Doctors are calling for people to consult with their physicians to deal with potentially deadly ectopic pregnancies instead of following the advice of an article published on the conservative website, The Federalist, on Monday, which claimed that procedures to save the lives of pregnant people were unnecessary. An ectopic pregnancy or EP occurs when a fertilized egg implants in a place other than inside the uterus, usually in the fallopian tube, which can rupture if the pregnancy continues.
In the piece—titled “Is Abortion Really Necessary For Treating Ectopic Pregnancies?”— Federalist correspondent Georgi Boorman also claims that EPs contribute to abortion rates, and demanded an end to all legal abortion, including for treatment of EP. "Abortion is never the answer," she writes.
Medical experts say an EP always ends in pregnancy loss, either on its own (a miscarriage) or because of an intervention to end the nonviable pregnancy. The complication impacts approximately one out of 100 pregnancies, and is the leading cause of maternal death in the first trimester due to internal bleeding. Between 1980 and 2007, 876 people died from an EP in the United States. Black women were disproportionately represented in those figures: Their mortality rates were 6.8 times higher than white women.
According to the American College of Obstetricians and Gynecologists, there are two treatments for ectopic pregnancy: medication to stop the pregnancy or surgery to remove it and sometimes portions of the fallopian tube. In both, the goal is to end the nonviable pregnancy—effectively a termination, though OB/GYNs point out that if a fetus isn't viable it's not considered an abortion—in order to protect the person from potentially facing life-threatening hemorrhaging. As the Mayo Clinic explains, “An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated.”
Yet Boorman argues in the Federalist that “we owe it to mothers and their babies to examine how severe and how common this threat to her life and health really is, and if there are other ways to ensure her safety that don’t include killing the child.” Too often, she says, doctors limit “patients' options, and move forward with hasty interventions that lower their risk of getting sued.”
Astoundingly, Boorman suggests that the risk of serious injury and death due to an EP diagnosis may be exaggerated. Referencing a 2012 paper published in the Journal of Family Planning and Reproductive Health Care, she writes that many ectopic deaths in the late 90s and early 2000s in the United Kingdom were ultimately attributed to misdiagnosis. There’s no way, Boorman says, to know if those women would have lost their lives had a doctor correctly diagnosed an EP and chosen to closely monitor the pregnancy until it ended on its own or required intervention.
The article also implies that people diagnosed with EP would be better off rupturing a fallopian tube and experiencing internal bleeding than choosing to terminate the pregnancy. Boorman references a procedure called autotransfusion (where a person receives their own blood for a transfusion) as having “a higher success rate than the most commonly employed abortive method.” Why does she suggest this? Because, she writes, putting one’s life at risk is preferable to “purposely destroying your own child.” Besides, she adds, “If left alone, a small minority of babies will reimplant in a safer location (such as on top of the tube) between weeks 5 and 10 and continue developing.”
The odds of a successful ectopic pregnancy are actually extremely rare—and cannot happen if the fertilized egg has implanted in the fallopian tube, which happens in more than 90 percent of EP cases.
It’s not the first time that those opposed to abortion have used inaccurate information regarding EPs as a way to advance their agenda that termination is never medically necessary. In May, an Ohio lawmaker garnered criticism from the medical community for introducing legislation that referenced a nonexistent treatment for EP that would “reimplant the fertilized ovum into the pregnant woman's uterus.”
Karen Meckstroth, a clinical professor of obstetrics and gynecology at the University of California, San Francisco, told VICE that it’s dangerous to suggest that patients aren’t being properly informed when they’re diagnosed with EP. “It appears to me this article is trying to use ectopic pregnancies to push their agenda of anti-abortion rhetoric rather than providing any helpful information.” The only time it’s appropriate talk about abortion and EPs in the same space is to help explain the differences to patients, she added.
The standard treatment for an EP is removing the nonviable pregnancy, Meckstroth continued. "It cannot lead to a baby.”
Although it is possible for the pregnancy to end on its own, as Boorman suggests in her article, Meckstroth said some people diagnosed with EP would be recommended expectant management, also known as “watchful waiting,” in certain circumstances. Providers monitor patients' hormone levels and perform ultrasounds anywhere from one to three times a week until intervention is required or the EP shrinks and dissolves on its own.
“For patients who present with low or declining levels of HCG (Human Chorionic Gonadotropin) and don’t have evidence of internal bleeding, we would recommend expectant management. That’s a very small subset of people,” she said.
But, Meckstroth cautioned, the risk of rupture in the fallopian tube is high. One population-based study published in 1999 found that 18 percent of 843 French women with EP experienced tubal rupture. Another review found that the rate of rupture for patients who received methotrexate—the medication administered to stop cell growth and dissolve existing cells if an EP is confirmed early, meaning the fallopian tube hasn't ruptured—still ranges from 7 percent to 14 percent.
“Every OB-GYN has seen at least one patient present with massive internal bleeding that was the result of an ectopic pregnancy,” Meckstroth said.
Indeed, Jen Gunter, an OB-GYN and author of The Vagina Bible, tweeted on Monday: “STOP TRYING TO MAKE ‘ECTOPIC PREGNANCIES ARE BABIES TOO’ A THING. If you have never treated a woman with a belly full of blood from an ectopic you should shut the fuck up and sit down and learn before you get someone killed.”
Ultimately, one of the main points Boorman and other anti-abortion activists and lawmakers are trying to make is that the reason doctors treat EP the way they do is because abortion is legal—not because removing the ectopic tissue is necessary to save lives. She claims that “doctors would be more likely to develop solutions that safeguard the welfare of both patients” if abortion wasn’t an option in any circumstances.
But, as Meckstroth pointed out, the science just isn’t there yet. Researchers have spent their whole careers trying to understand the complex mechanisms that connect a mother to a fetus, she said, yet no one has figured out how to successfully transplant a pregnancy that started elsewhere to the uterus where it can safely develop.
As another OB-GYN tweeted on Monday after reading Boorman’s piece: “To any woman reading this - an ectopic pregnancy can KILL you. Trash this article and talk to your doctor.”
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