CHAPTER 22
NEONATAL AND CHILDHOOD SEQUELAE
— RELATED TO ABORTION —
What is the main problem?
Premature birth and earlier losses. The main reason for this is cervical incompetence. This can result from the too-early, forceful dilatation (stretching open) of the cervix (mouth of the womb). During an abortion procedure, the cervical muscle must be stretched open to allow the surgeon to enter the uterus. There is no harm to the muscle in a D&C performed because of a spontaneous miscarriage, as the cervix is usually soft and often open. Also, there is rarely any damage caused by a D&C done on a woman for excessive menstruation, etc. When, however, a normal, well-rooted placenta and growing baby are scraped out of a firmly closed uterus, protected by a long, "green" (unripe) cervix, this "donut" muscle can be and often is torn. If enough muscle fibers are torn, the cervix is permanently weakened, the most damage being done if this is her first pregnancy.
Why is this a problem?
Let’s look at a woman’s first labor and delivery. Her labor is often 12 to 20 hours. The nurse, as she checks the mother’s progress, uses the terms "two fingers" (or cm) — "four fingers" — then "complete." These terms refer to measuring the slow dilatation of the cervix. Only when it is wide open ("complete") can the baby begin the journey through the birth canal.
Before birth, nature opens this "door" very slowly. In a miscarriage, all those cramps do the same thing. After emptying the uterus, this strong donut-like muscle closes tight again.
The lowest part of a woman’s uterus is the cervix, and, when a woman is pregnant and stands upright, the baby’s head rests on it — in effect, bouncing up and down on the "door" throughout the pregnancy. The muscle must be intact and strong in order to keep the cervix closed. If it is weak, or "incompetent," it may not stay closed and may result in premature opening and miscarriage, or premature birth.
"The main risk of induced abortion is . . . permanent cervical incompetence." L. Iffy, "Second-Trimester Abortions," JAMA, vol. 249, no. 5, Feb. 4, 1983, p. 588
Second trimester miscarriage and premature birth frequently follow induced abortions. A. Arvay et al., "Relation of Abortion to Premature Birth," Review French GYN-OB, vol. 62, no. 81, 1967 Levin et al., JAMA, vol. 243, 1982, p. 2495 A. Jakobovits & L. Iffy, "Perinatal Implications of Therapeutic Abortion." Principals and Practice of OB & Perinatalogy, New York, J. Wiley & Sons, 1981, p. 603 C. Madore et al., "Effects of Induce Abortion on Subsequent Pregnancy Outcome," Amer. Jour. OB/GYN, vol. 139, 1981, pp. 516-521 161
"In a series of 520 patients who had previously been aborted, 8.6% had premature labor compared to 4.4% of [non-aborted] controls." G. Ratten et al., "Effect of Abortion on Maturity of Subsequent Pregnancy," Med. Jour. of Australia, June 1979, pp. 479-480 "The induced abortion group had the highest incidence of late spontaneous abortion and premature delivery." O. Kaller et al., "Late Sequelae of Induced Abortion in Primigravidae," Acta OB GYN Scandinavia, vol. 56, 1977, pp. 311-317
Can this damage be prevented?
Using laminaria is an attempt to lessen such damage. This is a small bit of dehydrated material which is inserted into the cervix one day before the abortion. It absorbs water and swells to many times its size and, in the process dilates the cervix. Laminaria, incidentally, are seldom used in most freestanding abortion chambers because it means two visits, smaller volume, and smaller cash flow. The use of laminaria reduces, but does not eliminate, cervical incompetence. S. Harlap et al., "Spontaneous Fetal Losses After Induced Abortions," New England Jour. Med., vol. 8, Sept. 1971, p. 691
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