AAPLOG Responds to “Facts are Important: Understanding Ectopic Pregnancy”

ACOG recently released a statement, “Facts are Important: Understanding Ectopic Pregnancy.”

We absolutely agree that facts are important and that the timely diagnosis of an ectopic pregnancy is essential for excellent healthcare for women.   However, we do not agree that restrictions on abortion limit a physician’s ability to treat ectopic pregnancies.

Ectopic pregnancy is a life-threatening condition and treating it is not the same thing as performing an abortion and yet ACOG’s statement seems to conflate the two, which leads to confusion not only for physicians but also for policy makers. Although treatment for ectopic pregnancy results in the unfortunate death of the embryo, this is not the intent of the treatment.  The intent is to save the life of the mother.  The sole intent of an abortion is to end the life of the developing human being. Therefore, legislation restricting induced abortion should not be seen to limit a physician’s ability to treat ectopic pregnancy.

AAPLOG agrees that facts are important. Some important facts about ectopic pregnancies are:

• Ectopic pregnancies comprise 2% of all pregnancies and 2.7% of maternal deaths.[i]
• Most women with an ectopic pregnancy have no risk factors.[ii]
• Determination of pregnancy location requires an ultrasound.[iii]

Based on the above facts, it is not appropriate to provide medication abortion without an accurate determination of pregnancy location.  Evaluating for ectopic pregnancy by history alone is inadequate. An ultrasound is necessary to determine pregnancy location.

ACOG states that “An untreated ectopic pregnancy is life-threatening; withholding or delaying treatment can lead to death.” We agree with this statement and for that reason, argue that an ultrasound must be performed prior to a medication abortion. Mifepristone and misoprostol do not treat ectopic pregnancy and providing these or any other medication to terminate a presumed (but not confirmed) intrauterine pregnancy may delay detection and treatment of an ectopic pregnancy. Since women of color are disproportionately at greater risk for both ectopic pregnancy and abortion, providing medication abortion without first performing an ultrasound disproportionately puts minority women at risk.

Facts are important.