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How treatment of ectopic pregnancy fits into post-Roe medical care

How treatment of ectopic pregnancy fits into post-Roe medical care

As laws restricting abortion snap into place across at least 18 states after the June 24 Supreme Court decision to overturn Roe v. Wade, people have taken to social media to question whether this decision will limit access to the treatment for ectopic pregnancies. 

A Facebook post claimed “the treatment for an ectopic pregnancy is abortion.” 

This post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.) 

Similar posts have been shared widely across social media. Actress Halle Berry posted a similar graphic on Instagram.

Ectopic pregnancies happen when a fertilized egg implants itself outside of the uterus. This can cause life-threatening bleeding.

We found that while in some cases there is some overlap in the way ectopic pregnancies are treated and how pregnancies are electively terminated through abortion, that overlap appears to be small.

The larger issue is whether medical providers interpret restrictive abortion laws as limiting their ability to treat patients who present with ectopic pregnancies, which can be life-threatening.

How providers respond could depend on how “abortion” is defined under state laws.

Ectopic pregnancies are not viable

Ectopic or extrauterine pregnancies happen when the egg travels down the fallopian tube to meet the sperm but does not reach the uterus. In 90% of ectopic cases the fertilized egg attaches to the fallopian tube. In other cases it can attach to the cervix or to the scar of a cesarean section. Out of every 1,000 pregnancies in the U.S. around eight are ectopic. 

“As the pregnancy grows, it can cause the tube to burst,” which can lead to life-threatening internal bleeding, according to the American College of Obstetricians and Gynecologists.

These pregnancies are not viable and they cannot be reimplanted in the uterus. As a result, the pregnancy must be terminated. 

The symptoms for an ectopic pregnancy are similar to those of a normal pregnancy: low back pain, mild cramping and a missed menstrual period. 

Terminating a pregnancy is the treatment for an ectopic pregnancy

There are a few different treatment options for an ectopic pregnancy. These depend on how far along the pregnancy is. All treatments lead to the pregnancy ending. 

In most cases, ectopic pregnancies are treated as soon as possible to avoid the patient’s fallopian tube from rupturing — a condition that could otherwise lead to life-threatening blood loss. 

An ectopic pregnancy can be detected through a pelvic exam, blood test and ultrasound. And if it is detected early enough, it can be treated with prescribed medications. In this case, a doctor provides one or more shots of a medicine known as methotrexate. This medicine stops cell growth, ending the pregnancy, and dissolves the existing cells.

Research shows that when it comes to elective abortions, methotrexate can be used alongside another drug, misoprostol, to end viable, first-trimester pregnancies. But methotrexate’s price and possible side effects make it less likely to be used in such abortion procedures, according to Amy Addante, OB-GYN and fellow with Physicians for Reproductive Health.

A combination of mifepristone and misoprostol is the more common regimen for an induced abortion. 

If an ectopic pregnancy is farther along, or if it leads to the fallopian tube bursting, the patient will need to undergo surgery to end the pregnancy. This can be done through a laparoscopic procedure during which a doctor makes a small incision and uses a thin tube with a camera lens and light to perform the surgery.

Depending on the patient’s condition, the fallopian tube might need to be removed. 

If the ectopic pregnancy is causing heavy bleeding, an emergency surgery might be needed. For this, a doctor will make an incision in the patient’s abdomen. 

Neither of these procedures are performed in a surgical abortion. 

According to ACOG, there are three procedures for an abortion, which procedure is used depends on how far along the pregnancy is. The first involves a vacuum, where a tube is inserted into the cervix and attached to a suction pump to end the pregnancy. The second is a dilation and curettage where the cervix is dilated and instruments are used to remove the pregnancy tissue. The third, is a dilation and evacuation, similar to a dilation and curettage, the cervix is dilated but larger instruments are used along with a suction device. 

None of these procedures would be used for an ectopic pregnancy in the fallopian tube. 

However, if the ectopic pregnancy is located in the cervix or on the scar tissue from a cesarean section, the treatment could be the same as an abortion, according to Addante.

Medical v. legal defintions of ‘abortion’

The definition of an abortion varies depending on the medical source or expert consulted. Legal scholars tend to approach the matter differently than those in the medical community — the patient’s intent to terminate is key in this discussion.

In medical terms, abortion is broadly considered a procedure undertaken to end a pregnancy.

The National Institutes of Health defines an abortion as a procedure “to end a pregnancy.” 

Harvard Medical School describes it as a “removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterus.” Harvard clarifies that other terms for abortion include “elective abortion, induced abortion, termination of pregnancy and therapeutic abortion.”

The Mayo Clinic specifies the treatment for an ectopic pregnancy is not a medical abortion, which it defines as “a procedure that uses medication to end a pregnancy.” It adds that a medical abortion can be used “to complete an early miscarriage or end an unwanted pregnancy.” 

When it comes to legal definition, however, what constitutes an “abortion” is often dictated in part by whether the patient made a conscious decision to terminate the pregnancy. 

According to the Legal Information Institute at Cornell Law School an “abortion is the intentional termination of a pregnancy.”

Abortion laws across the states have used similar definitions. An Ohio law includes “the purposeful termination of a human pregnancy by any person.” A law in North Dakota defines it as “the use or prescription of any substance, device, instrument, medicine, or drug to intentionally terminate the pregnancy of an individual known to be pregnant.”

Most of the medical experts we talked to were clear that they don’t consider ectopic treatment an abortion. 

The lack of consensus over the definition for an abortion makes defining the treatment for an ectopic pregnancy confusing and it can have real-world implications.

“I think the reason this is coming up right now is because of the vague wording of so many of these laws, and I think that is what the general public and clinicians and lawyers are all kind of grappling with,” Addante said. “As a doctor, I would not, before a week ago, have considered the treatment of an ectopic pregnancy to be an abortion.”

Abortion laws could delay treatments for ectopic pregnancy

Health care experts told PolitiFact that even if the treatment for an ectopic pregnancy is not classified as an abortion, patients could still be put at risk as a result of laws banning or limiting abortions.

All of the 18 states expected to ban abortion following the overturning of Roe v. Wade have exceptions for the life of the patient or a medical emergency. 

Even so, experts say the vagueness of these laws could lead to complications with access to treatment for ectopic pregnancies. 

“These laws will have a chilling effect on clinicians, because they don’t want to be accused of committing a crime,” said Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at University of California San Francisco. “They may wait until the clinical presentation evolves to the point where it’s really clear that the person’s life is at risk, for example, waiting until the fallopian tube may have ruptured before intervening. That would be very bad medical care.”

The New England Journal of Medicine reports that this has already been the case for health care providers in Texas, where a restrictive abortion law, with an exception for the life of the mother, went into effect in September 2021. 

“It’s very, very important for people to understand that for political reasons, people mischaracterize biologic events and medical treatments,” said Wendy Chavkin, co-founder of Global Doctors for Choice and professor of obstetrics and gynecology at Columbia University. “And there is something called the standard of medical care, and that’s what people should be getting.” 

Most pregnancy related care is extremely time-sensitive, especially when it comes to treating an ectopic pregnancy.

“When people are unclear about what these laws mean, and you’re talking large penalties for physicians, you know, loss of license, jail time, felony charges,” Addante said. “The delays that are occurring as they seek legal clarity to make sure that they can legally do what they know to be medically right, it’s really dangerous for that patient.”

Source: PolitiFact.

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