As The Dallas Morning News recently reported, women in the United States are “stocking up” on abortion pills out of fear these drugs (mainly misoprostol and mifepristone) will become hard to source due to looming restrictions.
Indeed, the Supreme Court will be ruling later this year on an appeal by the Fifth Circuit Court of Appeals limiting access by mail to mifepristone. The appellate court overturned a portion of the lower court ruling rescinding the Federal Drug Administration’s long-standing approval of mifepristone. It left intact the ability for women to acquire the drug by mail until a SCOTUS ruling. Also left intact, however, were some restrictions, including the provision that mifepristone only be administered in the presence of a physician and only through the seventh week of pregnancy rather than the 10th.
In all of this, pro-abortion activists and the medical community at large have minimized the inherent risks of a pregnant woman ingesting, unsupervised, the abortion drugs mifepristone and misoprostol. These risks are real. But they are, at this time, ignored, even by this country’s supposedly primary women’s medical support group, the American College of Obstetricians and Gynecologists (ACOG).
In the not-too-distant past, an obstetrician would be considered negligent if he or she did not weigh the well-known and well-documented risks associated with an undiagnosed ectopic pregnancy or the Rh status of a patient at the time of a miscarriage or abortion.
So what has changed? Certainly not the inherent risks of these two complications.
Risk of Undiagnosed Ectopic Pregnancy
An ectopic pregnancy is one in which the fertilized egg implants and establishes itself outside the uterus, usually within the lining of the fallopian tube. The issue for the woman who takes the abortion pill without the supervision of a physician is that she might unknowingly have an ectopic pregnancy.
Even though this is fairly rare, I find it interesting that other conditions with a similar frequency of occurrence garner much more attention. Ovarian cancer is one such example. Ovarian cancer is a terrible disease, of course, but the incidence for both ovarian cancer and an ectopic pregnancy is about the same — approximately 1 in 80. Yet if any group advised complacency regarding a woman’s regular annual exams, it would be skewered by the media, and rightly so. One to 2 percent is rare but not rare enough to ignore a potentially serious risk and look the other way.
It is alarming the medical community is not telling women that ectopic pregnancy can lead to catastrophic hemorrhage. In 2021, in this country alone, there were 1,205 maternal deaths, up to 6 percent of which were the result of an extensive intra-abdominal hemorrhage caused by a ruptured ectopic pregnancy. That is about 72 deaths a year — nearly 1.5 per state.
Pro-life and pro-abortion debates aside, no woman should take abortion drugs without first being reassured she does not have an ectopic pregnancy. Suppose she obtains and takes mifepristone and misoprostol without evaluation or supervision, and she is the unfortunate 1 in 80 with an ectopic pregnancy. In that case, she runs a very real risk of hemorrhage. When OB-GYNs in training were taught in years past, “Don’t let the sun set on an ectopic pregnancy,” it was for a very good reason.
Risk Of Future Pregnancy Complications
The second potential complication minimized by ACOG and the medical community is the risk of Rh disease (Rh alloimmunization) in women who undergo an unsupervised medication-induced abortion.
Every human regardless of his or her blood type (A, B, AB, or O), is either Rh negative or Rh positive. In this country, approximately 15 percent of the population is Rh(-) while the remaining majority are Rh(+).
When it comes to pregnancy, if an Rh(-) woman is carrying an Rh(+) baby — which is the most likely scenario — the woman’s immune system will recognize the Rh(+) protein (referred to as Rh(D) or big D) contained in her baby’s blood and create antibodies that can and ultimately will attack the red blood cells of the unborn baby. This causes a potentially lethal condition referred to as hydrops. The first exposure (and antibody response) to the big D protein or antigen is relatively benign, but in each successive pregnancy, the condition worsens if the baby she is carrying is Rh(+).
Prior to the 1970s and the introduction of the prevention of Rh disease in the form of Rh(D)-immune globulin (an injected antibody that coats or “hides” the antigen), the mortality rate for the unborn child was 4/1,000 live births. Now, when properly managed, this risk is minimal.
It is an established fact that after a certain gestational age (that exact age is uncertain) the fetal blood of an Rh-positive baby can mingle with that of an Rh-negative mother and trigger the immune response that results in alloimmunization. This is why ACOG recommends that Rh(D)-immune globulin be administered to every Rh(-) woman at 28 weeks of pregnancy and even after she delivers if her baby’s blood type is determined to be Rh(+).
ACOG’s current position on this issue is straightforward. Within their Protocol for Medical Management of Early Pregnancy Loss they state: “Women who are Rh(D) negative and unsensitized should receive Rh(D)-immune globulin within 72 hours of the first misoprostol administration.” However, if alloimmunization has already occurred, Rh(D)-immune globulin will serve no useful purpose.
The incidence of Rh alloimmunization will surely increase with the availability of abortion drugs by mail. Without supervision, a woman might induce an abortion without knowing her Rh status. If she is Rh(-), and if alloimmunization has already occurred, she will be forever straddled with the associated risks of Rh alloimmunization in all subsequent pregnancies in which she is carrying an Rh(+) baby.
So why haven’t ACOG or other organizations purporting to protect women spoken out about these risks? It’s time the American Academy of Family Physicians and ACOG take a stand and advocate for the safety of women contemplating an unsupervised medical abortion.
Dr. Lloyd Holm is a retired OB/GYN and former President of the Iowa State Board of Health who is currently the Executive Director of Options for Women/River Falls, a pregnancy resource center in Western Wisconsin. His writings have appeared in The Omaha World-Herald, Obstetrics, and Gynecology, the American Journal of Obstetrics and Gynecology, Iowa Medicine, The Female Patient, Hospital Drive, and most recently, as a 2021-2022 and 2022-2023 Op-Med Fellow for the on-line networking platform for medical professionals, Doximity.
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