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Dyer C. The Savage case: disciplining consultants. Woodroffe C. Miscarriage or abortion. However, every experience is unique so the way that you feel can be very personal.
The main difference between pregnancy termination and miscarriage is the reasons why they happen. A termination is a procedure that a woman chooses to have in order to end her pregnancy. A miscarriage is something that happens unexpectedly and unintentionally. However, miscarriages are sometimes referred to as spontaneous abortions because the effects are so similar. The abortion pill actually works by triggering the same processes that occur during a miscarriage.
An abortion is a medical or surgical procedure that usually takes place early in the pregnancy. Most abortions are performed before 13 weeks, but it is legal to have a termination in the UK up to 24 weeks. Pregnancies can be terminated with the abortion pill or a minor surgical procedure to remove the contents of the womb. Women have abortions for many different reasons. In other cases, women may be worried about the impact on their emotional, social, family or financial wellbeing.
The term miscarriage is used to describe a pregnancy that ends before 24 weeks. Miscarriages can happen for various reasons, such as injuries or pregnancy complications. Sometimes it is just impossible for the pregnancy to continue. The foetus may have had an abnormality that was incompatible with life. Early Pregnancy Loss Management.
Almost all of the methods used to manage miscarriages and stillbirths are identical to those used in therapeutic abortions. Therefore, the clinical training necessary to safely manage a patient experiencing a pregnancy loss is very similar to that needed to perform abortions. As such, medical residents at religiously affiliated hospitals or in states with restrictive abortion laws may struggle to obtain the necessary training and caseload to become proficient in these skills.
Although miscarriage is common and it may seem as if physicians would easily obtain this training through managing pregnancy loss alone, research on this topic suggests otherwise; a study comparing U. When miscarriages present in emergency settings with significant bleeding or infection, it is imperative the clinician has the skills to promptly and safely treat that individual.
While miscarriages can be managed with misoprostol alone, the combination of misoprostol and mifepristone is more effective. Mifepristone is subject to Risk Evaluation and Mitigation Strategy REMS restrictions, 3 requiring it be dispensed only by certified providers in certain clinics and hospitals , rather than from a retail pharmacy.
This can be problematic for many emergency rooms, primary care or prenatal clinics where patients may be diagnosed with miscarriages, but cannot be adequately treated because their healthcare setting does not stock mifepristone or lacks certified providers. For comparison, all doctors in Canada can prescribe mifepristone and it can be picked up in pharmacies.
The REMS on Mifepristone impacts not only abortion care, but also limits miscarriage treatment as well. Some medications are used in pregnancy loss, abortions and pregnancy. What do these drugs do? Multiple uses in obstetrics and gynecology for labor induction, pregnancy loss, medication abortion, postpartum hemorrhage and before surgical procedures. Also used to prevent gastric ulcers. Mifepristone Mifeprex : Blocks the action of progesterone, causing the uterine lining to destabilize and stops progression of existing pregnancy.
Used in medication abortions, miscarriages and less frequently, for emergency contraception, endometriosis, fibroids and to induce labor. Oxytocin Pitocin : Causes uterine contractions.
Used to induce labor, treat postpartum hemorrhage and pregnancy loss, and sometimes to help uterus contract after abortions. Many states prohibit certain surgical methods for abortion, which may limit services for pregnancy loss.
Under less common circumstances, however, fetal cardiac activity may be present during cases of miscarriage Glossary , preventing the above procedures from being used where bans apply. For example, a patient with a pre-viable fetus at 20 weeks gestation may have a completely dilated cervix meaning the pregnancy loss is inevitable and be bleeding significantly, but denied surgical management until the fetus no longer has a heartbeat or until the situation is life threatening.
A study of Catholic-owned hospitals documented several cases of patients who were actively miscarrying and denied uterine evacuation while cardiac activity was still detectable, leading to delays in care and transfers to outside hospitals. It is therefore possible that surgical bans on abortion may limit medical decision making in nuanced cases of pregnancy loss. People experiencing pregnancy loss may be deterred from seeking medical care, particularly in places hostile to abortion.
For example, individuals may be investigated to ensure there was no intent to terminate the pregnancy. Meanwhile 10 states have laws criminalizing fetal harm without explicit exemptions for pregnant people Figure 3 ; these have been applied in cases of attempted maternal suicide and self-managed abortion, among other examples. These aforementioned laws are presumably enforceable until repealed or enjoined; in at least 20 states since Roe v.
Wade, criminal investigations or arrests have been made for alleged self-managed abortion Figure 4 , however it is unclear how many of these women were ultimately charged, and how many were found to be self-managed abortions verses pregnancy losses. These laws can be problematic for patients experiencing pregnancy loss, as they could prompt healthcare providers to report patients to law enforcement after pregnancy loss. There have been several cases where hospital workers have called the police on patients after suspecting intent to end their pregnancy, calling patient-provider confidentiality into question.
Several states have proposed requiring reporting of miscarriages. Kansas proposed a requirement for miscarriages and stillbirths to be reported to the state, while Virginia attempted to mandate reporting of pregnancy loss to law enforcement, including the name of the mother and the location of the pregnancy remains.
Mandated reporting could affect patient-provider confidentiality, and may result in some some women delaying seeking care until they are in emergency situations.
Many medical groups, including ACOG , the American Medical Association and Physicians for Reproductive Health , oppose criminalization of self-managed abortion and oppose mandated reporting by clinicians if a self-managed abortion is suspected. With a complete miscarriage, the bleeding and pain should subside quickly. Complete miscarriages can be confirmed through an ultrasound.
Alan Copperman is a board-certified reproductive endocrinologist and infertility specialist with a long history of success in treating infertility and applying fertility preservation technologies. He has been recognized by his peers and patient advocacy organizations for his commitment to patient-focused and data-driven care.
He has published more than original manuscripts and book chapters on reproductive medicine and has co-authored over scientific abstracts on infertility, in vitro fertilization, egg freezing, ovum donation, and reproductive genetics. Blighted Ovum Also known as anembryonic pregnancy, blighted ovum occurs very early in pregnancy, often before you even know you are pregnant. Missed Miscarriage A missed miscarriage , or a missed abortion, occurs when a fetus implants, but fails to develop.
The body does not expel the pregnancy tissue. Threatened Miscarriage A threatened miscarriage refers to vaginal bleeding that occurs during the first 20 weeks of pregnancy. Inevitable Miscarriage Inevitable miscarriage refers to unexplained vaginal bleeding and abdominal pain during early pregnancy. Incomplete Abortion An incomplete abortion, which is also called an incomplete miscarriage, happens when some—but not all—of the pregnancy tissue is passed.
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