Blackshaw, Daniel Rodger, Agency, Pregnancy and Persons, 2023
The claim that abortion is never medically necessary hangs on the definitions of abortion, medical necessity, and intentional action. Once these are clear, I will argue that while some circumstances make it necessary to deliver a fetus prematurely to save the mother’s life (and thereby expose it to potentially fatal harm), this need not be done in a way that intends fetal death. Fetal death need not be a means to the end of saving the mother’s life, although it may occur because of it. Since I define abortion as intentional feticide and argue that in licit premature delivery fetal death occurs outside of intention, I conclude that abortion is never medically necessary, for there is always an alternative course of action that does not intend fetal death. I am not suggesting that it is never medically necessary to end a pregnancy, but merely that ending a pregnancy with feticidal intention is never necessary. My aim is not to draw grand ethical conclusions from this distinction, although I will not ignore its implications in addressing objections but to question the common assumption that abortion is justified by medical necessity.
Paper 3
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Uterine rupture can occur at the site of weakness in the uterine wall, e.g. at the site of a Caesarean section scar. It is uncommon and usually presents with maternal shock and either fetal distress or no audible fetal heartbeat. Risk of fetal death is high. Refer immediately.
Pediatric and Fetal Autopsies
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Stefano D’Errico, Angelo Montana, Giulio Di Mizio, Monica Salerno
Fetal death is defined as death prior to the complete extraction or expulsion from its mother of a product of conception irrespective of the duration of pregnancy. It is divided further as early (<22 weeks of gestational age), intermediate (22–27 weeks of gestational age), and late (≥28 weeks of gestational age). Early deaths are designated as abortions, whereas intermediate and late deaths are known as stillbirths. In all situations, postmortem may provide information relevant to the management of subsequent pregnancies.
Value of Placental Examination in the Diagnostic Evaluation of Stillbirth
Published in Fetal and Pediatric Pathology, 2022
Developmental lesions, observed in 12% of our cases, were consistent with villous maturation abnormalities of non-ischemic origin. The causal relationship between delayed villous maturation (DVM) and stillbirth is still debated. It is not clear whether the fetal death is directly related to this placental anomaly or other associated pathogenic processes [40]. The strong association between DVM and obesity, gestational or pre-gestational maternal diabetes is reported in some studies [41,42]. In these conditions, DVM is thought to be due to excessive stimulation of placental growth by insulin and other growth factors with the detrimental effects on the villous maturation [41]. The association of DVM with histologic features of chromosomal aberration in both malformed and non-malformed fetuses of our series supports a genetic, especially chromosomal, cause for DVM [41]. A chromosomal aberration (trisomy 18) was diagnosed in two cases, where the fetal death occurred before the pregnancy termination. The proportion of chromosomal abnormalities in our stillbirth population was, however, underestimated as 5% of the fetuses had polymalformative syndromes, none of which were cytogenetically investigated. This limitation didn’t unfortunately allow us to establish a genotype–phenotype correlation or provide adequate genetic counseling for families. It’s also noteworthy that, in the absence of placental karyotyping, it was not possible to diagnose a confined placental mosaicism which might explain the DVM in non-malformed fetuses of our series [43].
Antenatal corticosteroids-to-birth interval in preterm birth
Published in Acta Clinica Belgica, 2021
Isabelle Dehaene, Kris De Coen, Anna Oostra, Johan Decruyenaere, Kristien Roelens, Koenraad Smets
The observational data originates from the preterm birth register of Ghent University Hospital, a referral center for high-risk obstetric patients in Belgium. The register was created in 2016 and includes all women who delivered from 24 + 0 to 33 + 6 weeks’ gestation. Patients with the diagnosis of intrauterine fetal death at admission or expecting a fetus with a major congenital disorder that could influence neonatal outcomes were not included since the main goal of the registry is to explore neonatal and long-term outcomes according to obstetrical management. Maternal data was obtained retrospectively from 2012 till 9 July, 2017. From 10 July, 2017, data was collected prospectively, after obtaining informed consent of the parents to be. Neonatal data was extracted from the already operational neonatal database and imported into the register. Patient involvement was limited to consenting in the registration of the data and using the data for scientific purposes. Based on the current literature, a set of important variables was collected and managed using REDCap (Research Electronic Data Capture), a secure, web-based application designed to support data capture for research studies [10]. Of the core outcome set for evaluation of interventions to prevent preterm birth, all but one core neonatal outcomes were included in the register (not included is harm from intervention). Only one of the four core maternal outcome was included (PPROM) [11]. No other core outcome sets on PTB are available.
Placental Pathologic Changes Associated with Fetal Growth Restriction and Consequent Neonatal Outcomes
Published in Fetal and Pediatric Pathology, 2021
Do Hwa Im, Young Nam Kim, Hwa Jin Cho, Yong Hee Park, Da Hyun Kim, Jung Mi Byun, Dae Hoon Jeong, Kyung Bok Lee, Moon Su Sung
Fetal growth restriction (FGR) is defined as the failure of the fetus to achieve its genetically determined growth potential and is generally indicated by fetal weight less than the 10th percentile of the neonate’s gestational age. This condition is associated with an increased risk of fetal death in utero as well as increased neonatal morbidity and mortality [1, 2]. Growth-restricted fetuses are more likely to exhibit cognitive delay during childhood and suffer from diseases such as obesity, type 2 diabetes mellitus, coronary artery disease and stroke during adulthood [3, 4]. Various factors, such as maternal, fetal, and placental conditions, may contribute to the development of FGR [5, 6], of which inadequate placental circulation has been reported to be the primary cause of abnormal fetal growth [7].