Late termination of pregnancy

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Late termination of pregnancy
Other namesPostviability abortion, third trimester abortion, induced termination of pregnancy (ITOP), [1] late-term abortion
Specialty Obstetrics and gynecology
ICD-10-PCS O04
ICD-9-CM 779.6
MeSH D000028
MedlinePlus 002912

Late termination of pregnancy, also referred to as third trimester abortion, [2] describes the termination of pregnancy by induced abortion during a late stage of gestation. [3] In this context, late is not precisely defined, and different medical publications use varying gestational age thresholds. [3] As of 2015 in the United States, more than 90% of abortions occur before the 13th week, 1.3% of abortions in the United States took place after the 21st week, [4] and less than 1% occur after 24 weeks. [5] [6]

Contents

Reasons for late terminations of pregnancy include circumstances where a pregnant woman's health is at risk or when birth defects, such as lethal fetal abnormalities, have been detected. [7] [8]

In the United States, the mortality rate for legal abortions overall is less than 1:100,000. The rate of mortality and morbidity increases with the gestational age of the fetus, so patients who have decided to have an abortion are strongly encouraged to get it early. [9] Still, later abortion is not associated with any greater net negative physical or mental health outcomes (including mortality) than full-term pregnancy and childbirth in the United States. [10] [8] [11]

Late termination of pregnancy is more controversial than abortion in general. All countries in Europe only permit abortion later in pregnancy (after 10-14 weeks in most countries, 18 weeks in Sweden and Iceland, and 24 weeks in the Netherlands and Great Britain) if specific circumstances are present, generally when the pregnancy represents a serious danger to the life, or to the physical or mental health of the woman, or when a serious malformation or anomaly of the fetus is diagnosed. [12]

Definition

A late termination of pregnancy often refers to an induced ending of pregnancy after the 20th week of gestation, i.e. after a fetal age (time since conception) of about 18 weeks. The exact point when an abortion is considered late-term, however, is not clearly defined. In three articles published in 1998 in the same issue of the Journal of the American Medical Association (JAMA), two chose the 20th week of gestation and one chose the 28th week of gestation as the point where an abortion procedure would be considered late-term. [13] [14] [15] The American College of Obstetricians and Gynecologists defines a late term pregnancy as 41 weeks 0 days through 41 weeks 6 days, which differs from how the term is used in the abortion context. [16]

In the United States, the point at which an abortion becomes late-term is often related to fetal viability (ability of the fetus to survive outside the uterus). Thus, late-term abortions are sometimes referred to as post-viability abortions. [17]

Viability

There is no sharp limit of development, age, or weight at which a fetus becomes viable. [18] A 2015 study found that even with active treatment, no infants born at less than 22 weeks survived, but an infant born at 21 weeks and one day in April of 2021 did survive his premature birth. [19] At 23 weeks survival without severe impairment is less than 2%, and at 25 weeks, up to 30% might survive without severe impairment. [20] [21] According to studies between 2003 and 2005, [22] [23] [24] 20 to 35 percent of babies born at 24 weeks of gestation survived, while 50 to 70 percent of babies born at 25 weeks, and more than 90 percent born at 26 to 27 weeks, survived. [21] Because the chance of survival is variable based on interventions available and the weight and sex of the fetus, there is no consensus on viability. The American College of Obstetricians and Gynecologists reports that 23% of abortion providers offer abortions at 20 weeks of gestation and later, most often using a method called dilation and evacuation (D&E). [25]

Incidence

Histogram of abortions by gestational age in England and Wales during 2019. UK abortion by gestational age 2019 histogram.svg
Histogram of abortions by gestational age in England and Wales during 2019.
Abortion in the United States by gestational age, 2016. (Data source: Centers for Disease Control and Prevention) US abortion by gestational age 2016 histogram.svg
Abortion in the United States by gestational age, 2016. (Data source: Centers for Disease Control and Prevention)

Reasons

United States

Reasons for late terminations of pregnancy include when a pregnant woman's health is at risk or when lethal fetal abnormalities have been detected. [7] [8]

A 2013 study found, after excluding abortion "on grounds of fetal anomaly or life endangerment", that women seeking late abortions "fit at least one of five profiles: They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and nulliparous". The study concluded that "bans on abortion after 20 weeks will disproportionately affect young women and women with limited financial resources". [37]

