Is Abortion Really Necessary For Treating Ectopic Pregnancies?

Is Abortion Really Necessary For Treating Ectopic Pregnancies?

Just like the common false positives that result from early prenatal screening, the false dogma surrounding ectopic pregnancies is contributing to the abortion rate.
Georgi Boorman
By

UPDATE: The author has publicly apologized for this article, which no longer expresses her opinion after more consultation with medical doctors and research. Please read her apology here.

If you Google “can an ectopic pregnancy be saved?” the consensus is like a hard slap in the face: no.

An ectopic pregnancy occurs when the embryo implants and begins growing somewhere outside the uterus, almost always in one of the mother’s fallopian tubes. “In these cases, the pregnancy can’t continue normally, and it requires emergency treatment,” states WebMD.

“Unfortunately, the foetus cannot be saved in an ectopic pregnancy. Treatment is usually needed to remove the pregnancy before it grows too large,” says the U.K.’s National Health Service. “There is no way to save an ectopic pregnancy. It cannot turn into a normal pregnancy,” according to the major health provider Cigna. “You will need quick treatment to end it before it causes dangerous problems.”

Every patient-facing source I’ve found gives the same answer: Agree to abortion, or risk your own death.

Is Abortion Always the Only Answer?

As I wrote recently with regard to NIPT (Non-Invasive Prenatal Testing), medical professionals and those who report on medical issues sometimes perpetuate false, and lethal misunderstandings. Doctors aren’t infallible; they are liable to accept the status quo without question, thus limiting patients’ options, and move forward with hasty interventions that lower their risk of getting sued.

Abortion is almost universally assumed by pro-lifers and abortion advocates alike to be the only answer in cases of ectopic pregnancy. Pro-lifers say it’s “the sad exception” to abortion bans because “the mother’s life is threatened.”

This threat is rarely defined but extremely alarming, especially when pronounced by a doctor. It’s no wonder nearly every mother facing an ectopic pregnancy chooses to terminate. But 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.

According to a 2017 report in Obstetrics and Gynecology, 54 U.S. deaths were due to ectopic pregnancies in 2011-2013. If roughly 2 percent of all pregnancies are ectopic, we can estimate a maternal death rate of 0.023 percent for ectopic pregnancies.*

We don’t know what the rate would be if abortion weren’t employed in most of these cases, but more importantly, what’s missing from the data are the specific reasons these deaths occurred (e.g., delayed treatment, misdiagnosis, etc). Data from the U.K. and Ireland might help clarify whether the risk of death or serious injury can be substantially mitigated in cases where ectopic pregnancies are left to continue.

The Facts About Ectopic Pregnancies

Ectopic pregnancy (EP) deaths “mainly occur after an acute initial presentation,” according to a clinical practice guide from the Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Directorate of Clinical Strategy and Programmes, Health Service Executive, revised in 2017. In other words, no warning signs presented, so there was therefore no opportunity to manage the situation before it became an urgent matter. The guide also noted that “in about half of those with EP presenting to emergency departments the diagnosis is missed at first assessment.”

Likewise, according to 2003-2005 data from the U.K., an inquiry into maternal deaths indicated that “most of the women who died from ectopic pregnancy were misdiagnosed in the primary care or accident and emergency settings.” That is to say, they died because health care providers thought something else was wrong with them, such as appendicitis, not because doctors saw they had an ectopic pregnancy and opted for close monitoring of the pregnancy until it ended on its own or required medical intervention (called “expectant management” or “watchful waiting”) instead of immediate abortion.

It’s important to note that about half of tubally implanted embryos die on their own without medical intervention (between 47 percent and 82 percent in cases of expectant management) and without threatening the mother’s health. Embryos are reabsorbed into the tissue, which is exactly what methotrexate, the widely popular “early intervention” alternative to surgical removal, is used for.

In cases where the tube ruptures, on the other hand, the baby has most likely perished already, so abortion isn’t necessary in this circumstance, either. In cases where neither scenario has played out yet, there’s a strong argument to be made that abortion is not necessary.

According to Dr. Patrick Johnston in an article for Celebrate Life Magazine, suctioning out the hemorrhaged blood, filtering it, and reinserting it via IV (called autotransfusion) “has a higher success rate than the most commonly employed abortive method.” A study of 632 cases of exclusive use of autotransfusion for ruptured ectopic pregnancies in 16 developing and 5 developed countries yielded one death “thought to be due to pulmonary embolism” and “nine major and minor complications.”

So, the death rate was 0.16 percent, and 98.4 percent of patients had no complications. That’s better than the 94.4 percent non-morbidity rate for the least invasive form of appendectomy (although there were no deaths in that study).

Knowing that a medical condition carries a very small chance of death is scary, and 0.16 percent is higher than the estimate given above, where abortion is aggressively used to “treat” the pregnancy. The sample size for the study is 382 times smaller than my U.S. EP estimate, of course, but assuming it’s accurate, is that very small chance enough to prompt you to suffer through purposely destroying your own child? Would you rather live with that on your conscience, knowing that in all likelihood it wasn’t necessary?

