Ultrasound in the First Trimester
Asim Kurjak in CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
In a study performed at our institution on a population of 142 pregnant women with bleeding in early pregnancy, in 103 (72.5%) of the cases it was demonstrated that the fetus was alive. In the remaining 39 cases (27.5%) there were no signs of fetal life. In the 39 cases where fetal life was not demonstrated, the most frequent cause was blighted ovum (38.5%), followed by missed abortion (33.3%) and abortus incompletus (25.6%), and just one case (2.6%) of ectopic pregnancy. Out of the 142 women, 82 delivered a live baby, meaning that 58% of cases, regardless of bleeding in early pregnancy, were brought to term. In a very recent paper, Cashner et al.24 made an analysis of pregnancy outcome in 489 pregnant women after ultrasound documentation of fetal viability at 8 to 12 weeks. Obtained results suggest that if a live fetus is documented by ultrasonography at 8 to 12 weeks of gestation, the risk of spontaneous abortion before 20 weeks of gestation in an uninstrumented population is 2.0%. In a study given by Anderson,25 97.3% of pregnancies in which fetal cardiac motion was noted after 7 weeks carried in term. Jouppila et al.26 observed that in patients with threatened abortions, the positive finding of fetal heart action was associated with delivery of a viable infant in 90.0% of the cases.26
Pregnancy and mitral stenosis
Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi in Mitral Stenosis, 2018
Ideally, the best time to perform the procedure is before conception. In patients who present with symptomatic severe MS in early pregnancy, PTMC may be delayed until organogenesis of the fetus is complete (i.e., 12–14 weeks), to avoid radiation exposure to the fetus in the first trimester. The best time frame for performing a PTMC is 14–22 weeks in these circ*mstances.43 In the early second trimester the fetus is small and thus causes minimal interference with catheter manipulation. Also, it may be easier to keep the fetus out of the radiation field due to the smaller size of the fetus. However, many patients become symptomatic only after 20 weeks of gestation when the expansion of blood volume peaks. In such cases the procedure should be deferred to 26–30 weeks of gestation, so that fetal viability is achieved in case of inadvertent preterm delivery.43 The procedure becomes more challenging in the third trimester (due to the size of gravid uterus causing venacaval compression and interfering with catheter manipulation). The risk of maternal complications is also increased in the late third trimester. However, even if a patient becomes symptomatic in the late third trimester, PTMC should not be denied.
In defence of children and their rights
Théodore H MacDonald, Noël A Kinsella, John A Gibson in The Global Human Right to Health, 2018
The issue of infant mortality is complex because different countries have often defined the key indicators differently. Since 1990, the World Health Organization has used the following definitions, and most countries have fallen into line with regard to these.Infant mortality is the death of infants within the first year of life. In the LDCs, the leading causes of infant mortality are dehydration and waterborne diseases. In the First World, the major causes of infant mortality are congenital malformation, infection and sudden infant death syndrome (SIDS). Infant mortality can be subdivided as follows.Perinatal mortality refers to deaths between the age of fetal viability (defined as 28 weeks of pregnancy or 1,000 g body weight) and the end of the 7th day of life.Neonatal mortality refers to deaths in the first 27 days of life.Postnatal death refers to deaths between the ages of 28 days and 1 year.Child mortality refers to deaths within the first 5 years of life.
People’s knowledge of and attitudes toward abortion laws before and after the Dobbs v. Jackson decision
Published in Sexual and Reproductive Health Matters, 2023
Kristen N. Jozkowski, Xiana Bueno, Ronna C. Turner, Brandon L. Crawford, Wen-Juo Lo
On 24th June 2022, the Supreme Court of the United States (SCOTUS) upheld a 2018 Mississippi law (i.e. Gestational Age Act) in Dobbs v. Jackson Women’s Health Organization (hereafter Dobbs v. Jackson). A draft of the decision was leaked in May 2022 and received tremendous media coverage. The Mississippi law restricted abortion after 15 weeks “except in a medical emergency or in the case of a severe fetal abnormality”.1 This decision overturned the 1973 decision in Roe v. Wade and eliminated the constitutional protection for the right to abortion up to viability or approximately 22–24 weeks of pregnancy. Of note, scientific and medical organisations provide guidelines for fetal/neonatal care that suggest the potential for viability at 22–24 weeks,2 which is often the timeframe cited by politicians and in the media as “fetal viability”. As a result of the Dobbs v. Jackson decision, state lawmakers are positioned to enact legislation that can further restrict abortion beyond the bounds they were able to previously because of the trimester framework established in Roe v. Wade. The ruling in Roe v. Wade indicated in the first trimester, the decision to have an abortion is solely between a pregnant person and their healthcare provider. In the second trimester, the state is permitted to regulate abortion for concerns related to maternal health. In the third trimester, or at the point of fetal viability, states are permitted to either regulate or prohibit abortion with exceptions for cases of life endangerment for the pregnant person.
The effect of low-dose ovarian stimulation with HMG plus progesterone on pregnancy outcome in women with history of recurrent pregnancy loss and secondary infertility: a retrospective cohort study
Published in Gynecological Endocrinology, 2018
Maria Elisabetta Coccia, Francesca Rizzello, Mauro Cozzolino, Valentina Turillazzi, Tommaso Capezzuoli
In the control group, spontaneous growth of the follicles was monitored with ultrasound. In both the study and control groups, hCG was administered when the follicles had reached 18–20 mm. The couple was invited to have intercourses during the next 3–4 days. The presence of the corpus luteum was evaluated three days after hCG administration by TV-US. The luteal phase was supported by 400 mg of micronized progesterone administered vagin*lly, starting 4 days after the induction of ovulation with hCG, and continued over the next 10 days. If no bleeding occurred within 4 days from progesterone withdrawal, a urinary pregnancy test was performed. All pregnancies were confirmed by ultrasonography. Patients with positive test continued to receive micronized progesterone until the 10th week of gestation. A TV-US using transducers of 7.5 MHz was performed at the 6th week of gestation. Clinical pregnancy was confirmed if an intrauterine gestational sac with heart beat was detected. All pregnant patients followed a clinic protocol including a TV-US to assess fetal viability on a weekly basis, until the 12th week of gestation.
Feminist Concerns About Artificial Womb Technology
Published in The American Journal of Bioethics, 2023
Tamara Kayali Browne, Evie Kendal, Tiia Sudenkaarne
A risk associated with AWT, however, is that it could be used to justify further restrictions on reproductive rights, such as abortion. In a world where AWT is available, it is possible that states attempting to impose legislative measures against abortion may argue that it is no longer justifiable at any gestational age, as those who do not wish to carry their fetus to term can transfer it to an artificial womb for continued development and subsequent adoption. This argument could be used particularly in states where fetal viability is already used to decide the stage of pregnancy at which abortion should be allowed. However, as Claire Horn (2020) has argued, this argument rests on an anachronistic understanding of how and why abortions are conducted. According to existing predictions, transferring a fetus to AWT would entail major abdominal surgery (Eindhoven University of Technology 2022), and thus is not an ethical substitute for the majority of abortions, which are achieved simply and safely using medication early in gestation. Moreover, the details of how exactly the fetus would be extracted from the womb are almost never described. Yet it is important to pay attention to such details, especially if there would be coercion in cases in which AWT is viewed as “saving” the fetus from a substance-abusive fetal environment (in much the same way that forced C sections are conducted for “fetal interests”). Ignoring this issue reproduces the discourse of women’s pain and suffering being made invisible around pregnancy and childbirth (cf. obstetric violence) and might produce an entirely new reproductive justice issue.
