Abortion, partial birth

Definition

Partial birth abortion, medically known as intact dilation and extraction (IDX), is a method of late-term abortion that ends a pregnancy and results in the death and intact removal of a fetus from the uterus. In the United States, the procedure is illegal.


Purpose

Partial birth abortion, or IDX, is performed to end a pregnancy in the mid to late second trimester. It is typically performed between weeks 19 and 26 of pregnancy. IDX is highly controversial. Some physicians argue that IDX has advantages that make it preferable to other late-term abortion procedures in some circumstances. One advantage is that the fetus is removed largely intact, allowing for better evaluation and autopsy of the fetus in cases of fetal abnormalities. Intact removal of the fetus also may carry a lower risk of puncturing the uterus or damaging the cervix. Another perceived advantage is that IDX ends the pregnancy without requiring the woman to go through labor. This may reduce the emotional trauma of ending the pregnancy when compared to other methods of late-term abortion. In addition, IDX may offer a lower cost and shorter procedure time. Regardless of any perceived advantages, the procedure is illegal in the United States. Even before the procedure became illegal, it was performed only rarely.


Precautions

IDX is illegal in the United States. Women considering IDX in countries where the procedure is legal should be aware of the highly controversial nature of this procedure. One controversy common to this and all late-term abortions is determining at what point in the pregnancy the fetus is viable (able to survive outside the mother' body). In technologically advanced countries, fetuses generally are viable at 28 weeks of pregnancy; some fetuses as young as 24 weeks survive. Another area of controversy specific to IDX is that fetal death does not occur until after most of the fetus's body has exited the uterus. Because of these concerns, many physicians who perform abortions do not perform IDX; this tends to limit the availability of the procedure.

Description

IDX first involves administration of medications to cause the cervix to dilate. Dilation usually occurs over the course of several days. Next, the physician rotates the fetus to a footling breech position. The body of the fetus is then drawn out of the uterus feet first, until only the head remains inside the uterus. The physician then uses an instrument to puncture the base of the skull, which collapses the fetal head. Typically, the contents of the fetal head are then partially suctioned out, which results in the death of the fetus and reduces the size of the fetal head enough to allow it to pass through the cervix. The dead but otherwise intact fetus is then removed from the woman's body.

Preparation

Medical preparation for IDX involves an outpatient visit to administer dilation medications such as laminaria. Psychological preparation is desirable.
In addition, preparation may involve fulfilling local legal requirements, such as a mandatory waiting period, counseling, or an informed consent procedure reviewing stages of fetal development, childbirth, alternative abortion methods, and adoption.

Aftercare

IDX typically does not require an overnight hospital stay. A follow-up doctor's visit usually is scheduled to monitor the woman for any complications.

Risks

With all abortion, the later in pregnancy an abortion is performed, the more complicated the procedure and the greater the risk of injury to the woman. In addition to associated emotional reactions, IDX carries the risk of injury to the woman, including heavy bleeding, blood clots, damage to the cervix or uterus, pelvic infection, and anesthesia-related complications. There also is a risk of incomplete abortion, meaning that the fetus is not dead when removed from the woman's body. Possible long-term risks include difficulty becoming pregnant or carrying a future pregnancy to term.

Normal results

The expected outcome of IDX is the termination of a pregnancy and death of the fetus.