England and Wales

The NHS records the reasons given for abortions at all stages of development. In 2015, 2,877 abortions were performed at 20 weeks or above, and only 230 of these at or beyond 24 weeks gestation. Of all abortions at 20 weeks or above, 23 (0.8%) were performed to save the life of the pregnant woman, 1,801 (63%) were performed for mental or physical health reasons, and 1046 (36%) were performed because of fetal abnormalities. [38]

As of 1998, among the 152 most populous countries, 54 either banned abortion entirely or permitted it only to save the life of the pregnant woman. [39]

On the other hand, as of 1998, 49 of the 152 most populous countries allowed abortion without restriction as to reason, but 44 of these required specific justification after a particular gestational age: [39]

Dutch Criminal Code defines the "viability" of a fetus to 24 weeks, [40] but doctors de facto limit on-request abortions to 22 weeks as a margin of error.[ citation needed ]

As of 2011 among those countries that allowed abortion without restriction as to reason, the gestational limits for such abortions on request were: 37 countries set a gestational limit of 12 weeks, 7 countries of 14 weeks, 4 did not set limits, 3 at viability, 3 at 10 weeks, one at 90 days, one at 8 weeks, one at 18 weeks, and one at 24 weeks. In addition, Abortion in Australia, and, to a certain extent, Abortion in the United States, is regulated at state/territory level, and laws vary by region. [41]

In these countries, abortions after the general gestational age limit are allowed only under restricted circumstances, which include, depending on country, risk to the woman's life, physical or mental health, fetal malformation, cases where the pregnancy was the result of rape, or poor socio-economic conditions. For instance, in Italy, abortion is allowed on request up until 90 days, after which it is allowed only if the pregnancy or childbirth pose a threat to the woman's life, a risk to physical health of the woman, a risk to mental health of the woman; if there is a risk of fetal malformation; or if the pregnancy is the result of rape or other sexual crime. [42] Denmark provides a wider range of reasons, including social and economic ones, which can be invoked by a woman who seeks an abortion after 12 weeks. [43]

Abortions at such stages must in general be approved by a doctor or a special committee, unlike early abortions which are performed on demand. The ease with which the doctor or the committee allows a late term abortion varies significantly by country, and is often influenced by the social and religious views prevalent in that region.[ citation needed ]

Some countries, like Canada, China (mainland only) and Vietnam have no legal limit on when an abortion can be performed. [39]

United States

The United States Supreme Court decisions on abortion, including Roe v. Wade , allow states to impose more restrictions on post-viability abortions than during the earlier stages of pregnancy.

As of December 2014, forty-three states had bans on late-term abortions that were not facially unconstitutional under Roe v. Wade or enjoined by court order. [44] In addition, the Supreme Court in the case of Gonzales v. Carhart ruled that Congress may ban certain late-term abortion techniques, "both previability and postviability", [45] as it had done in banning intact dilation and extraction with the Partial-Birth Abortion Ban Act of 2003. [46]

The Supreme Court has held that bans must include exceptions for threats to the woman's life, physical health, and mental health, but four states allow late-term abortions only when the woman's life is at risk; four allow them when the woman's life or physical health is at risk, but use a definition of health that abortion-rights organizations believe is impermissibly narrow. [44] Note that just because a portion of a state's law is found to be unconstitutional does not mean that the entire law will be deemed unconstitutional: "[I]nvalidating the statute entirely is not always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief," meaning the court could declare that only those parts of the law that are violative of the Constitution are invalid (declaratory relief), or that the court can prohibit the state from enforcing those portions of the law (injunctive relief). [47]

Eighteen states prohibit abortion after a certain number of weeks' gestation (usually 22 weeks from the last menstrual period). [44] The U.S. Supreme Court held in Webster v. Reproductive Health Services that a statute may create "a presumption of viability" after a certain number of weeks, in which case the physician must be given an opportunity to rebut the presumption by performing tests. [48] Because this provision is not explicitly written into these state laws, as it was in the Missouri law examined in Webster, abortion-rights organizations believe that such a state law is unconstitutional, but only "to the extent that it prohibits pre-viability abortions". [49]

Ten states (although Florida's enforcement of such laws are under permanent injunction) require a second physician's approval before a late-term abortion can be performed. [44] The U.S. Supreme Court struck down a requirement of "confirmation by two other physicians" (rather than one other physician) because "acquiescence by co-practitioners has no rational connection with a patient's needs and unduly infringes on the physician's right to practice". [50] Abortion-rights organizations, such as the Guttmacher Institute, posit that some of these state laws are unconstitutional, based on these and other Supreme Court rulings, at least to the extent that these state laws require approval of a second or third physician. [44]

