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الصفحة الرئيسية / Late Term Abortion, on a Healthy Baby and Healthy Mother

Late Term Abortion, on a Healthy Baby and Healthy Mother

إرسال تعليق

Late-term abortion

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

[edit on Wikidata]

Tardily termination of pregnancy (also referred to as late-term abortion)[2] describes the termination of pregnancy by induced ballgame during a late phase of gestation.[iii] "Late", in this context, is not precisely defined, and different medical publications use varying gestational age thresholds.[3] In 2015 in the United States, nigh 1.3% of abortions took identify after the 21st week,[4] and less than 1% occur after 24 weeks.[5]

Reasons for tardily terminations of pregnancy include circumstances where a meaning woman'southward health is at risk or when lethal fetal abnormalities have been detected.[6] [7] Later abortion is not associated with any negative physical or mental health outcomes,[8] [seven] and the gamble of expiry following a surgical abortion after 20 weeks is less than that of typical total-term childbirth in the United States.[9]

Belatedly termination of pregnancy is more politically controversial than ballgame in general. Nearly countries in Europe only permit ballgame in after stages of pregnancy if specific circumstances are present, by and large when the pregnancy represents a serious danger to the life, or to the physical or mental health of the adult female, or when a serious malformation or anomaly of the fetus is diagnosed.[ten]

Definition [edit]

A late termination of pregnancy often refers to an induced ending of pregnancy after the 20th calendar week of gestation, i.e. afterwards a fetal age (time since conception) of well-nigh 18 weeks. The exact bespeak when an abortion is considered late-term, nonetheless, is non conspicuously defined. In three articles published in 1998 in the same consequence of the Journal of the American Medical Clan (JAMA), two chose the 20th week of gestation and 1 chose the 28th week of gestation as the point where an abortion procedure would be considered belatedly-term.[xi] [12] [13] 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.[14]

In the US, the point at which an abortion becomes belatedly-term is often related to the "viability" (ability to survive outside the uterus) of the fetus. Sometimes tardily-term abortions are referred to every bit post-viability abortions, though this is not a medical term.[ commendation needed ]

Viability [edit]

There is no sharp limit of evolution, age, or weight at which a fetus becomes viable.[15] A 2015 study plant that even with active treatment, no infants born at less than 22 weeks survived, at 23 weeks survival without severe impairment is less than two%, and at 25 weeks, up to 30% might survive without severe impairment.[16] [17] According to studies between 2003 and 2005, twenty to 35 percent of babies built-in at 24 weeks of gestation survived, while fifty to 70 per centum of babies born at 25 weeks, and more than than 90 percent born at 26 to 27 weeks, survived.[18] The American College of Obstetricians and Gynecologists and the Lodge for Maternal and Fetal Medicine states that in cases of delivery occurring before 26 weeks, "given the potential for maternal and perinatal mortality and morbidity, the pick of pregnancy termination should exist reviewed with the patients."[19] Considering the risk 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, nigh oftentimes using a method called dilation and evacuation (D&E).[20]

Mental health [edit]

Ballgame was shown to carry far less risk of physical and psychological morbidity and mortality than childbirth.[eight] [7] A Consensus Report Report concluded that in United states of america, ballgame does not increase the run a risk of experiencing symptoms of low, anxiety or stress in the short term or over five years.[21] A previous history of mental wellness conditions, sexual assault, and intimate partner violence were strongly associated with experiencing negative mental health outcomes after the abortion.[22]

Incidence [edit]

Abortion in the United states by gestational age, 2016. (Data source: Centers for Disease Control and Prevention)

