History of Abortion in U.S.

1
History of Abortion in U.S.

• induced abortion termination of implanted
  embryo by artificial measures
• used for centuries to terminate unwanted
  pregnancies, adjust sex ratios, eliminate
  malformed fetuses, control population growth
• prior to 1973, was illegal in U.S.
• decision of U.S. Supreme Court in Roe v. Wade
  legalized abortion
• 1st trimester by request
• 2nd trim only in cases of fetal defects or
  danger to mothers health
• 3rd trim individual states can regulate must
  allow if preg. poses danger to womans health

2
History, contd.

• in 1977, Hyde Amendment supported by Supreme
  Court prohibits use of federal funds (e.g.
  Medicaid) for abortion unless womans life is in
  danger
• in 1992, Roe v. Wade upheld again by Supreme
  Court decision, but deleted reference to
  trimesters
• legal upon request prior to time when fetus can
  survive on its own (22 wks from conception)
• after this time, states can prohibit unless
  pregnancy endangers womans health or life
• states allowed to regulate abortion unless it
  places undue burden on womens right to
  terminate

3
History, contd.

• in 1983, Congress debated Human Life Amendment
• Congress finds that present day scientific
  evidence indicates significant likelihood that
  actual human life exists from conception.
• amendment didnt pass 18 votes shy of 2/3
  majority
• if passed in the future, the following
  contraceptive measures would be illegal (in
  addition to abortion) IUDs, birth control pills,
  minipills, Depo-provera,MAP, RU486, norplant

4
Statistics

• in 1973, 616,000 abortions performed
• in 1996, 1.6 million performed
• trend exists towards earlier abortion (1st
  trimester)
• 1/3 of all abortions in U.S. are performed on
  teens
• 3/4 are performed on unmarried women
• 23 states restrict access of minors to abortion
  (require parental notification or consent),
  including Wisconsin

5
Wisconsin Laws re Abortion

• no Wisconsin clinic performs abortions beyond 22
  weeks
• law was recently passed (not yet implemented)
  requiring 24 hr. waiting period before abortion
• patient must see doctor and receive state
  materials 24 hrs. prior
• more restrictive than waiting period passed in
  other states, which dont require physician visit

6
Wisconsin laws, contd.

• in case of minors, Wis. requires familial
  consent
• can be from parents, aunt, uncle, grandparent,
  brother or sister over 25 yrs., stepparent that
  has custody of the minor
• can bypass and obtain judicial consent
• exception emancipated minor who has left home
  and broken parental ties

7
1st trimester abortionsmenstrual regulation

• lowest risk, least painful
• performed within 2 wks. of missed period
• flexible plastic tube inserted thru cervix into
  uterus
• syringe attached to other end of tube
• suction applied to remove endometrium, embryo
• anesthesia not required
• after 10-30 min, patient can go home
• small risk of uterine infection, cramping,
  bleeding

8
1st trimesterprostaglandins

• used up to 3 weeks after missed period
• taken orally or as vaginal suppository
• causes contraction of uterine muscles and
  abortion of fetus
• takes several hours
• 100 effective within 3 weeks of missed period
• little risk to woman
• side effects nausea and diahrrea (treatment with
  digestive relaxant can alleviate) uterine
  bleeding can last 10-14 days

9
Mifepristone (RU486)

• became available in France in 1988
• approved for use in U.S. in 1996
• marketing held up due to legal battle
• prevents progesterone from binding to its
  receptor, inducing abortion
• approved for use up to 5 weeks in U.S.
• pill taken orally at clinic woman returns in
  36-48 hrs. for prostaglandins to expel embryo
• 97 affective
• side effects uterine bleeding (10 days) risk of
  infection
• Alternative methotrexate (blocks actions of
  folic acid)

10
1st trimester D C

• performed 6-12 weeks after missed period
• cervix is dilated and metal scraper is used to
  remove fetus and endometrium
• safest method of dilation laminaria tents
  (cylinders of dried and sterilized seaweed)
• surgery performed under anesthesia
• takes lasts 10-15 minutes
• side effects cramping bleeding risk of damage
  to cervix or uterus risk of infection
• performed on outpatient basis

11
1st trimestervacuum aspiration

• safer method replacing D and C
• faster
• less painful
• less bleeding
• less risk of infection
• less risk to cervix
• performed 3-9 weeks after missed period
• anesthetic injected into cervical wall
• tube placed in uterus
• suction applied for 1-1.5 min. to remove
  embryonic, placental tissue

12
2nd trimester abortions

• more complicated and risky
• more than 100,000 performed in U.S. per year
• reasons
• amnio revealed genetic defects
• maternal disorder
• unaware of pregnancy
• lacked money for abortion (350-500)
• unaware of options
• uterus is thin and highly vascular from 12th-15th
  week risk of uterine hemorrhage
• some will advise women to wait until 16th week

13
2nd trimesterintraamnionic saline method.

• performed in hospital
• cervix dilated with laminaria tent
• long needle inserted through abdominal and
  uterine walls, into amniotic sac
• syringe is used to remove amniotic fluid and
  inject saline solution
• kills the fetus and induces delivery with 24-48
  hrs (sometimes oxytocin is administered)

14
2nd trimester, contd.

• placenta may have to be scraped (10-16 of time)
• fetus may be born alive eventually dies due to
  respiratory failure
• risk of hemorrhage
• normal complications of labor

15
2nd trimesterprostaglandin injection

• most widely used procedure in U.S. at this stage
• most effective from 15th - 20th week
• procedure similar to saline method, only no fluid
  is withdrawn
• instead of saline, prostaglandins are injected
• advantages over saline method
• delivery occurs within 6-8 hrs. if cervix is
  dilated with laminaria tent
• fewer complications

16
3rd trimester abortions

• dilattion and evacuation (D E) procedure
• performed from 20th week on
• labor is induced with hormones
• brain of fetus is removed by suction while still
  in birth canal
• rarely used procedure
• Congress moved to outlaw procedure is still
  under debate