Thirteen states have laws that require a second physician to be present during late-term abortion procedures in order to treat a fetus if born alive. [44] The Court has held that a doctor's right to practice is not infringed by requiring a second physician to be present at abortions performed after viability in order to assist in the case of a living fetus. [51] It is not common for live infants to be born after an abortion at any stage in pregnancy. [52]

Live birth

In 2019, a US Senate Bill entitled the "Born-Alive Abortion Survivors Protection Act" raised the issue of live birth after abortion. [53] [54] The bill would mandate that medical providers resuscitate neonates delivered showing signs of life during an abortion process. [53] [54] During the debate around this issue, US Republicans alleged that medical providers "execute" live-born babies. Existing US laws would punish execution as homicide. Furthermore, US abortion experts refute the claim that a "born-alive" fetus is a common event and oppose enactment of laws that would mandate resuscitation against the wishes of the parents. [54] [55]

1.3% of abortions occur after 21 weeks of pregnancy in the US. Although it is very uncommon, women undergoing surgical abortion after this gestational age sometimes give birth to a fetus that may survive briefly. [56] [57] [58] The periviable period is considered to be between 20 and 25 weeks gestation. [59] Long-term survival is possible after 22 weeks. [60] However, odds of long-term survival between 22 and 23 weeks are 2–3 percent and odds of survival between 23 and 24 weeks are 20 percent. [61] "Intact survival", which means survival of a neonate without subsequent damage to organs such as the brain or bowel is 1% at 22 weeks and 13% at 23 weeks. [61] Survival odds increase with increasing gestational age. [61]

If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not. [62] [63] [64] Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended by some sources to avoid this and to comply with the US Partial Birth Abortion Ban. [65] [66] [67] [68] [69] Induced fetal demise does not improve the safety of an abortion procedure and may incur risks to the health of the woman having the abortion. [66]

Methods

There are at least four medical procedures associated with late-term abortions:

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons women give for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

Intact dilation and extraction is a surgical procedure that terminates and removes an intact fetus from the uterus. The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy.

<span class="mw-page-title-main">Live birth (human)</span> Event that a fetus is born alive with heartbeats or respiration

In human reproduction, a live birth occurs when a fetus exits the mother showing any definite sign of life such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or placenta are intact. After the fetus is expelled from the maternal body it is called a neonate. Whether the birth is vaginal or by caesarean section, and whether the neonate is ultimately viable, is irrelevant.

<span class="mw-page-title-main">Stillbirth</span> Death of a fetus before or during delivery, resulting in delivery of a dead baby

Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and sudden infant death syndrome, where the baby dies a short time after being born alive.

<span class="mw-page-title-main">Abortion in the United States</span> Termination of a pregnancy in the United States

Abortion is a divisive issue in the United States. The issue of abortion is prevalent in American politics and culture wars, though a majority of Americans support continued access to abortion. There are widely different abortion laws depending on state.

<span class="mw-page-title-main">Partial-Birth Abortion Ban Act</span> 2003 U.S. federal law banning partial-birth abortion

The Partial-Birth Abortion Ban Act of 2003 is a United States law prohibiting a form of late termination of pregnancy called "partial-birth abortion", referred to in medical literature as intact dilation and extraction. Under this law, any physician "who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both". The law was enacted in 2003, and in 2007 its constitutionality was upheld by the U.S. Supreme Court in the case of Gonzales v. Carhart.

<span class="mw-page-title-main">Abortion law</span> Laws that allow, prohibit, or regulate abortion

Abortion laws vary widely among countries and territories, and have changed over time. Such laws range from abortion being freely available on request, to regulation or restrictions of various kinds, to outright prohibition in all circumstances. Many countries and territories that allow abortion have gestational limits for the procedure depending on the reason; with the majority being up to 12 weeks for abortion on request, up to 24 weeks for rape, incest, or socioeconomic reasons, and more for fetal impairment or risk to the woman's health or life. As of 2022, countries that legally allow abortion on request or for socioeconomic reasons comprise about 60% of the world's population. In 2024, France became the first country to explicitly protect abortion rights in its constitution.

