Which Was It ?

Recently, more than one woman, as the nuances are parsed out, has come to realize that what they thought of as a miscarriage was actually a type of abortion. Truth is the definition means that both result in a similar outcome.

Medically, an abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to a viability allowing it to continue living. Many doctors now prefer to refer to this event as a termination rather than an abortion (for obvious reasons). This can happen either spontaneously or it can be induced. Generally, the more spontaneous is referred to as a miscarriage and this can occur even rather late in a pregnancy. When the event is induced, it is referred to as an abortion. Often, when a D&C is performed, medical personnel don’t really know for certain, if an embryo is present. I remember having to have a D&C when I was receiving reproductive assistance between the births of my two sons due to my lining not developing well enough and being asked directly if I was or could be pregnant. Since I was experiencing secondary infertility due to age and had not had any embryos transferred, I could be confident in my answer. With recent laws at some state’s level, this kind of situation could risk legal ramifications for the medical personnel and the woman.

During in vitro fertilization, it is common to fertilize more eggs than will be needed as the goal is to increase the woman’s chances of a successful pregnancy. Those excess fertilized eggs are commonly frozen, disposed of or donated for scientific research (which will then cause their destruction) – none of those choices are thought of as abortion. Some couples, as we did, will donate their frozen embryos to another couple – though in our case – the couple whose effort initially was successful and joyous, ultimately failed to develop after that point. All reproductive assistance patients want their pregnancy to be successful. In my mom’s group, only about half of the woman who started off in the group with us ended up with a pregnancy and ultimately, a child or children (we had quite a few twins and even a set of triplets in our group).

Often tens of thousands of dollars have been invested in the effort. Though this effort may initially appear successful, the pregnancy can still end and a decision must be made to remove those cells and the lining. Technically, this would be defined as an abortion. I read today about one case where a patient was carrying triplets. The pregnancies created by through in vitro fertilization, each implanted but stopped developing at different stages: one at six weeks, one at seven and one at eight. Therefore, none of these embryos were going to be successful in producing a child. Her doctor had to remove that tissue. It is not healthy and serves no purpose in remaining.

There is a kind of miscarriage that will be referred to as a missed abortion. The pregnancy actually ended, even though no symptoms of that had occurred. The contents of the uterus have not been naturally expelled. Sometimes, there may be some brownish discharge. The fact that the embryo has died is often discovered during a routine scan by her OB. The patient will be given Oxytocin, antibiotics and a D&C (a complete uterine evacuation – abortion). This is a situation where new laws could become problematic, especially if this occurs after 6 weeks and a positive indication of pregnancy.

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