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Mellquist M, Hoedt M, Fusco KN, Alef R, Dittmer K, Ash H, Shoukat W, Fonteyn L, Herzstein S, Heineman A, Mayrovitz HN. Medical Implications of Restricting Abortions on Women Diagnosed With Fetal Anomalies Following the Overturn of Roe v. Wade: A Scoping Review. Cureus 2024; 16:e58994. [PMID: 38800251 PMCID: PMC11127699 DOI: 10.7759/cureus.58994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
This scoping review addresses the potential maternal health outcomes of abortion restrictions in the U.S. by studying and analyzing the reported effects of abortion bans or limitations globally. The goal was to examine the medical implications for pregnant women who are unable to abort fetuses that have severe medical anomalies due to imposed restrictions. EMBASE, Medline, and CINAHL databases were searched for studies published in English concerning the medical implications of abortion restrictions in any country prior to the overturn of Roe v. Wade in 2022. For the search criteria using Boolean operators, keywords included the terms "fetal anomaly," "abortion ban," and "implications." Inclusion criteria incorporated studies published between 1980 and 2021, and controlled experimental research studies aimed to evaluate interventions were excluded. This resulted in 469 records initially found. Duplicate records were removed, and two separate tier reviews were conducted. Eleven reviewers independently screened abstracts and titles of 332 records to ascertain eligibility. Eligibility included pregnant women diagnosed with fetal anomalies, women denied access to safe abortions, and the maternal and fetal medical impacts of this. Three reviewers in the second screening independently read 36 full articles to further assess eligibility, resulting in 14 articles in the final review. Findings from this study showed that abortion bans in countries around the world have led to health complications in women seeking illegal abortion services, a decline in maternal mental health, including stress and depression, various medical complications such as obstructed labor, and an increase in high-risk fetuses born with severe deficits. The findings of this review portend similar negative consequences to be experienced by women who are subject to stricter abortion laws in the U.S.
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Affiliation(s)
- Madison Mellquist
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Megan Hoedt
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Kellie N Fusco
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Rachel Alef
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Kaitlyn Dittmer
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Henry Ash
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Wamika Shoukat
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Lorenzo Fonteyn
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Salome Herzstein
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Allie Heineman
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVBD, Guimarães ICB, Corrêa IVDS, Pedrosa KLM, Lopes LM, Nicoloso LHS, Barberato MFA, Zamith MM. Brazilian Fetal Cardiology Guidelines - 2019. Arq Bras Cardiol 2019; 112:600-648. [PMID: 31188968 PMCID: PMC6555576 DOI: 10.5935/abc.20190075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simone R F Fontes Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.,Hospital do Coração (HCor), São Paulo, SP - Brazil
| | - Paulo Zielinsky
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
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Rosa RFM, Targa LV, Altmayer SPL, Lliguin KLP, Denardin D, da Cunha AC. Pre- and postnatal findings of a dicephalus tetrabrachius-dipus conjoined twins with a diaphragmatic hernia. Radiol Bras 2015; 48:61-2. [PMID: 25798012 PMCID: PMC4366033 DOI: 10.1590/0100-3984.2013.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | - Daniela Denardin
- Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, RS, Brasil
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Cacique DB, Passini Junior R, Osis MJMD. Validação de conteúdo do Mosaico de Opiniões sobre o Aborto Induzido (Mosai). Rev Assoc Med Bras (1992) 2013; 59:576-82. [DOI: 10.1016/j.ramb.2013.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/30/2013] [Indexed: 11/25/2022] Open
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Denardin D, Telles JAB, Betat RDS, Fell PRK, da Cunha AC, Targa LV, Zen PRG, Rosa RFM. Imperfect twinning: a clinical and ethical dilemma. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2013; 31:384-91. [PMID: 24142323 PMCID: PMC4182971 DOI: 10.1590/s0103-05822013000300017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/22/2013] [Indexed: 11/21/2022]
Abstract
UNLABELLED OBJECTIVE To review the history, epidemiology, etiology, gestational aspects, diagnosis and prognosis of imperfect twinning. DATA SOURCES Scientific articles were searched in PubMed, SciELO and Lilacs databases, using the descriptors "conjoined twins", "multiple pregnancy", "ultrasound", "magnetic resonance imaging" and "prognosis". The research was not delimited to a specific period of time and was supplemented with bibliographic data from books. DATA SYNTHESIS The description of conjoined twins is legendary. The estimated frequency is 1/45,000-200,000 births. These twins are monozygotic, monochorionic and usually monoamniotic. They can be classified by the most prominent fusion site, by the symmetry between the conjoined twins or by the sharing structure. The diagnosis can be performed in the prenatal period or after birth by different techniques, such as ultrasound, magnetic resonance imaging and echocardiography. These tests are of paramount importance for understanding the anatomy of both fetuses/children, as well as for prognosis and surgical plan determination. CONCLUSIONS Although imperfect twinning is a rare condition, the prenatal diagnosis is very important in order to evaluate the fusion site and its complexity. Hence, the evaluation of these children should be multidisciplinary, involving mainly obstetricians, pediatricians and pediatric surgeons. However, some decisions may constitute real ethical dilemmas, in which different points should be discussed and analyzed with the health team and the family.