Fetal viability is the ability of a human fetus to survive outside the uterus. Viability depends upon factors such as birth weight, gestational age, and the availability of advanced medical care. In low-income countries, more than 90% of extremely preterm newborns die due to a lack of said medical care; in high-income countries, the vast majority of these newborns survive.

In obstetrics, gestational age is a measure of the age of a pregnancy taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method, if available. Such methods include adding 14 days to a known duration since fertilization, or by obstetric ultrasonography. The popularity of using this measure of pregnancy is largely due to convenience: menstruation is usually noticed, while there is generally no convenient way to discern when fertilization or implantation occurred.

<span class="mw-page-title-main">Pregnancy</span> Time of offspring development in mothers body

Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins.

Dilation and evacuation (D&E) or dilatation and evacuation is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

A fetus or foetus is the unborn offspring that develops from a mammal embryo. Following embryonic development, the fetal stage of development takes place. In human prenatal development, fetal development begins from the ninth week after fertilization and continues until the birth of a newborn. Prenatal development is a continuum, with no clear defining feature distinguishing an embryo from a fetus. However, a fetus is characterized by the presence of all the major body organs, though they will not yet be fully developed and functional and some not yet situated in their final anatomical location.

<span class="mw-page-title-main">Abortion law in the United States by state</span> Termination of pregnancy in states of the United States

The legality of abortion in the United States and the various restrictions imposed on the procedure vary significantly depending on the laws of each state or other jurisdiction. Some states prohibit abortion at all stages of pregnancy with few exceptions, others permit it up to a certain point in a woman's pregnancy, while others allow abortion throughout a woman's pregnancy. In states where abortion is legal, several classes of restrictions on the procedure may exist, such as parental consent or notification laws, requirements that patients be shown an ultrasound before obtaining an abortion, mandatory waiting periods, and counseling requirements.

Abortion in Greece has been fully legalized since 1986, when Law 1609/1986 was passed effective from 3 July 1986. Partial legalization of abortion in Greece was passed in Law 821 in 1978 that provided for the legal termination of a pregnancy, with no time limitation, in the event of a threat to the health or life of the woman. This law also allowed for termination up to the 12th week of pregnancy due to psychiatric indications and to the 20th week due to fetal pathology. Following the passage of the 1986 law, abortions can be performed on-demand in hospitals for women whose pregnancies have not exceeded 12 weeks. In the case of rape or incest, an abortion can occur as late as 19 weeks, and as late as 24 weeks in the case of fetal abnormalities. In case of inevitable risk to the life of the pregnant woman or a risk of serious and continuous damage to her physical or mental health, termination of pregnancy is legal any time before birth. Girls under the age of 18 must get written permission from a parent or guardian before being allowed an abortion.

Foeticide, or feticide, is the act of killing a fetus, or causing a miscarriage. Definitions differ between legal and medical applications, whereas in law, feticide frequently refers to a criminal offense, in medicine the term generally refers to a part of an abortion procedure in which a provider intentionally induces fetal demise to avoid the chance of an unintended live birth, or as a standalone procedure in the case of selective reduction.

Definitions of abortion vary from one source to another. Abortion has many definitions that can differ from each other in significant ways. Given the contentious nature of abortion, lawmakers and other stakeholders often face controversy in defining abortion. Language referring to abortion often reflects societal and political opinions . Influential non-state actors like the United Nations and the Roman Catholic Church have also engendered controversy over efforts to define abortion.

Abortion in San Marino is legal in the first 12 weeks of gestation for any reason. It is also legal until fetal viability if the pregnancy poses a risk to the woman's life, if the fetus has an anomaly that poses a risk to the woman's health, or if the pregnancy is the result of rape of incest. In case of risk to the woman's life after fetal viability, the pregnancy may also be interrupted by attempting a live birth.

Maternal somatic support after brain death occurs when a brain dead patient is pregnant and their body is kept alive to deliver a fetus. It occurs very rarely internationally. Even among brain dead patients, in a U.S. study of 252 brain dead patients from 1990–96, only 5 (2.8%) cases involved pregnant women between 15 and 45 years of age.

A termination for medical reasons (TFMR) is an induced abortion motivated by medical indications involving the fetus or mother. In some countries, health risks are the only basis for obtaining a legal abortion. Prenatal screening can allow early diagnosis, and abortion if desired or necessary. Some medical organizations advocate the offer of diagnostic testing by chorionic villi sampling, and amniocentesis to all pregnant women, as a matter of course.

