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Safety problems with medical abortions are extremely rare, experts emphasize
Massachusetts

Safety problems with medical abortions are extremely rare, experts emphasize



CNN

Two Georgia mothers, Amber Thurman and Candi Miller, died in 2022 due to a lack of care most likely related to the state’s abortion ban, nonprofit news outlet ProPublica reported this week. Both had complications after taking abortion drugs, the report said – complications, doctors stressed, that are extremely rare and entirely treatable.

“When you read in the United States that a mother who is just trying to make the best decisions for herself and her family dies from a disease that is entirely preventable, I don’t think the word ‘tragedy’ is strong enough,” said Dr. Ghazaleh Moayedi, a gynecologist and founder of the Pegasus Health Justice Center in Dallas.

According to the report, Thurman received abortion drugs at a North Carolina clinic shortly after her home state of Georgia banned abortions after six weeks. A few days later, she went to her local hospital with a severe infection because her body had not expelled all of the fetal tissue.

“There should not have been a need to wait a second” to receive treatment, Moayedi told CNN. “She should have been taken immediately for a uterine aspiration,” a procedure that removes the contents of the uterus and is performed in both abortions and miscarriages.

Instead, ProPublica reported, Thurman’s fetal tissue was surgically removed 20 hours later. The report said Thurman’s records did not indicate why doctors waited so long, but the procedure had been criminalized just weeks earlier by the state’s abortion ban after the U.S. Supreme Court overturned Roe v. Wade in the summer. Thurman’s heart stopped during the operation, the newspaper reported, after she was diagnosed with acute severe sepsis and began experiencing organ failure in the hospital.

A second report said Miller never went to the hospital at all, even though, as her son told ProPublica, she was bedridden for days in pain after taking abortion pills. A Clayton County coroner’s report obtained by CNN cited a conversation with her husband in which he said she “did not go to the gynecologist because of current pregnancy and abortion laws.”

Miller also had not expelled all of the fetal tissue, ProPublica reported, and she would have had to undergo curettage (dilation and curettage) to remove the tissue and prevent infection. Her autopsy report, obtained by CNN, showed she died from a combination of drugs, including the painkillers fentanyl and acetaminophen; the medical examiner’s report noted that she had no history of illegal drug use.

The Georgia Department of Public Health told CNN that the reports of its committee investigating maternal mortality were confidential. ProPublica, citing unnamed sources including members of the committee, noted that those reports classified Thurman and Miller’s deaths as “preventable” and, in Miller’s case, linked them to the state’s abortion law.

The reports have fueled the political debate over abortion access, with Vice President Kamala Harris saying this week, “This is exactly what we feared would happen when Roe was overturned.” Harris will visit Georgia on Friday to make further remarks on women’s reproductive rights.

Opponents of abortion rights accused Thurman’s doctors of not helping them immediately – and blamed the medical abortion itself.

But researchers who study medical abortions and doctors who prescribe them stressed to CNN that the treatment is safe and offered advice on what patients should do if they experience rare complications.

Medical abortion has been approved by the U.S. Food and Drug Administration since 2000 and can currently be performed up to the tenth week of pregnancy.

Data shows that this is now the most common way to have an abortion in the United States. According to the Guttmacher Institute, a research group that supports abortion rights, it accounted for about two-thirds of the roughly one million abortions performed in the U.S. public health system last year.

It consists of two drugs, mifepristone and misoprostol. Mifepristone blocks the hormone progesterone, which is necessary for a pregnancy to continue, and is taken first. A day or two later, misoprostol follows, which triggers contractions of the uterus, causing cramping and bleeding, during which the pregnancy tissue is expelled.

The process, Moayedi explained, is “physiologically basically the same” as a miscarriage.

According to Dr. Daniel Grossman, director of the Advancing New Standards in Reproductive Health (ANSIRH) program at the University of California, San Francisco, serious adverse events occur in less than 0.5% of cases with medication abortions. These adverse events can include hospitalization, blood transfusions and surgery, he said.

Retention of pregnancy tissue requiring vacuum aspiration occurs in 3 to 5 percent of women who undergo medical abortion, Grossman said. But this is not considered a serious complication and is usually treated on an outpatient basis. Moayedi said retained pregnancy tissue rarely leads to infections.

Deaths after medication abortions are also very rare, Grossman noted: Between 2000 and 2022, 32 cases were reported among women taking mifepristone, at a time when about 5.9 million women were using the drug. He said his team reviewed the causes reported to the FDA and nearly half of them were likely unrelated to the abortion.

“I have cared for thousands and thousands of people with medication abortion,” said Moayedi, whose clinic offers “wraparound care” and provides pre- and post-abortion care in Texas, where abortion is illegal with few exceptions. “I can count on one hand the number of people who have had an infection afterward – less than one hand. So it’s extremely rare.”

Particularly rare, says Moayedi, because women can “seek help immediately” if they have a problem – something she fears, according to ProPublica’s reporting, is less easy to do in states with abortion bans.

Signs of complications include fever, severe abdominal pain and bleeding that soaks more than two sanitary pads per hour for two hours, Moayedi said. Grossman added that feeling very weak or experiencing nausea, vomiting or diarrhea more than a day after taking the last pill can also be signs of infection.

He advises people who experience troubling symptoms to contact the clinic or service that provided the medication or call the Miscarriage and Abortion Hotline at 1-833-246-2632, a toll-free line where doctors answer questions and offer support.

“However, if a patient has any of the symptoms listed above and is unable to speak to a doctor on the phone,” Grossman said, “they should go to the emergency room.”

People with these complications can – and should – be treated legally anywhere, even in states where abortion is banned, doctors told CNN, so they should not hesitate to go to a hospital for emergency care.

But responsibility for medical care cannot rest solely with the patient, Moayedi stressed; hospital systems must also ensure they understand the laws and have plans in place that enable doctors to provide the necessary treatment, she said.

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Grossman also pointed out that “the same complications that occur with a medical abortion can also occur with a miscarriage and the treatment is the same.”

“I would never advise a patient to lie, but I am very concerned about these reports that patients in states with abortion bans are having their treatment delayed when they have complications after an abortion – even though the law should not apply to these cases,” he said, noting that through its research, his team has heard of similar delays in treating other patients. “Doctors may treat the patient with bleeding or an infection without knowing whether the patient has taken medication or not.”

He said he advises doctors not to ask patients whether they have taken medication to terminate their pregnancy, “as this will have no impact on their treatment and instead may only increase the legal risks for the patient.”

CNN’s Jeffrey Kopp and Sandee LaMotte contributed to this report.

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