Still, death isn’t the only concern in ectopic pregnancies. A loss of a functioning fallopian tube due to rupture lowers fertility, although in some cases doctors can repair a ruptured tube. As it stands, 60 percent of women who have had ectopic pregnancies go on to have another normal pregnancy (including women who didn’t plan to conceive). Even if this weren’t the case, is the potential loss of fertility a sufficient reason to keep abortion legal for ectopic pregnancies? It is right to destroy a human life for fear you may have trouble creating more?

And the risks associated with EPs must also be contextualized by the fact that ectopic pregnancies sometimes do result in live births, so a woman with an EP isn’t necessarily risking her health for no child.

Some Embryos Reimplant — and Survive

In a 1982 paper in the Journal of the National Medical Association, author John F. J. Clark discusses the success rates of embryos naturally reimplanting from the fallopian tube to other areas outside the uterus. “In the 20 patients who had the symptoms, reimplantation occurred from five weeks to ten weeks,” he states, showing that chorionic tissue (the membrane surrounding the embryo) is, “very adaptable in relocating on various sites.”

Out of 44 patients with advanced ectopic pregnancy, 18 cases progressed beyond 28 weeks of gestation, and 9 babies were delivered live, all between 34 and 40 weeks.

Specific cases of infant survival have come to light as well, such as that of Thomas Smith, born January 1974, and twins Heidi and Halle, born August 2013. In the latter case, an embryo traveled down the tube into the womb shortly before the surgery to remove the tube and the embryo thought still to be inside it.

Taken altogether, this evidence suggests that patients with ectopic pregnancies that don’t “resolve on their own” (about half of cases) but cause a rupture and hemorrhaging can be effectively treated with autotransfusion. 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. Twenty percent or more of those could result in a live birth at term or near term, with at least another 20 percent making it past the current point of viability at 22 weeks.

The Medical Consequences of Abortion Legality

Obviously, it’s much safer for a baby to develop in the uterus. One might think that, two decades into the 21st century, doctors would have found a way to transplant an embryo from the tube to the uterus, yet we have only a little evidence it has ever been done successfully.

In a 1990 letter to the editor in Human Reproduction, Landrum B. Shettles described his success. He is elsewhere cited by J. G. Grudzinskas as having performed a successful transfer. Letters to the editor are not excellent evidence, however.

There are two other reports of successful embryo transfers leading to live birth, one from 1917 by C.J. Wallace, which wasn’t peer-reviewed and likely didn’t happen, and another in 1994 by J.M. Pearce that was retracted by the journal after an investigation found no evidence he ever performed the study.

Even if no transfer has yet been successful, it may be because, as the authors of the report to which Grudzinskas was responding, stated, the window for a successful transfer surgery is “just where laparoscopic surgery and medical therapy afford the best results.” In other words, why bother attempting more invasive surgery if you can less invasively remove the embryo (thus resulting in its death) or chemically destroy it by causing its reabsorption into the tissue? As long as the woman can maintain her fertility, what’s the big deal?

Take note: This near-universal refusal to save tiny lives is a consequence of legal abortion, which promotes the idea that only one patient’s welfare — the larger, older one — must be considered when her health is at risk. As long as abortion is legal, it is the go-to “preventative” solution for ectopic pregnancies. Doctors don’t want to be sued for malpractice if a pregnancy develops complications, and they tell mothers that abortion is their only safe option. As long as the tiny life is expendable, why not just kill it to be on the “safe side” and move on?

Abortion Is Never the Answer

But if killing the preborn weren’t legal, doctors would be more likely to develop solutions that safeguard the welfare of both patients. That includes improving the accuracy of early diagnosis, so patient and doctor can be informed of the signs and symptoms of rupture, and discovering and improving techniques to reimplant the embryo in the uterus. Most mothers want desperately for their baby to survive — and knowing that abortion is not necessary and not an option, they’ll fight for their little one, encouraging health care providers to fight, too.

Just like the common false positives that result from early prenatal screening, which parents are led to believe are extremely rare, the false dogma surrounding ectopic pregnancies is likely contributing to the abortion rate. The goal of debunking the conventional wisdom shouldn’t be merely to ensure patients “know their options,” though. It should be to wake up the whole world to the fact that abortion is never the answer and galvanize citizens to demand an end to the abominable practice — with no exceptions.

*This is a rough figure using 102 percent of the total live births (11,838,612) during that time period as total number of pregnancies. If one includes an estimate of miscarriages and non-EP abortions, the death rate would be even lower, as the estimated number of ectopic pregnancies would be even higher.

This article offers no medical advice for specific cases; in such circumstances, always consult your doctor.

Georgi is a Senior Contributor at The Federalist, host of The 180 Cast, and coauthor of "Clocking Out Early: The Ultimate Guide to Early Retirement." Follow her on Twitter.
Photo U.S. Army / public domain

Copyright © 2019 The Federalist, a wholly independent division of FDRLST Media, All Rights Reserved.