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Antepartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Antepartum haemorrhage (APH) is defined as bleeding from the genital tract after 20 weeks of gestation and prior to the onset of labour. The cut-off for the period of gestation varies from 20 to 24 weeks among different countries in keeping with national definitions of fetal viability. The causes of APH are listed in Table 13.1.
Hypertension and pre-eclampsia (PET)
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Hospitalisation is usually required to enable more intense monitoring of the maternal and fetal condition with the aim of stabilisation and expediting the birth at the optimum time. For some women the condition may develop rapidly even before a stage where fetal viability is a possibility, while for others the progression of the disease may be more gradual and/or occur later in the pregnancy or following birth. Due to the potential rapid progress of the disease, in particular thrombocytopenia, a FBC is necessary within two hours of planned epidural or spinal siting38 for induction of labour or Caesarean section.
Ultrasound in the First Trimester
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
Asim Kurjak, Vincenzo D’Addario
In a study performed at our institution on a population of 142 pregnant women with bleeding in early pregnancy, in 103 (72.5%) of the cases it was demonstrated that the fetus was alive. In the remaining 39 cases (27.5%) there were no signs of fetal life. In the 39 cases where fetal life was not demonstrated, the most frequent cause was blighted ovum (38.5%), followed by missed abortion (33.3%) and abortus incompletus (25.6%), and just one case (2.6%) of ectopic pregnancy. Out of the 142 women, 82 delivered a live baby, meaning that 58% of cases, regardless of bleeding in early pregnancy, were brought to term. In a very recent paper, Cashner et al.24 made an analysis of pregnancy outcome in 489 pregnant women after ultrasound documentation of fetal viability at 8 to 12 weeks. Obtained results suggest that if a live fetus is documented by ultrasonography at 8 to 12 weeks of gestation, the risk of spontaneous abortion before 20 weeks of gestation in an uninstrumented population is 2.0%. In a study given by Anderson,25 97.3% of pregnancies in which fetal cardiac motion was noted after 7 weeks carried in term. Jouppila et al.26 observed that in patients with threatened abortions, the positive finding of fetal heart action was associated with delivery of a viable infant in 90.0% of the cases.26
People’s knowledge of and attitudes toward abortion laws before and after the Dobbs v. Jackson decision
Published in Sexual and Reproductive Health Matters, 2023
Kristen N. Jozkowski, Xiana Bueno, Ronna C. Turner, Brandon L. Crawford, Wen-Juo Lo
On 24th June 2022, the Supreme Court of the United States (SCOTUS) upheld a 2018 Mississippi law (i.e. Gestational Age Act) in Dobbs v. Jackson Women’s Health Organization (hereafter Dobbs v. Jackson). A draft of the decision was leaked in May 2022 and received tremendous media coverage. The Mississippi law restricted abortion after 15 weeks “except in a medical emergency or in the case of a severe fetal abnormality”.1 This decision overturned the 1973 decision in Roe v. Wade and eliminated the constitutional protection for the right to abortion up to viability or approximately 22–24 weeks of pregnancy. Of note, scientific and medical organisations provide guidelines for fetal/neonatal care that suggest the potential for viability at 22–24 weeks,2 which is often the timeframe cited by politicians and in the media as “fetal viability”. As a result of the Dobbs v. Jackson decision, state lawmakers are positioned to enact legislation that can further restrict abortion beyond the bounds they were able to previously because of the trimester framework established in Roe v. Wade. The ruling in Roe v. Wade indicated in the first trimester, the decision to have an abortion is solely between a pregnant person and their healthcare provider. In the second trimester, the state is permitted to regulate abortion for concerns related to maternal health. In the third trimester, or at the point of fetal viability, states are permitted to either regulate or prohibit abortion with exceptions for cases of life endangerment for the pregnant person.
Feminist Concerns About Artificial Womb Technology
Published in The American Journal of Bioethics, 2023
Tamara Kayali Browne, Evie Kendal, Tiia Sudenkaarne
A risk associated with AWT, however, is that it could be used to justify further restrictions on reproductive rights, such as abortion. In a world where AWT is available, it is possible that states attempting to impose legislative measures against abortion may argue that it is no longer justifiable at any gestational age, as those who do not wish to carry their fetus to term can transfer it to an artificial womb for continued development and subsequent adoption. This argument could be used particularly in states where fetal viability is already used to decide the stage of pregnancy at which abortion should be allowed. However, as Claire Horn (2020) has argued, this argument rests on an anachronistic understanding of how and why abortions are conducted. According to existing predictions, transferring a fetus to AWT would entail major abdominal surgery (Eindhoven University of Technology 2022), and thus is not an ethical substitute for the majority of abortions, which are achieved simply and safely using medication early in gestation. Moreover, the details of how exactly the fetus would be extracted from the womb are almost never described. Yet it is important to pay attention to such details, especially if there would be coercion in cases in which AWT is viewed as “saving” the fetus from a substance-abusive fetal environment (in much the same way that forced C sections are conducted for “fetal interests”). Ignoring this issue reproduces the discourse of women’s pain and suffering being made invisible around pregnancy and childbirth (cf. obstetric violence) and might produce an entirely new reproductive justice issue.
Value of Placental Examination in the Diagnostic Evaluation of Stillbirth
Published in Fetal and Pediatric Pathology, 2022
The definition of stillbirth varies between countries depending on the used viability threshold. World Health Organization defines stillbirth as the fetal death that occurs at 22 weeks gestation (WG) or later or the birth of a stillborn that weighs at least 500 g. However, the French National College of Gynecologists and Obstetricians (FNCGO) proposed a standardized definition for stillbirth including all fetal deaths occuring after 14 WG [1]. The use of this threshold is justified by the need to determine not only the cause of death of viable fetuses, but also the cause of stillbirth that prevents fetal viability. Indeed, before 14 WG, the most common cause of miscarriage is chromosomal aberration [2]. After 14 WG, etiology especially involves placental and maternofetal disorders, some of which may be prevented or treated. As a result, the management and etiologic evaluation are different.