Third Trimester Abortion Due To Fetal Anomaly

Abortion Procedures – Frequently Asked Questions

If you are reading this information regarding late abortion for fetal anomaly it may mean that either you or someone close to you has received catastrophic news regarding their pregnancy. I am very sorry that this has occurred. At the same time, we are here to help and guide you through one of the most difficult times in your life. Finding out that your fetus or that of someone that you know has a severe fetal or congenital abnormality, or a lethal health problem is a very serious matter from both a Physical and Psychological aspect. You want to have the Physicians and medical staff who have the experience, understanding, and compassion, in caring for patients that have a fetus with anomalies. It is my belief that Prenatal testing should include giving the patient the choice to keep or terminate her pregnancy after being given this kind of detrimental news.

Patients can spend a lot of physical and psychological energy which creates tremendous stress, anxiety, depression, worry, and lack of sleep. This is not to mention the time, and money, finding out the patient is carrying a fetus that has a lethal or severe abnormality. We at the Women’s Centers acknowledge the heartbreaking and dreadful situation that this causes you and members of your family. Unfortunate news like this is always devastating. To diagnose fetal abnormalities and not be able to terminate the pregnancy is wrong if the woman chooses to do so. Hospitals across the U.S. as well as the majority of Maternal-Fetal Medicine Specialists, and some OB/Gyn Physicians choose not to participate in ending pregnancies even when the fetus has lethal abnormalities. This is the sole reason that I ultimately chose not to practice High Risk pregnancy which I was trained in a prestigious Fellowship to do. Patients elect to end their pregnancies early based on the information their physician, genetic counselor, pediatric surgeon, Primatologist, or other medical personnel have given them when diagnosing the abnormalities of the pregnancy. Patients end pregnancies early for several reasons:

1. Prevent pain and suffering of a sick, unborn baby
2. Stop the pain and suffering for family members, friends
3. To bring closure and start the healing process (guilt, depression, anger, and acceptance) required for you and your family member

We recognize the grief, sorrow, and suffering that this has caused you and your family. Most families or individuals have never faced a catastrophe of this magnitude.

At our Women’s Centers, numerous patients and loved ones we see are confronted with these complex issues when they were prepared to have a healthy child and are suddenly faced with the prospect of terminating the pregnancy.

At the Women’s Centers we are prepared to aid patients and their families in getting through the entire process with our compassionate and caring staff; supporting them from the beginning to the end of the termination procedure. Each patient goes through the procedure process differently. We encourage all patients to at least see the baby minimally as we believe that this is the best way to bring closure for families. We are also prepared to help families have a memory of their child such as having a handprint or a footprint. Some patients want the baby to be cremated and others want a burial to take place.

For the past 14 years, we have helped hundreds of families cope with similar circumstances. We provide the safest methods for ending pregnancies.

Criteria for Admission

A patient’s private Physician, genetic counselor, or Primatologist, generally provides medical records that include documentation and diagnosis of fetal abnormalities that state continuing the pregnancy will be a threat to the mother’s life, or health. For the past 14 years we have terminated pregnancies for fetal abnormalities such as 1) Central Nervous System that include: holoprosencephaly, encephalocele, encephalomyelocele, hydrocephalus, Spina Bifida, holorachischisis, Dandy Walker, anencephaly, holoanencephaly, absence of corpus callosum; 2) Cardiac abnormalities that include: Primary Pulmonary Hypertension, Hypolastic left and right ventricle, holoacardius, tetraloy of Fallot, Eisenmenger’s complex, transposition of great vessels; 3) Chromosomal abnormalities that includes a) Common: trisomy 13, 18, 21, b) less common: trisomy 16, short arm and long arm deletions; 4) Skeletal abnormalities: Polydactyly, Achondroplasia, Osteogenesis imperfecta, lethal dwarfism, 5) Kidney abnormalities: Adult and Infantile Polycystic Kidney diseases, Potter’s Syndrome; 6) GI abnormalities: gastroschisis, omphalocele.

Why do these fetal and other abnormalities occur?

1. Unfortunately severe fetal abnormalities occur
2. 3% of babies have a severe congenital/chromosomal abnormality
3. 97% of babies born in the US are healthy

Women’s Centers Late Term Abortion Care:

The Women’s Center’s approach is for the patient to have a miscarriage which is 1/6 to 1/3 the size in weight of a normal pregnancy. At the Women’s Centers, the Fetal Indication Pregnancy Termination Program consists of inducing labor and delivery of a stillborn fetus. Priming of the cervix (opening and softening) will be initiated at the Physician’s discretion using either Misoprostol and or Laminaria. Labor will be induced by continuing to use Misoprostol, or beginning an IV infusion of Oxytocin (Pitocin). The fetal heart is generally stopped on the first day of the process via an injection of medications called digoxin and potassium chloride into the fetal heart, Intramuscularly, or injected into the amniotic fluid (sac around the fetus). Cervical priming of the cervix (opening and softening) can be started on an outpatient basis and the labor and delivery process takes place in our offices. Patients are usually able to travel home or to their hotels within 45 minutes to an hour after delivery.

