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By Miriam Raftery

August 26, 2012 (San Diego’s East County) – How common are life-threatening pregnancy conditions?  The question is timely given the Republican Party’s platform calling for a ban on abortions, even when a mother’s life is at risk. Some who advocate outlawing all abortions have sought to justify the position by arguing that life-threatening conditions are rare. 

But in fact, the most common cause of death in early pregnancy has increased dramatically.

About 1 in every 38 pregnancies is now ectopic (26.2 for every 1,000 pregnancies, or 2.6 for every 100 pregnancies) the American Journal of Preventive Medicine reported last year. That’s a huge rise from just .045%, or less than half a percent, back in 1970 and from 1993, when the rate was 1.9%, or about 1 in 50.

Ectopic pregnancies, often called “tubal” pregnancies, are the leading cause of death in early pregnancy and is a “true medical emergency,”  accounting for 10-15% of all maternal deaths, American Family Physician reported in 2000.  

Further, maternal death rates in the U.S. have doubled in the U.S. in recent years from a variety of causes.  Efforts by the “pro life” movement to protect the unborn from the moment of conception, however well intentioned,  is clearly putting the lives of mothers at risk.

Types of ectopic pregnancy

Ectopic pregnancies occur when a fertilized egg fails to implant in the uterus but instead, becomes implanted elsewhere, usually in the Fallopian tubes, though ectopic pregnancies can occur in the ovary, cervix, or even the abdominal cavity outside the womb.    

About 95% of ectopic pregnancies occur in the Fallopian tube, where there is no room for a fetus to grow.  It is impossible to save a fetus implanted in the Fallopian tube. You can, however, save the mother by terminating the pregnancy. Left untreated, the Fallopian tube can rupture, causing massive internal bleeding, infection, and sometimes death. 

Some pro-lifers have suggested that an ectopic pregnancy can possibly be viable and have sought to discourage women from seeking abortions even with this extreme condition.  While it’s true that on very rare occasions, an ectopic pregnancy inside the abdominal cavity has resulted in a live birth, only about 1% of ectopic pregnancies are abdominal pregnancies—and the risks to both mother and baby are extremely high.

Implantation of the fertilized egg may attach to organs such as the bowel or liver.  Hemorrhagic shock from bleeding can be fatal to the mother, as can toxemia, anemia, pulmonary embolism, and infection.  Death rates for the fetus are as high as 95%, and even if the fetus survives an abdominal pregnancy, the lack of amniotic fluid and compression cause serious birth defects ranging from skull and limb deformities to nervous system disorders. Labor does not occur, so delivery must be done surgically.

Why are ectopic pregnancy rates so high?

Doctors are not sure what’s accounting for the sharp increase in ectopic pregnancy rates.  Part may be due to better diagnosis techniques.  But several factors are known to increase your risk of having an ectopic pregnancy.

According to WebMD, risk factors include:

·         Exposure to the prescription drug DES (Diethylstilbestrol) before you were born. DES was given to women in the 1950s to prevent miscarriages, but in fact caused reproductive tract problems in their daughters.

·         In-vitro fertilization and other fertility treatments

·         Infection from prior surgeries of the uterus or Fallopian tubes

·         Tubal ligation failure or surgery to reverse a tubal ligation

·         History of pelvic inflammatory disease and infections, such as Chlamydia or gonorrhea

·         Cigarette smoking

·         Failure of progestin-only birth control pills

·         Endometriosis, or lining of the uterus growing outside, causing scarring in or around Fallopian tubes

·         A prior ectopic pregnancy dramatically increases risks

Treatment and medical consequences of ectopic pregnancy

Medical experts recommend termination of ectopic pregnancy, which can be done in early stages with medication or laparospic surgery.  It is sometimes possible to take a watch and wait approach, since some ectopic pregnancies will resolve on their own, resulting in miscarriage. Any woman with an ectopic pregnancy should be closely monitored, because a rupture is an immediately life threatening condition.  Besides death, a ruptured ectopic pregnancy can also cause sterility or severe infection/peritonitis.

Ectopic pregnancy is just one of many causes of death in pregnant woman and alarmingly, the overall maternal death rate in the U.S. has risen dramatically.

Maternal deaths have risen in U.S.

The Association of Reproductive Health Professionals in a March 2011 editorial called soaring maternal deaths in the United States a “human rights failure.”  The ARHP notes that from 1990 to 2009,  maternal death rates nearly doubled in the U.S. – at the same time the rate globally decreased by 34%. 

In 1987,  the maternal death rate in the U.S. had fallen to its all-time low of 6.6 deaths per 100,000 live births.  The rate began rising again in 2000 and has recently nearly doubled; between 2003 and 2007 the rate was between 12 and 15 mothers’ deaths per 100,000 live births.

 In addition, “near misses” or pregnancy complications in which women nearly died also increased 27% from 1998 to 2005.  Such complications are NOT rare:  in the U.S., 34,000 women face life-threatening pregnancy conditions each year. 

Leading causes of mothers’ deaths during pregnancy include hemorrhage, pregnancy-related hypertensive disorders, infection, thrombotic pulmonary embolism, cardiomyopathy, cardiovascular conditions, and other medical conditions. These include deaths during pregnancy as well as post-delivery deaths.

Abortion deaths vs. pregnancy deaths in U.S. and worldwide

In developing countries the leading causes of death are obstructed labor and unsafe abortions.  Globally, 219 women die every day from unsafe abortions, according to the World Health Organization; where abortions remain illegal or unsafe they account for 13% of the 600,000 annual pregnancy-related deaths worldwide.

But deaths from abortions in the U.S. have actually gone down sharply since Roe v.Wade legalized abortion, according to a fact sheet from the Abortion Access Project. Before, as many as 5,000 women a year died of abortion.  Since legalization, the rate has dropped to 0.6 per 100,000 abortions performed in the U.S. , which incidentally is 11 times safer statistically than carrying a pregnancy to term.

So if deaths from abortions have gone down in the U.S., what is causing the rise in the death rate of pregnant women?  

Healthcare access linked to  U.S. deaths of pregnant mothers

The rising number of recent maternal deaths in the U.S. can be firmly blamed on lack of access to healthcare in many cases.  Women who don’t get prenatal care are three to four times more likely to die of pregnancy-related complications than women who have prenatal care—and those with high-risk pregnancies are 5.3 times more apt to die without care.  Lack of insurance coverage remains a key barrier to healthcare access.

In the U.S., 25% of women don’t get adequate prenatal care—and that figure rises to 32% for African-American women and 41% for Native American women. Minorities have higher death rates and poorer quality of care overall. Shockingly, African American women are FOUR TIMES more likely to die of pregnancy related complications in the U.S. than white women.  Studies have found they do not suffer serious conditions at higher rates than whites, but rather they are not having access to treatments that could save their lives.

The AHRP concludes, “It is both a tragedy and a human rights failure when a woman dies needlessly of preventable causes in a country that lacks the political will to have prevented her death.”


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