As of 2024, abortion is currently illegal in Indiana. It's only legal in cases involving fatal fetal abnormalities, to preserve the life and physical health of the mother, and in cases of rape or incest up to 10 weeks of pregnancy. Previously abortion in Indiana was legal up to 20 weeks; a near-total ban that was scheduled to take effect on August 1 was placed on hold due to further legal challenges, but is set to take place, after the Indiana Supreme Court denied an appeal by the ACLU, and once it certifies a previous ruling, that an abortion ban doesn't violate the state constitution. In the wake of the 2022 Dobbs Supreme Court ruling, abortion in Indiana remained legal despite Indiana lawmakers voting in favor of a near-total abortion ban on August 5, 2022. Governor Eric Holcomb signed this bill into law the same day. The new law became effective on September 15, 2022. But on September 22, 2022, Special Judge Kelsey B. Hanlon of the Monroe County Circuit Court granted a preliminary injunction against the enforcement of the ban. Her ruling allows the state's previous abortion law, which allows abortions up to 20 weeks after fertilization with exceptions for rape and incest, to remain in effect.

References

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  40. 1 2 Zaken, Ministerie van Algemene (May 11, 2015). "What is the time limit for having an abortion?".
  41. ↑ "The World's Abortion Laws 2011" (PDF). Center for Reproductive Rights . Retrieved June 30, 2019.
  42. ↑ "Archived copy" (PDF). Archived from the original (PDF) on March 13, 2013. Retrieved October 7, 2012.{{cite web}}: CS1 maint: archived copy as title (link)
  43. ↑ "Denmark". harvard.edu. Retrieved October 13, 2015.
  44. 1 2 3 4 5 6 Guttmacher Institute. (April 1, 2007). State Policies on Later-Term Abortions. State Policies in Brief. Retrieved April 19, 2007.
  45. ↑ Annas, George J. (May 24, 2007). "The Supreme Court and Abortion Rights". New England Journal of Medicine. 2007 (356): 2201–2207. doi:10.1056/NEJMhle072595. PMID   17476003.
  46. ↑ Hern, Warren M. (October 22, 2003). "Did I violate the Partial-Birth Abortion Ban?". Slate.com. Retrieved October 27, 2017.
  47. ↑ Ayotte v. Planned Parenthood , 546 U.S. 320 (2006).
  48. ↑ Webster v. Reproductive Health Services, 492 U.S. 490 (1989).
  49. ↑ NARAL Pro-Choice America. (2007). "Delaware." Who Decides? The Status of Women's Reproductive Rights in the United States. Retrieved April 19, 2007.
  50. ↑ Doe v. Bolton , 410 U.S. 179 (1973).
  51. ↑ Planned Parenthood Ass'n v. Ashcroft, 462 U.S. 476, 486–490 (1983).
  52. ↑ Robertson, Lori (March 4, 2019). "The Facts on the Born-Alive Debate". FactCheck.org. Retrieved July 29, 2019.
  53. 1 2 Robertson, Lori (March 4, 2019). "The Facts on the Born-Alive Debate". FactCheck.org. Retrieved August 5, 2019.
  54. 1 2 3 Grady, Denise (February 26, 2019). "'Executing Babies': Here Are the Facts Behind Trump's Misleading Abortion Tweet". The New York Times. ISSN   0362-4331 . Retrieved August 5, 2019.
  55. ↑ Jatlaoui, Tara C. (2018). "Abortion Surveillance – United States, 2015". MMWR. Surveillance Summaries. 67 (13): 1–45. doi:10.15585/mmwr.ss6713a1. ISSN   1546-0738. PMC   6289084 . PMID   30462632.
  56. ↑ "The Care of Women Requesting Induced Abortion. Evidence-Based Clinical Guideline no. 7" (PDF). Royal College of Obstetricians and Gynaecologists. November 2011. Archived (PDF) from the original on November 14, 2015. Retrieved October 31, 2015. Recommendation 6.21 Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation to ensure that there is no risk of a live birth.
  57. ↑ Society of Family Planning (February 2011). "Clinical Guidelines, Labor induction abortion in the second trimester". Contraception. 84 (1): 4–18. doi: 10.1016/j.contraception.2011.02.005 . PMID   21664506. Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin.
  58. ↑ Fletcher; Isada; Johnson; Evans (August 1992). "Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues". Obstetrics and Gynecology. 80 (2): 310–313. PMID   1635751. following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management.
  59. ↑ "Periviable Birth – ACOG". www.acog.org. Retrieved July 14, 2019.