What To Expect During the Labor Induction Process

Fetal Demise

This is initiated by injection of the combination of Digoxin and Potassium Chloride (most commonly) into the fetal heart to assure the following:

• No additional pain or discomfort to the fetus
• Generally assures no chance of a live birth
• The fetal tissue becomes softer which makes it easier for the tissue to pass safely through the mother’s cervix
• Many studies show a fetus that succumbs in the uterus delivers faster

Priming of the Cervix (softening and opening):

Prostaglandins

They are found in most cells in the body at low doses. They have different actions from preventing peptic ulcer disease, vasoconstriction (tightening of the blood vessels), vasodilation (opening of the blood vessels), bronchospasms (tightening of lung tissue), and asthmatic symptoms, to bronchodilation (opening of lung tissue. They increase during the start of labor which causes uterine contractions and cervical softening which leads to dilation of the cervix.

There are several types of prostaglandins.

• Prostaglandin E2

There is an increase in the chance of side effects which include but are not limited to nausea, vomiting, diarrhea, fever, elevated blood pressure, coma, stroke and heart attack.

• 1. Must be kept in the refrigerator or becomes unstable and ineffective
  2. The dose is not the same throughout the capsule. The entire dose may be only 1/4 part of the capsule
• Prostaglandin F2

High incidence of live births, cervical tears and retained tissue

• Prostaglandin E1 (Misoprostol)
  1. Naturally found in the stomach and decreases the incidence of gastric ulcers when taking non-steroidal anti-inflammatories (Motrin, Ibuprofen, Advil, Naproxen, etc.)
  2. Less side effects than E2 and F2
  3. Stable if stored at room temperature

Laminaria

A naturally occurring seaweed that has been used as an energetic food in Northern China for over 1000 years. They come in single sterilized packets which are about the length of Q-tip. They swell by absorbing the fluid that is being excreted from the cervix within several hours of being inserted and become larger. One to as many as thirty Laminaria can be inserted inside the cervix depending on the degree of dilation necessary to carry out the termination procedure safely. They can be removed after being placed inside the cervix for several hours or the patient is discharged overnight and returns to the facility the next day where the Laminaria are removed. Laminaria help to dilate (open) the cervix so that it will be less dangerous to induce labor or perform surgery to remove the premature pregnancy. The advantages of using Laminaria include less pain during labor process, a decrease in the incidence of uterine perforation, or damage to the bowel, bladder or other pelvic organs.

Oxytocin (Pitocin)

A hormone secreted in the brain that is important for initiating breast feeding, female orgasms, and when present in artificial high doses it can begin the labor process by causing uterine contractions. Oxytocin is used for priming of the cervix (opening and softening) for term delivery or premature delivery of the fetus.

Intrauterine Instillation of Caustic Agents

• Concentrated Normal Saline (20%)
  1. Causes initiation of labor within 24 to 36 hours (faster initiation of labor and delivery with use of oxytocin)
  2. High incidence of side effects
  • Disseminated Intravascular Coagulation (DIC) Blood unable to clot which leads to organ failure
  • Blood Transfusions
  • Intrauterine Infections- Endometritis
  • Sepsis- Infection in bloodstream that can lead to low blood pressure, multiple organ failure, and death
• Concentrated Urea (40 grams)

Side effects include:

1. 1. Infection
   2. Blood Transfusion

Premature Delivery

1. Time from initiation of Cervical Maturation until delivery is from 2 to 32 hours. The average time is 10 hours.
2. Patients are monitored throughout their stay in our facilities. Less than 5 percent of patients require pain medication.

What to expect with Stillborn Birth

There are no absolutes that must be done following the birth of a Stillborn. We are here to serve our patients and carry out their requests the best we can. We understand that each patient and family members are individual people and their background socially, culturally, spiritually, and emotionally must be considered when caring out their final wishes for the Stillborn fetus.

Some women want to bond with their baby once the premature delivery occurs. This is an important step for the patient and her family which helps to bring closure to this devastating crisis. Some couples initially find this a very frightening thought, but we have found that couples who wish to view or hold their child are able to work through the grieving process more effectively and efficiently. When couples elect not to see their child they may later regret their decision. We encourage you to take pictures of the baby alone and with family members. We can arrange for your baby to have an autopsy or other confirmatory studies that must be arranged prior to your arrival with your doctor or geneticist. Cremation or a funeral with burial can be arranged.

Support and Healing Group

Patients may see and talk with other women who are in our facility for the reason of carrying a fetus with a lethal anomaly. Patients occasionally exchange e-mails, addresses, and phone numbers and continue to communicate with each other for days, months and years later.

How does this premature delivery process work?

