A call for an evidence-based evaluation of late midtrimester abortion

Abstract

March 29, 2004 marked the beginning of the US government’s defense of the so-called ‘‘Partial-Birth’’ Abortion Ban (Public Law 108-105). The bill was signed into law by President Bush on November 5 of 2003 after considerable debate, but it has yet to be enforced after 3 court challenges were quickly filed in New York, San Francisco, and Lincoln, Nebraska. Initial physician testimony in defense of the ban has included reference to the fact there is little medical literature addressing the safety of the intact dilation and extraction (D & X) procedure. Indeed, on the occasion of its passage, Senate majority leader Bill Frist, a physician, suggested that the passage of the law would save lives. Given the paucity of published reports on this procedure, a variant of the far more commonly performed dilation and evacuation (D & E), it is timely that this month’s issue of the American Journal of Obstetrics and Gynecology includes an article by Chasen et al which compares the safety and outcome of D & E vs intact D & X in late second trimester abortions (O20 wk). While the study is retrospective and the number of cases evaluated modest, these results, presented from an academic medical center, provide considerable reassurance as to the safety of the intact D & X procedure in the hands of accomplished gynecologic surgeons. It has been widely suggested as part of the justification for the ‘‘partial-birth’’ abortion ban legislation that the maternal risks associated with the procedure are significantly increased over other available techniques for midtrimester pregnancy termination (D & E, induction). Specifically, Sprang and Neerhof suggested