Abortion, Partial Birth

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Abortion, Partial Birth

Definition

Partial birth abortion is a method of late-term (after 20 weeks) abortion that terminates a pregnancy and results in the death and intact removal of a fetus. This procedure is most commonly referred to as intact dilatation and extraction (D & X). It occurs in a rare percentage of pregnancies.

Purpose

Partial birth abortion, or D&X, is performed to end a pregnancy and results in the death of a fetus, typically in the late second or third trimester. Although D&X is highly controversial, some physicians argue that it has advantages that make it a preferable procedure in some circumstances. One perceived advantage is that the fetus is removed largely intact, allowing for better evaluation and autopsy of the fetus in cases of known fetal abnormalities. Intact removal of the fetus also may carry a lower risk of puncturing the uterus or damaging the cervix. Another perceived advantage is that D&X ends the pregnancy without requiring the woman to go through labor, which may be less emotionally traumatic than other methods of late-term abortion. In addition, D&X may offer a lower cost and shorter procedure time.

Precautions

Women considering D&X should be aware of the highly controversial nature of this procedure. A controversy common to all late-term abortions is whether the fetus is viable, or able to survive outside of the woman's body. A specific area of controversy with D&X is that fetal death does not occur until after most of the fetal body has exited the uterus. Several states have taken legal action to limit or ban D&X and many physicians who perform abortions do not perform D&X. This may restrict the availability of this procedure to women seeking late-term abortions.

In March 2003, the United States Senate passed a bill banning partial birth abortions and implementing fines or maximum two-year jail terms for physicians who perform them. In June 2003, the House approved a ban as well. President George W. Bush signed the legislation into law, but a federal judge declared the law unconstitutional, so that the government had not been able to enforce it. One of the opponents' claims was the legislation did not provide for exceptions for cases in which the procedure was needed to protect the mother's health.

Description

Intact D&X, or partial birth abortion first involves administration of medications to cause the cervix to dilate, usually over the course of several days. Next, the physician rotates the fetus to a footling breech position. The body of the fetus is then drawn out of the uterus feet first, until only the head remains inside the uterus. Then, the physician uses an instrument to puncture the base of the skull, which collapses the fetal head. Typically, the contents of the fetal head are then partially suctioned out, which results in the death of the fetus and reduces the size of the fetal head enough to allow it to pass through the cervix. The dead and otherwise intact fetus is then removed from the woman's body.

Preparation

Medical preparation for D&X involves an outpatient visit to administer medications, such as laminaria, to cause the cervix to begin dilating.

In addition, preparation may involve fulfilling local legal requirements, such as a mandatory waiting period, counseling, or an informed consent procedure reviewing stages of fetal development, childbirth, alternative abortion methods, and adoption.

Aftercare

D&X typically does not require an overnight hospital stay, so a follow up appointment may be scheduled to monitor the woman for any complications.

Risks

With all abortion, the later in pregnancy an abortion is performed, the more complicated the procedure and the greater the risk of injury to the woman. In addition to associated emotional reactions, D&X carries the risk of injury to the woman, including heavy bleeding, blood clots, damage to the cervix or uterus, pelvic infection, and anesthesia-related complications. There also is a risk of incomplete abortion, meaning that the fetus is not dead when removed from the woman's body. Possible long-term risks include difficulty becoming pregnant or carrying a future pregnancy to term.

Normal results

The expected outcome of D&X is the termination of a pregnancy with removal of a dead fetus from the woman's body.

KEY TERMS

Cervix— The narrow outer end of the uterus that separates the uterus from the vaginal canal.

Footling breech— A position of the fetus while in the uterus where the feet of the fetus are nearest the cervix and will be the first part of the fetus to exit the uterus, with the head of the fetus being the last part to exit the uterus.

Laminaria— A medical product made from a certain type of seaweed that is physically placed near the cervix to cause it to dilate.