  • Australia: As of 2015[update], Southward Australia is the just Australian state or territory to proceed reliable abortion statistics. During 2012, 92% of abortions were performed before fourteen weeks' gestation, half-dozen% betwixt 14 and 20 weeks, and 2% (n=96) at a later stage. Of the 96 abortions carried out across 20 weeks, 53 were due to bodily or probable fetal abnormality.[23]
  • Canada: During the year 2019, approximately 87% of abortions occurred by 12 weeks, with 1.17% occurring afterwards 21 weeks.[24]
  • England and Wales: In 2015, viii% of abortions occurred after 12 weeks; 0.i% occurred at or over 24 weeks.[25]
  • New Zealand: In 2003, 2.03% of induced abortions were done betwixt weeks 16 and 19, and 0.56% were done over 20 weeks.[26]
  • Norway: In 2005, 2.28% of induced abortions were performed betwixt thirteen and 16 weeks, one.24% of abortions between 17 and twenty weeks, and 0.20% over 21 weeks.[27] Between February 15, 2010, and December 1, 2011, a total number of ten abortions were performed betwixt 22 and 24 weeks. These take been declared illegal past The Norwegian Directorate of Health. Women who seek an abortion after the 12-week fourth dimension limit must apply to a special medical assessment board – called an "ballgame board"(Norwegian: 'abortnemnd' or 'primærnemnd') – that will decide whether or not to grant them an abortion.[28]
  • Scotland: In 2005, six.1% of abortions were washed between xiv and 17 weeks, while 1.six% were performed over 18 weeks.[29]
  • Sweden: In 2005, 5.six% of abortions were carried out between 12 and 17 weeks, and 0.8% at or greater than xviii weeks.[30]
  • Switzerland: In 2016, x% of abortions performed after the legal term were carried out afterwards week 21 (a full of 36 cases).[31] Of these cases 86% were carried out due to physical bug with the child or mother.[31]
  • Us: In 2003, from data nerveless in those areas that sufficiently reported gestational age, it was constitute that half-dozen.2% of abortions were conducted between 13 and xv weeks, 4.2% betwixt 16 and 20 weeks, and 1.4% at or later on 21 weeks.[32] In 2014, the CDC reported that one.3% of reported abortions (five,578) were performed at 21 weeks of gestation or later.[33]

Reasons [edit]

U.s.a. [edit]

Reasons for late terminations of pregnancy include when a significant adult female's health is at risk or when lethal fetal abnormalities have been detected.[6] [7]

A study from 2013 found after excluding abortion "on grounds of fetal anomaly or life endangerment", that women seeking belatedly abortions "fit at to the lowest degree i of five profiles: They were raising children lone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding so had admission issues, or were young and nulliparous". They concluded that "bans on abortion after twenty weeks will disproportionately touch young women and women with express financial resources".[34]

England and Wales [edit]

The NHS records the reasons given for abortions at all stages of development. In 2015, two,877 abortions were performed at twenty weeks or above, and only 230 of these at or beyond 24 weeks gestation. Of all abortions at 20 weeks or to a higher place, 23 (0.8%) were performed to salve the life of the pregnant woman, 1,801 (63%) were performed for mental or physical health reasons, and 1046 (36%) were performed because of foetal abnormalities.[35]

Legal restrictions [edit]

Every bit of 1998, among the 152 most populous countries, 54 either banned abortion entirely or permitted it only to salvage the life of the pregnant woman.[36]

On the other hand, every bit of 1998, 49 of the 152 almost populous countries allowed abortion without restriction as to reason, but 44 of these required specific justification after a particular gestational age:[36]

  • 12 weeks (Albania, Armenia, Republic of azerbaijan, Belarus, Kingdom of belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Cuba, Czech Commonwealth, Denmark, Estonia, French republic, Georgia, Hellenic republic, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Mongolia, Norway, Russia, Saudi arabia, Slovakia, Slovenia, South Africa, Ukraine, Tajikistan, Tunisia, Turkey, Turkmenistan and Uzbekistan)
  • 13 weeks (Italy)
  • 14 weeks (Argentine republic, Austria, Cambodia, Germany, Republic of hungary, Romania and Spain)
  • xviii weeks (Sweden)
  • 22 weeks (N Macedonia)
  • 24 weeks (Singapore, Netherlands[37])
  • viability (to some extent the United states of america)
  • no limit (Canada, some states in the United States, China, and Democratic people's republic of korea)

Dutch Criminal Code defines the "viability" of a fetus to 24 weeks, but doctors de facto limit on-request abortions to 22 weeks as a margin of fault.[37]

