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Pastimes : Let's Talk About Our Feelings!!! -- Ignore unavailable to you. Want to Upgrade?

To: Zoltan! who wrote (83464)	7/6/2000 1:21:52 PM
From: Ilaine	Read Replies (1) \| Respond to of 108807

Zoltan, you really need to actually read the stuff the AMA wrote on the subject. You say "the AMA says that partial birth abortion is never medically necessary." Wrong. The AMA says that dilation and extraction is never medically necessary. In cases where late term abortion is medically necessary, they do support pregnancy termination by induction or by dilation and evacuation. Yet they admit that this has a high risk of causing maternal mortality and morbidity. I don't find it surprising that their position is very close to my own. Late term abortion should NEVER be used for purposes of family planning and birth control. If late term abortion is medically necessary, due to fetal death or abnormality, it should be done as early as possible. If the reason for the abortion is for the health of the mother, and the fetus is viable, the fetus should be saved, if possible. Due to your snide comments to e-Bill, I am not going to post any more on this topic to you. You want to make it into a political issue. I don't. My position is thoughtful, and reasoned, and there is nothing to be gained by prolonged interaction with people who don't bother to actually read what I've written. >>Termination of Late-term Pregnancies Many of the medical and ethical issues that pertain to intact D&X also apply to late-term pregnancy terminations, defined for the purposes of this article as termination beyond 20 weeks' gestation. Pregnancy termination at this gestational age can be accomplished either by labor induction or by D&E. [D&E is abortion - so is induction, unless the fetus is viable.] 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. [Rare means it does happen sometimes.] 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. Maternal Considerations.—The risk of maternal mortality and morbidity associated with termination of pregnancy increases with advancing gestational age. Induced midtrimester abortion accounts for an estimated 10% to 20% of all abortions, and for two thirds of abortion-related major complications especially maternal mortality.[22] Women undergoing legal abortions during the first 8 weeks of gestation have the lowest risk of death (0.4 per 100,000 abortions), whereas procedures performed beyond 20 completed weeks of gestation are associated with the highest risk (10.4 per 100,000 abortions).[23] On average, the mortality from induced abortions increases 30% with each passing week of gestation.[24] At 21 weeks or more, the risk of death from abortion is 1 in 6000 and exceeds the risk of maternal death from childbirth, 1 in 13,000.[25] The risk of abortion-related maternal morbidity also increases with advancing gestational age. 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] Termination of pregnancy at more advanced gestational ages may predispose to infertility from endometrial scarring or adhesion formation (documented in 1 study in 23.1% of patients with induced midtrimester abortions[29]) and from pelvic infections, which occur in 2.8% to 25% of patients following midtrimester terminations.[30,31] 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] [These are the reasons for D&X, in a nutshell.] Considering that the risks of maternal morbidity and mortality increase substantially with advancing gestational age, elective abortions, if they are to be performed, should be performed as early as possible in gestation. Limiting [not banning] late-term abortions would minimize maternal risks.<< partialbirthabortion.org It's the "almost always" and "almost never" that does the authors in.