Hysterotomy abortion

Hysterotomy abortion
Background
Abortion type	Surgical
First use	<1913
Gestation	2nd Trimester and Later
Usage
	U.S. figures include both hysterotomy and hysterectomy.
United States	<0.01% (2016)
	Infobox references

Hysterotomy abortion is a surgical procedure that removes an intact fetus from the uterus in a process similar to a cesarean section. The procedure is generally indicated after another method of termination has failed, or when such a procedure would be medically inadvisable, such as in the case of placenta accreta.^[1]

In 2016, this method made up less than 0.01% of all abortions in the United States, with the CDC reporting only 51 having occurred due to the invasive and complex nature of the procedure, and the availability of much simpler and safer methods.^[2] In 2022, scholars reported that in the aftermath of the overturning of Roe v. Wade by Dobbs v. Jackson Women's Health Organization, Texas and other states where so called trigger laws immediately outlawed or heavily restricted reproductive healthcare, providers began performing hysterotomy abortions again. These providers have done so under the justification that such a procedure may not technically be considered an abortion under existing law.^[3]

Indications

As with other abortion procedures, the purpose of a hysterotomy abortion is to end a pregnancy by removing the fetus and placenta. This method is the most dangerous of any conventional abortion procedure, and has the highest complication rate.^[1] The procedure is specifically indicated in the management of certain medical conditions including Cesarean Scar Pregnancy.^[4]

Procedure

Hysterotomy is major abdominal surgery; it is generally only performed in hospitals and other advanced practice settings. The procedure is nearly identical to a cesarean section, with two main exceptions: the conduction of foeticide guaranteeing compliance with various laws on the subject, and preventing an unintended live birth; and the size of the incision, which is generally smaller than that of a cesarean section, as the fetus is generally not full term.

History

Scholarly sources place the use of this method since at least 1913.^[5] Health officials in the United States warned practitioners against performing hysterotomy abortion in an outpatient setting after it led to the deaths of two women in New York during 1971.^[6]^[7] The rate of mortality of abortion by hysterotomy and hysterectomy reported in the United States between 1972 and 1981 was 60 per 100,000, or 0.06%.^[8]

References

^ ^a ^b Roche, Natalie E. (June 16, 2006). Surgical Management of Abortion. Retrieved July 1, 2007.
^ Jatlaoui, Tara C. (2019). "Abortion Surveillance — United States, 2016". MMWR. Surveillance Summaries. 68 (11): 1–41. doi:10.15585/mmwr.ss6811a1. ISSN 1546-0738. PMC 6289084. PMID 31774741.
^ Arey, Whitney; Lerma, Klaira; Beasley, Anitra; Harper, Lorie; Moayedi, Ghazaleh; White, Kari (August 4, 2022). "A Preview of the Dangerous Future of Abortion Bans — Texas Senate Bill 8". The New England Journal of Medicine. 387 (5): 388–390. doi:10.1056/NEJMp2207423. PMID 35731914. S2CID 249956428.
^ Doğru, Şükran; Akkuş, Fatih; Atci, Aslı ALTINORDU; Eren, Gülnur; Acar, Ali (19 Jan 2023). "Cesarean Scar Pregnancies and Reproductive Outcomes: A Single Center Experience". Journal of Clinical Obstetrics & Gynecology. 33: 36–42. doi:10.5336/jcog.2022-93710. S2CID 257643701.
^ Bonney, Victor (October 1918). "On Abdominal Evacuation of the Pregnant Uterus Before Viability". The Lancet. 192 (4964): 518. doi:10.1016/s0140-6736(01)02878-1. ISSN 0140-6736.
^ Berger GS, Tietze C, Pakter J, Katz SH (March 1974). "Maternal mortality associated with legal abortion in New York State: July 1, 1970--June 30, 1972". Obstet Gynecol. 43 (3): 315–26. PMID 4814448.
^ Stroh G, Katz SH, Hinman AR (October 1975). "Performing second-trimester abortions. Rationale for inpatient basis". N Y State J Med. 75 (12): 2168–71. PMID 1059921.
^ Grimes DA, Schulz KF (July 1985). "Morbidity and mortality from second-trimester abortions". J Reprod Med. 30 (7): 505–14. PMID 3897528.