As of 2011 amid those countries that allowed abortion without restriction as to reason, the gestational limits for such abortions on request were: 37 countries prepare a gestational limit of 12 weeks, vii countries of fourteen weeks, 4 did not gear up limits, 3 at viability, iii at x weeks, ane at 90 days, one at 8 weeks, i at 18 weeks, and one at 24 weeks. In add-on, Abortion in Commonwealth of australia, and, to a sure extent, Ballgame in the United States, is regulated at state/territory level, and laws vary by region.[38]

In these countries, abortions after the full general gestational historic period limit are allowed only nether restricted circumstances, which include, depending on country, chance to the woman's life, concrete or mental health, fetal malformation, cases where the pregnancy was the issue of rape, or poor socio-economical conditions. For example, in Italy, abortion is allowed on asking up until xc days, after which it is immune merely if the pregnancy or childbirth pose a threat to the adult female'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 effect of rape or other sexual crime.[39] Denmark provides a wider range of reasons, including social and economical ones, which can exist invoked by a woman who seeks an abortion subsequently 12 weeks.[40]

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

Some countries, like Canada, Prc (Mainland only) and Vietnam have no legal limit on when an abortion can be performed.[36]

U.s. [edit]

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

As of December 2014, forty-two states had bans on late-term abortions that were not facially unconstitutional under Roe v. Wade or enjoined by court order.[41] In add-on, the Supreme Court in the instance of Gonzales v. Carhart ruled that Congress may ban sure late-term ballgame techniques, "both previability and postviability",[42] every bit information technology had done in banning intact dilation and extraction with the Partial-Nativity Abortion Ban Act of 2003.[43]

The Supreme Court has held that bans must include exceptions for threats to the woman'due south life, physical health, and mental health, but four states allow late-term abortions simply when the adult female's life is at risk; four allow them when the woman'southward life or physical health is at risk, but utilize a definition of wellness that pro-option organizations believe is impermissibly narrow.[41] Note that but because a portion of a country'south law is found to be unconstitutional does not mean that the entire law will be accounted unconstitutional: "[I]nvalidating the statute entirely is non always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief," meaning the courtroom could declare that only those parts of the law that are violative of the Constitution are invalid (declaratory relief), or that the courtroom can prohibit the land from enforcing those portions of the law (injunctive relief).[44]

Eighteen states prohibit abortion after a certain number of weeks' gestation (usually 22 weeks from the last menstrual period).[41] 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 instance the physician must be given an opportunity to rebut the presumption by performing tests.[45] Because this provision is non explicitly written into these state laws, as it was in the Missouri constabulary examined in Webster, pro-choice organizations believe that such a state law is unconstitutional, just merely "to the extent that it prohibits pre-viability abortions".[46]

Ten states (although Florida'south enforcement of such laws are under permanent injunction) require a second md'southward approval before a late-term abortion can be performed.[41] The U.Due south. Supreme Court struck down a requirement of "confirmation by two other physicians" (rather than i other physician) because "amenability by co-practitioners has no rational connexion with a patient's needs and disproportionately infringes on the physician's right to practice".[47] Pro-selection organizations, such as the Guttmacher Constitute, posit that some of these country laws are unconstitutional, based on these and other Supreme Courtroom rulings, at least to the extent that these state laws require blessing of a second or third medico.[41]

Thirteen states have laws that require a second dr. to exist present during late-term abortion procedures in gild to care for a fetus if born live.[41] The Court has held that a doctor's right to practice is non infringed by requiring a 2nd dr. to be nowadays at abortions performed afterwards viability in order to assist in the case of a living fetus.[48] Information technology is non common for alive infants to be built-in later on an abortion at any stage in pregnancy.[49]

Live birth [edit]

In 2019, a US Senate Beak entitled the "Born-Alive Ballgame Survivors Protection Act" raised the upshot of live nascence later abortion.[l] [51] The bill would mandate that medical providers resuscitate neonates delivered showing signs of life during an abortion process.[50] [51] During the argue effectually this issue, US Republicans falsely alleged that medical providers "execute" live-born babies. Existing The states laws would punish execution as homicide. Furthermore, United states abortion experts refute the merits that a "born-live" fetus is a common result and reject laws that would mandate resuscitation against the wishes of the parents.[51] [52]