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Affiliation(s)
- Daniela Denardin
- Médica do Programa de Residência Médica em Ginecologia e Obstetrícia
do Hospital Materno Infantil Presidente Vargas, Porto Alegre, RS,
Brasil
| | - Jorge Alberto B. Telles
- Mestre pelo Programa de Pós-Graduação em Ciências da Saúde-Pediatria
da Universidade Federal do Rio Grande do Sul (UFRGS); Médico do Serviço de Medicina
Fetal do Hospital Materno Infantil Presidente Vargas, Porto Alegre, RS,
Brasil
| | - Rosilene da Silveira Betat
- Médico Especialista em Ginecologia e Obstetrícia e Preceptor do
Serviço de Medicina Fetal do Hospital Materno Infantil Presidente Vargas, Porto
Alegre, RS, Brasil
| | - Paulo Renato K. Fell
- Médico Especialista em Ginecologia e Obstetrícia e Preceptor do
Serviço de Medicina Fetal do Hospital Materno Infantil Presidente Vargas, Porto
Alegre, RS, Brasil
| | - André Campos da Cunha
- Médico Especialista em Ginecologia e Obstetrícia e Preceptor do
Serviço de Medicina Fetal do Hospital Materno Infantil Presidente Vargas, Porto
Alegre, RS, Brasil
| | - Luciano Vieira Targa
- Médico Especialista em Radiologia do Hospital Materno Infantil
Presidente Vargas, Porto Alegre, RS, Brasil
| | - Paulo Ricardo G. Zen
- Doutor pelo Programa de Pós-Graduação em Patologia da UFCSPA;
Professor-Adjunto da Disciplina de Genética Clínica da UFCSPA, Porto Alegre, RS,
Brasil
| | - Rafael Fabiano M. Rosa
- Doutor pelo Programa de Pós-Graduação em Patologia da UFCSPA;
Geneticista Clínico do Hospital Materno Infantil Presidente Vargas;
Professor-Colaborador do Programa de Pós-Graduação em Patologia da UFCSPA, Porto
Alegre, RS, Brasil
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Lopes LM, Brizot ML, Schultz R, Liao AW, Krebs VLJ, Francisco RPV, Zugaib M. Twenty-five years of fetal echocardiography in conjoined twins: lessons learned. J Am Soc Echocardiogr 2013; 26:530-8. [PMID: 23562084 DOI: 10.1016/j.echo.2013.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to determine the accuracy of prenatal echocardiography in the diagnosis of intracardiac malformations and the degree of cardiac fusion in conjoined twins presenting to a single center over a 25-year period. METHODS The study group included 53 sets of conjoined twins from 1987 to 2012, including 38 thoracopagus, six parapagus, six omphalo-ischiopagus, two omphalopagus, and one cephalopagus. Twins were classified according to the degree of cardiac fusion: separate hearts and pericardium (group A, n = 10), separated hearts and common pericardium (group B, n = 2), fused atria and separated ventricles (group C, n = 2), and fused atria and ventricles (group D, n = 39). Postmortem examination was possible in 68 individual cases (98 deaths [69.3%]). RESULTS Cardiac defects were diagnosed in 47 sets of twins (88.6%). In 10 (18.8%), only one fetus was affected, and in 37 (69.8%), both fetuses were affected (n = 84/106 [79.2%]). There was a high predominance of right-sided lesions (63.0% [53 fetuses in 84 affected]) including pulmonary atresia or stenosis (35.7%), tricuspid atresia (11.9%), and hypoplastic or small right ventricle (21.4%). Autopsy findings added information to fetal echocardiographic findings in nine sets of twins (25.7%). Three pairs classified antenatally in groups A, B, and D were confirmed by autopsy in groups B, C, and C, respectively. CONCLUSIONS This study demonstrates that specialized fetal echocardiography is not a perfect diagnostic tool but is sensitive enough to establish prognosis in the counseling process. Because of complexity, such evaluations should be performed only at tertiary centers by specialists who are familiar with the peculiarities of this rare malformation. The predominance of right-sided lesions is not only an interesting finding, but this information has essential importance in terms of shortening examination times, allowing a more focused analysis of the fetal heart.
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Affiliation(s)
- Lilian M Lopes
- Department of Obstetrics and Gynecology, Hospital das Clínicas, São Paulo University Medical School, São Paulo, Brazil.
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