When doctors recommend aborting a fetus, the compelling medical reasons include problems with the normal progress of the pregnancy, health conditions of the mother, and fetal abnormalities. The decision-making process to end these pregnancies can be straightforward for some of these situations, but not as easy for others.
Abnormal Progress of Pregnancy
When a pregnancy doesn't appear to be developing on a normal course, doctors will recommend an abortion. An early procedure will decrease the risk of maternal complications, such as uterine or systemic infection.
A Non-Viable Intrauterine Fetus
Most non-viable fetuses occur in the first trimester and are caused by abnormal implantation or chromosomal defects. The pregnancy might spontaneously abort, but some women might prefer not to wait and opt for an induced abortion.
A intrauterine non-viable fetus is usually diagnosed by falling HCG levels or on ultrasound by an abnormal or empty sac, a smaller-than-expected fetus, or absence of a fetal heartbeat.
Intrauterine Fetal Death
When a seemingly normal fetus dies in the second trimester up to the 20th week of pregnancy, it is referred to as a as an intrauterine fetal death (IUFD). After 20 weeks, it is referred to as stillbirth. The risks of waiting for the fetus to pass spontaneously include maternal infection and hemorrhage.
An abortion procedure is recommended when the death occurs before 24 weeks of gestation. After 24 weeks, a patient might undergo induction of labor instead. Causes of IUFD include fetal anomalies, drugs, and maternal medical problems.
Premature Rupture of Membranes
The fetal membranes (bag of waters) can rupture before the fetus becomes viable to survive outside the uterus (less than 24 weeks). Abortion becomes necessary if the woman doesn't have a spontaneous miscarriage up to 20 weeks or go into premature labor if she is past her 20th week of pregnancy.
A placental separation from the wall of the uterus (placental abruption) can cause heavy bleeding. In early pregnancy if bleeding doesn't stop, or the condition is untreatable, the mother will require an abortion if she doesn't miscarry the fetus.
Fetal congenital abnormalities and genetic chromosome disorders are often not diagnosed until the late second trimester of pregnancy. Early diagnosis might make it easier for a mother to make a decision and avoid the more complicated abortion procedures in the late second or third trimester.
Fetal Congenital Birth Defects
Some fetal birth defects are incompatible with life and often end in death of the newborn shortly after birth. Other congenital abnormalities severely affect the quality of a child's life or shorten his life-expectancy. These defects are often detected by genetic testing or on ultrasound and include:
- Spina bifida is a defect in the developing spinal cord or neural tube (a neural tube defect). Some forms of spina bifida are reparable and cause no problems after birth, but others can cause urinary incontinence and inability to walk. Other spinal abnormalities include meningocele and the more severe myelomeningocele.
- Anencephaly is abnormal development that causes lack of growth of the brain. These fetuses die before birth or soon after.
- Conjoined twins can be considered a form of birth defect. This situation where twins are joined at various body parts might severely affect their health and survival after birth.
- Severe fetal heart or kidney abnormalities that appear to be incompatible with a normal life are a birth defect.
Maternal exposure to harmful agents: A variety of noxious agents can lead to severe fetal abnormalities or intrauterine fetal death, especially if this occurs in the first trimester of pregnancy. These agents include:
- Maternal infection: Infectious organisms can pass from mother to fetus and cause severe fetal anomalies of the brain and other organs, especially in early pregnancy. They include Rubella (german measles), cytomegalovirus (CMV), varicella, herpes, Zika virus, HIV, toxoplasmosis, and syphilis.
- Medicines: This includes prescriptions drugs, such as Coumadin (warfarin) and Accutane (isotretoin), as well as over-the-counter medicines.
- Illicit drugs: This includes heroin and cocaine.
- Harmful doses of radiationmay also cause birth defects.
Genetic disorders of the fetus can be detected by ultrasound, chorionic villus sampling at 10 to 14 weeks, and amniocentesis as early as 14 weeks. These genetic abnormalities can affect the health and physical or mental development and shorten the life of a child. They include:
- Chromosome trisomies: There are three copies of certain chromosomes instead of the normal two, such as trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome).
- Duchenne muscular dystrophy: This is an X-linked recessive disorder that affects more boys than girls and causes problems of muscles, heart, and spine.
- Other X-linked diseases, such as Fragile-X and hemophilia
- Tay-Sachs: This is a recessive inherited enzyme defect that causes increased fatty deposits in the nervous system which affects its function.
Maternal Medical Conditions
Several medical conditions that worsen or develop during pregnancy can put a woman's life at risk if her pregnancy continues. A doctor and his patient must weigh the degree of that risk to the mother against the life of her fetus.
In some circumstances, a doctor might recommend immediate termination of pregnancy - abortion for a non-viable fetus or early delivery for a viable fetus even if not at term. A 2009 Global Library of Women's Medicine (GLOWN) article lists many of these health problems.
Cardiovascular diseases can compromise a women's health in pregnancy. Heart and lung function can deteriorate because of the physiologic changes in pregnancy, and these organs can fail and increase the risk of maternal death. The diseases include:
- Cardiomyopathy (diseased heart muscle) caused by changes of pregnancy or other problems
- Hypertensive heart disease from long-standing high blood pressure, which can lead to heart failure
- History of heart attack causing poor function of the heart during pregnancy
- Eisenmenger's syndrome, which is disease of the arteries of the lungs caused by a congenital hole in the heart and carries a high risk of death during pregnancy
- Pulmonary hypertension, a problem of high blood pressure in the arteries in the lungs, which can be severe and lead to heart failure and death
Kidney failure from primary diseases of the kidneys or from complications of other diseases, such as diabetes or high blood pressure, can worsen during pregnancy. An abortion might be necessary early in pregnancy if a woman's life is at risk.
Preeclampsia is a disorder of pregnancy with progressive maternal signs and symptoms that include:
- High blood pressure, headaches, and disturbed vision
- Renal and liver dysfunction and failure
- Cardiovascular disturbance
- Blood clotting abnormalities and risk of hemorrhage
- Risk of stroke and death
The syndrome is more common in the third trimester when the fetus is viable or close to viability, in which case early delivery of a live fetus can be planned. However, when it occurs earlier in the pregnancy and significantly puts a mother's life in jeopardy before fetal viability, an abortion is the usual remedy.
An abortion might be necessary in the setting of terminal cancer or when cancer is diagnosed during early pregnancy. Cancers of the cervix or breast are the most common forms discovered in pregnancy.
Treatment of mother when cancers are diagnosed in pregnancy might include surgery, radiation, or chemotherapy, which can be harmful to the fetus. On the other hand, delay in treatment until after delivery can be detrimental to the mother's life.
A pregnant woman might develop an infection in the uterus that infects the fetal membranes (chorioamnionitis). An abortion might be necessary to prevent maternal systemic infection and death. An intrauterine infection can also lead to premature rupture of membranes and labor or premature death of the fetus.
Other Medical Problems
Other diseases that can cause significant problems during pregnancy and put a fetus and a woman's life at risk if difficult to control include:
- Poorly controlled diabetes with severe maternal cardiovascular, renal, and vision complications
- Thrombotic thrombocytopenic purpura, a blood disorder of low platelets that can lead to hemorrhage
- Maternal genetic diseases, such as Marfan's syndrome - a disease that affects connective tissue, especially in the heart, blood vessels, and bones. A severely affected aorta can lead to death.
The decision to have an abortion for medical reasons can be difficult and stressful for a woman and her partner. If you are faced with this situation, make sure you have all the facts and weigh the pros and cons to make the best informed decision. However, recognize that in an emergency situation where your life is in critical danger, you might not have the ability to consider your options.