Only 1.3% of abortions occur subsequently 21 weeks of pregnancy in the US. Although information technology is very uncommon, women undergoing surgical abortion after this gestational age sometimes requite birth to a fetus that may survive briefly.[53] [54] [55] The periviable period is considered to be between twenty and 25 weeks gestation.[56] Long-term survival is possible later 22 weeks.[57] Withal, odds of long-term survival between 22 and 23 weeks are 2–3 percent and odds of survival betwixt 23 and 24 weeks are xx percentage.[58] "Intact survival", which ways survival of a neonate without subsequent harm to organs such as the encephalon or bowel is i% at 22 weeks and 13% at 23 weeks.[58] Survival odds increment with increasing gestational age.[58]

If medical staff notice signs of life, they may exist required to provide care: emergency medical care if the kid has a skilful risk of survival and palliative care if not.[59] [sixty] [61] Induced fetal demise before termination of pregnancy after 20–21 weeks gestation is recommended by some sources to avert this and to comply with the US Partial Nascence Ballgame Ban.[62] [63] [64] [65] [66] Induced fetal demise does not better the rubber of an ballgame procedure and may incur risks to the health of the woman having the abortion.[63]

Methods [edit]

There are at to the lowest degree four medical procedures associated with late-term abortions:

  • Dilation and evacuation (D&Due east)
  • Early labor induction (sometimes called "induction abortion")
  • Intact dilation and extraction (IDX or D&10), sometimes referred to as "partial-birth abortion"
  • Hysterotomy abortion

References [edit]

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  60. ^ Gerri R. Baer; Robert M. Nelson (2007). "Preterm Birth: Causes, Consequences, and Prevention. C: A Review of Ethical Issues Involved in Premature Nativity". Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Archived from the original on 31 Dec 2015. In 2002, the 107th U.South. Congress passed the Born-Alive Infants Protection Act of 2001. This law established personhood for all infants who are born "at whatsoever stage of development" who exhale, take a heartbeat, or "definite motility of voluntary muscles", regardless of whether the birth was due to labor or induced abortion.
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  62. ^ "Do Bulletin: Second-Trimester Abortion" (PDF). Obstetrics & Gynecology. 121 (half-dozen): 1394–1406. June 2013. doi:10.1097/01.AOG.0000431056.79334.cc. PMID 23812485. S2CID 205384119. Archived (PDF) from the original on fourteen Nov 2015. Retrieved 30 October 2015. With medical ballgame after 20 weeks of gestation, induced fetal demise may be preferable to the woman or provider in order to avert transient fetal survival after expulsion.
  63. ^ a b Higginbotham Susan (January 2010). "Clinical Guidelines: Induction of fetal demise earlier abortion" (PDF). Contraception. 81 (half dozen): 462–73. doi:x.1016/j.contraception.2010.01.018. PMID 20472112. Archived (PDF) from the original on 23 Nov 2015. Retrieved 26 October 2015. Inducing fetal demise before induction termination avoids signs of live birth that may have beneficial emotional, ethical and legal consequences.
  64. ^ Committee on Health Care for Underserved Women (November 2014). "Commission Opinion 613: Increasing Access to Abortion". Obstetrics & Gynecology. 124 (5): 1060–65. doi:x.1097/01.aog.0000456326.88857.31. PMID 25437742. Archived from the original on 28 October 2015. Retrieved 28 October 2015. "Fractional-birth" abortion bans – The federal Partial-Birth Abortion Ban Human action 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 "fractional-nascence abortion" contained in the statute, with no exception for procedures necessary to preserve the wellness of the adult female...physicians and lawyers have interpreted the banned procedures as including intact dilation and evacuation unless fetal demise occurs before surgery.
  65. ^ "2015 Clinical Policy Guidelines" (PDF). National Ballgame Federation. 2015. Archived (PDF) from the original on 12 August 2015. Retrieved 30 October 2015. Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the get-go trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be specially important when problems of viability arise.
  66. ^ Milliez Jacques (2008). "FIGO Committee Report: Ethical aspects concerning termination of pregnancy post-obit 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 later on 22 weeks must be preceded by a feticide.

External links [edit]

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Source: https://en.wikipedia.org/wiki/Late_termination_of_pregnancy

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