1. Arrive at scheduled appointment time
2. Greeted by Intake Personnel
3. Fill out History form and other important medical papers
4. Lab and counseling
5. Perform ultrasound
6. Go to Business Office
7. Digoxin/Potassium Chloride fetal intra-cardiac injection to stop fetal heart beat.
8. Begin cervical preparation process
9. Labor Process begins

Counseling

When we use the term counseling at the Women’s Centers, it does not mean that we delve into psychotherapy or interventional techniques as those patients in need of this type of service will be referred to the appropriate professional. Our first concern is to provide support for the woman seeking our services. In addition, we wish to provide support for her family to the fullest extent possible and appropriate.

A counseling session has several objectives:

To give the woman an opportunity to express and understand her feelings about her pregnancy and her decision to have or not to have an abortion. We want to determine that this is really her decision and that she is not being pressured in any way to end the pregnancy.

To provide the woman with accurate information about the procedure she is requesting; it is important that she know and understand important facts and details in order to give informed consent.

To make sure the woman understands her own reproductive anatomy and physiology. Most women do; however, even highly educated women sometimes have misunderstandings or questions.

To help each woman understand the methods of contraception available to her and her partner following the abortion. As a part of this, we want to make sure each woman has a plan for follow-up care in order to assure she does not experience complications, and that she receives appropriated treatment should they develop. We encourage each patient to see her own physician or other qualified physician in her community for follow-up care; however, we will provide this care if the woman desires.

For couples who come to us with a desired pregnancy which must be terminated for reasons of fetal malformation or genetic disorder, we are prepared to give total support. However, we feel that their most satisfactory, permanent support is likely to be found with their own physician or counselor in their home community.

The individuals who provide counseling and information sessions for patients at Women’s Centers are experienced nurses and counselors who are thoroughly familiar with all aspects of abortion. They are fully supportive of women who wish to terminate a pregnancy, and are able to answer most of their questions. After the patient reviews informational material and meets with her counselor, she will meet with the Doctor. If she has questions that have not been answered by her counselor, she may have them answered at this time. She then signs the consent form indicating that she understands and requests the procedure to terminate her pregnancy. She may bring her partner or other family members with her during this session.

The patient’s partner, friends, or family may accompany her during her counseling session, the meeting with the Doctor, and they may even be in the recovery room when appropriate; however, these persons are not permitted in the operating room.

Postoperative Care

Because pregnancy is not a benign condition, and terminating a pregnancy is a surgical procedure, each patient must have excellent post-operative and follow-up care. This is absolutely necessary to prevent complications. No matter how well an abortion is performed, complications can occur. The difference between a safe result with a full return to good health and an undesirable result is often good post-operative care and prompt treatment of complications.

Each patient who has an abortion at the Women’s Centers is taken from the procedure room into a recovery room where she can lie down, relax, and receive the attention of the recovery room staff as well as her family members and friends. During this time, her blood pressure and pulse as well as other aspects of physical evaluation will be monitored by expert recovery room staff. She will receive information concerning aftercare and her follow-up examination. If she has chosen a method of birth control, she may receive information or, in the case of oral contraceptives, a starting supply. Her vital signs (blood pressure, pulse) will be observed on several occasions after the abortion, before leaving the operating room, upon arriving to the recovery room, and before being discharged. The medical staff makes numerous other observations of each patient such as general status, presence or absence of abdominal pain, amount of bleeding, and state of recovery from pain medications. Follow-up exams at the Women’s Centers are included in the fee for those who can and wish to return to see the Doctor and medical staff for the follow-up exam.

Our purpose is to ensure that every woman who comes to our Women’s Centers for a termination of pregnancy receives the safest possible care and the most compassion and support for the patient and her family. When she leaves, we want her to feel confident that she is returning to good health and is able to live her life as she chooses.

The Women’s Centers are a professional organization dedicated to providing expert, confidential, and respectful health care services. We maintain a national and international reputation for providing the highest quality abortion services in a safe and caring environment. Kindness, courtesy, and respect are the cornerstones of our patient-provider relationships.

We believe that women and families are intellectually, emotionally, spiritually, and ethically competent to face complex health issues-including abortion – and come to decisions that are appropriate for themselves.

REFERRAL AREAS

Patients have come to us from all parts of the world:

South America, Japan, Korea, Puerto Rico
Mexico, Iran, Kuwait, Russia
China, India, Egypt, Morocco
Australia, France, Germany, Switzerland
Netherlands, Pakistan, Qatar, Virgin Islands
United Kingdom, Israel, Canada, United States

MATERNAL MORBIDITY AND MORTALITY

Over 1000 procedures done with our technical procedure

1. No deaths
2. Less than 1% incidence of infection
3. No C-Sections
4. No Hysterotomies

Extensive review of statistics and reports from the facilities that perform induction procedures show that Women’s Centers is one the safest places worldwide to have a premature delivery for Fetal Indication for termination of pregnancy performed.

Patient safety and comfort are our number one priority.

Staff is Caring and Compassionate

Major hospital is located 0.2 miles from our office. Back up coverage with OB/GYN service is available at all times.