  60. ↑ "Termination of Pregnancy for Fetal Abnormality" (PDF). Royal College of Obstetricians and Gynaecologists. May 2010. pp. 29–31. Archived (PDF) from the original on December 22, 2015. Retrieved October 26, 2015.
  61. 1 2 3 Younge, Noelle; Goldstein, Ricki F.; Bann, Carla M.; Hintz, Susan R.; Patel, Ravi M.; Smith, P. Brian; Bell, Edward F.; Rysavy, Matthew A.; Duncan, Andrea F. (February 16, 2017). "Survival and Neurodevelopmental Outcomes among Periviable Infants". New England Journal of Medicine. 376 (7): 617–628. doi:10.1056/NEJMoa1605566. ISSN   0028-4793. PMC   5456289 . PMID   28199816.
  62. ↑ "Critical care decisions in fetal and neonatal medicine: a guide to the report" (PDF). Nuffield Council on Bioethics. 2007. Archived (PDF) from the original on March 4, 2016. Retrieved October 29, 2015. Under English law, fetuses have no independent legal status. Once born, babies have the same rights to life as other people.
  63. ↑ Gerri R. Baer; Robert M. Nelson (2007). "Preterm Birth: Causes, Consequences, and Prevention. C: A Review of Ethical Issues Involved in Premature Birth". Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Archived from the original on December 31, 2015. In 2002, the 107th U.S. Congress passed the Born-Alive Infants Protection Act of 2001. This law established personhood for all infants who are born "at any stage of development" who breathe, have a heartbeat, or "definite movement of voluntary muscles", regardless of whether the birth was due to labor or induced abortion.
  64. ↑ Chabot, Steve (August 5, 2002). "H.R. 2175 (107th): Born-Alive Infants Protection Act of 2002". govtrack.us. Archived from the original on November 14, 2015. Retrieved October 30, 2015. The term "born alive" is defined as the complete expulsion or extraction from its mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of the voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.
  65. ↑ "Practice Bulletin: Second-Trimester Abortion" (PDF). Obstetrics & Gynecology. 121 (6): 1394–1406. June 2013. doi:10.1097/01.AOG.0000431056.79334.cc. PMID   23812485. S2CID   205384119. Archived (PDF) from the original on November 14, 2015. Retrieved October 30, 2015. With medical abortion after 20 weeks of gestation, induced fetal demise may be preferable to the woman or provider in order to avoid transient fetal survival after expulsion.
  66. 1 2 Diedrich, Justin; Drey, Eleanor (June 2010). "Clinical Guidelines: Induction of fetal demise before abortion" (PDF). Contraception. 81 (6): 462–473. doi:10.1016/j.contraception.2010.01.018. PMID   20472112. S2CID   12555553. Archived (PDF) from the original on November 23, 2015. Retrieved October 26, 2015. Inducing fetal demise before induction termination avoids signs of live birth that may have beneficial emotional, ethical and legal consequences.
  67. ↑ Committee on Health Care for Underserved Women (November 2014). "Committee Opinion 613: Increasing Access to Abortion". Obstetrics & Gynecology. 124 (5): 1060–1065. doi:10.1097/01.aog.0000456326.88857.31. PMID   25437742. Archived from the original on October 28, 2015. Retrieved October 28, 2015. "Partial-birth" abortion bans – The federal Partial-Birth Abortion Ban Act of 2003 (upheld by the Supreme Court in 2007) makes it a federal crime to perform procedures that fall within the definition of so-called "partial-birth abortion" contained in the statute, with no exception for procedures necessary to preserve the health of the woman...physicians and lawyers have interpreted the banned procedures as including intact dilation and evacuation unless fetal demise occurs before surgery.
  68. ↑ "2015 Clinical Policy Guidelines" (PDF). National Abortion Federation. 2015. Archived (PDF) from the original on August 12, 2015. Retrieved October 30, 2015. Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise.
  69. ↑ Milliez Jacques (2008). "FIGO Committee Report: Ethical aspects concerning termination of pregnancy following prenatal diagnosis". International Journal of Gynecology and Obstetrics. 102 (1): 97–98. doi:10.1016/j.ijgo.2008.03.002. PMID   18423641. S2CID   39838077. Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide.
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