背景:许多国家和地方政府以前允许在严重胎儿异常的情况下合法堕胎,已经通过了新的立法,明确取消了这些津贴。然而,我们对这种限制对产妇健康的影响知之甚少。
目的:本研究旨在检查萨尔瓦多孕妇的健康结局,这些孕妇的胎儿被诊断患有致命的先天性畸形,并且法律要求在国家的绝对堕胎禁令下进行这些无生命妊娠。
方法:我们回顾了2013年1月1日至2018年12月31日在萨尔瓦多国家妇女医院进行评估的所有239例胎儿的图表,这些胎儿被分类为18例先天性畸形中的1例,通常被认为与子宫外寿命不相容。因为在萨尔瓦多识别妊娠并发症的区域医疗保健提供者被指示将这些患者转诊到国家妇女医院,我们的分析记录了由国家公共卫生系统治疗的致命性胎儿畸形的总数.我们记录了怀孕患者的社会经济特征,妊娠相关并发症,以及用于减轻并发症的医疗程序。
结果:需要携带严重胎儿畸形妊娠至足月(或直到自然早产开始)的个体经历了很高的产妇发病率。超过一半(54.9%)的孕妇经历了至少1次与妊娠相关的严重健康并发症。而47.9%的人接受了物理侵入性医疗程序来管理并发症,包括剖腹产,减压羊膜腔,胎儿头部减压术,and,在一种情况下,全子宫切除术.共有9%的患者在接受致命的胎儿畸形诊断后选择停止治疗。我们还发现,医生如何管理致命胎儿畸形的怀孕,这表明对法律的不同解释会导致个人层面的患者护理不平等。
结论:法律禁止在严重胎儿畸形的情况下进行流产,可能会增加妊娠患者的风险,因为它要求临床医生对健康患者进行导致发病的疗程。
BACKGROUND: A striking number of national and subnational governments that previously allowed legal abortion in cases of severe fetal anomaly have passed new
legislation to explicitly remove these allowances. However, we know little about the maternal health implications of such restrictions.
OBJECTIVE: This study aimed to examine the health outcomes of pregnant individuals in El Salvador whose fetuses were diagnosed with a fatal congenital malformation and who were legally required to carry these nonviable pregnancies to term under the nation\'s absolute abortion ban.
METHODS: We reviewed the charts of all 239 pregnancies with fetuses classified as having 1 of 18 congenital malformations typically considered to be incompatible with extrauterine life that were evaluated at the National Women\'s Hospital in El Salvador between January 1, 2013 and December 31, 2018. Because regional healthcare providers who identify pregnancy complications in El Salvador are instructed to refer those patients to the National Women\'s Hospital, our analysis captured the total population of lethal fetal malformations treated by the national public health system. We documented pregnant patients\' socioeconomic characteristics, pregnancy-related complications, and the medical procedures used to mitigate complications.
RESULTS: Individuals who were required to carry pregnancies with severe fetal malformations to term (or until preterm labor began naturally) experienced high rates of maternal morbidity. More than half (54.9%) of pregnancies experienced at least 1 serious pregnancy-related health complication, whereas 47.9% underwent a physically-invasive medical procedure to manage complications, including cesarean deliveries, decompression amniocenteses, fetal head decompressions, and, in 1
case, a full hysterectomy. A total of 9% of patients opted to discontinue care after receiving the diagnosis of fatal fetal malformation. We also found striking variation in how physicians managed pregnancies with fatal fetal malformations, suggesting that different interpretations of the law lead to inequities in individual-level patient care.
CONCLUSIONS: Laws prohibiting abortions in cases of severe fetal malformation can increase risks to pregnant patients by requiring clinicians to subject healthy patients to a course of treatment that generates morbidity.