Patrick B. San Luis A2D3 Health Ethics 8-9:30pm Definition from Healthline.

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Induced abortion is the intentional termination of a pregnancy before the fetus can live independently. An abortion may be elective (based on a woman's personal choice) or therapeutic (to preserve the health or save the life of a pregnant woman). Purpose An abortion may be performed whenever there is some compelling reason to end a pregnancy. An abortion is termed "induced" to differentiate it from a spontaneous abortion in which the products of conception are lost naturally (also called a miscarriage). An abortion is considered to be elective if a woman chooses to end her pregnancy, and it is not for maternal or fetal health reasons. Some reasons a woman might choose to have an elective abortion are: * Continuation of the pregnancy may cause emotional or financial hardship. * The woman is not ready to become a parent. * The pregnancy was unintended. * The woman is pressured into having one by her partner, parents, or others. * The pregnancy was the result of rape or incest. A therapeutic abortion is performed in order to preserve the health or save the life of a pregnant woman. A health care provider might recommend a therapeutic abortion if the fetus is diagnosed with significant abnormalities or not expected to live, or if it has died in utero. Therapeutic abortion may also be used to reduce the number of fetuses if a woman is pregnant with multiples; this procedure is called multifetal pregnancy reduction (MFPR). A therapeutic abortion may be indicated if a woman has a pregnancy-related health condition that endangers her life. Some examples of such conditions include: * severe hypertension (high blood pressure) * cardiac disease * severe depression or other psychiatric conditions * serious kidney or liver disease * certain types of infection * malignancy (cancer) * multifetal pregnancy Demographics Abortion has been a legal procedure in the United States since 1973. Since then, more than 39

Patrick B. San Luis A2D3 Health Ethics 8-9:30pm million abortions have taken place. It is estimated that approximately 1.31.4 million abortions occur in the United States annually. Induced abortions terminate approximately half of the estimated three million unplanned pregnancies each year and approximately one-fifth of all pregnancies. In 2000 an estimated 21 out of 1,000 women aged 1544 had an abortion. Out of every 100 pregnancies that year that ended in live birth or abortion, approximately 24 were elective terminations. The highest abortion rates in 2000 occurred in New Jersey, New York, California, Delaware, Florida, and Nevada (greater than 30 per 1,000 women of reproductive age). Kentucky, South Dakota, Wyoming, Idaho, Mississippi, Utah, and West Virginia had the lowest rates (less than seven per 1,000 women). In 2000 and 2001, the highest percentage of abortions were performed on women between the ages of 20 and 30, with women ages 2024 having the highest rate (47 per 1,000 women). Adolescents ages 1519 accounted for 19% of elective abortions, while 25% were performed on women older than 30. Approximately 73% of women having an abortion had previously been pregnant; 48% of those had a previous abortion. Non-hispanic, white women reported the highest percentage of abortions in 2000 and 2001 (41%). African American women accounted for 32%, Hispanic women for 20%, Asian and Pacific Islander women for 6%, and Native American women for 1%. The highest abortion rates occurred among African American women (49 per 1,000 women), with Hispanic and Asian women also reporting higher-than-average rates (33 and 31 per 1,000 women, respectively). The rate was the lowest among white women (13 per 1,000 women).

What is a miscarriage? MedicineNet.com A miscarriage (spontaneous abortion) is any pregnancy that ends spontaneously before the fetus can survive. The World Health Organization defines this unsurvivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less. Miscarriage occurs in about 15-20% of all recognized pregnancies, and usually occurs before the 13th week of pregnancy. The actual percentage of miscarriages is estimated to be as high as 50% of all pregnancies, since many miscarriages occur without the woman ever having known she was pregnant. Of those miscarriages that occur before the eighth week, 30% have no fetus associated with the sac or placenta. This condition is called blighted ovum, and many women are surprised to learn that there was never an embryo inside the sac. Some miscarriages occur before women recognize that they are pregnant. About 15% of fertilized eggs are lost before the egg even has a chance to implant (embed itself) in the wall of the uterus. A woman would not generally identify this type of miscarriage. Another 15% of conceptions are lost before eight weeks' gestation. Once fetal heart function is detected in a given pregnancy, the chance of miscarriage is less than 5%.

Patrick B. San Luis A2D3 Health Ethics 8-9:30pm A woman who may be showing the signs of a possible miscarriage (such as vaginal bleeding) may hear the term "threatened abortion" used to describe her situation.

What causes a miscarriage, and what are the tests for the different causes? The cause of a miscarriage cannot always be determined. The most common known causes of miscarriage in the first third of pregnancy (1st trimester) are chromosomal abnormalities, collagen vascular disease (such as lupus), diabetes, other hormonal problems infection, and congenital (present at birth) abnormalities of the uterus. Chromosomal abnormalities of the fetus are the most common cause of early miscarriages, including blighted ovum (see above). Each of the causes will be described below. Chromosomes are microscopic components of every cell in the body that carry all of the genetic material that determine hair color, eye color, and our overall appearance and makeup. These chromosomes duplicate themselves and divide many times during the process of development, and there are numerous points along the way where a problem can occur. Certain genetic abnormalities are known to be more prevalent in couples that experience repeated pregnancy losses. These genetic traits can be screened for by blood tests prior to attempting to become pregnant. Half of the fetal tissue from1st trimester miscarriages contain abnormal chromosomes. This number drops to 20% with 2nd trimester miscarriages. In other words, abnormal chromosomes are more common with 1st trimester than with 2nd trimester miscarriages. First trimester miscarriages are so very common that unless they occur more than once, they are not considered "abnormal" per se. They do not prompt further evaluation unless they occur more than once. In contrast, 2nd trimester miscarriages are more unusual, and therefore may trigger evaluation even after a first occurrence. It is therefore clear that causes of miscarriages seem to vary according to trimester. Chromosomal abnormalities also become more common with aging, and women over age 35 have a higher rate of miscarriage than younger women. Advancing maternal age is the most significant risk factor for early miscarriage in otherwise healthy women. Collagen vascular diseases are illnesses in which a person's own immune system attacks their own organs. These diseases can be potentially very serious, either during or between pregnancies. In these diseases, a woman makes antibodies to her own body's tissues. Examples of collagen vascular diseases associated with an increased risk of miscarriage are systemic lupus erythematosus, and antiphospholipid antibody syndrome. Blood tests can confirm the presence of abnormal antibodies and are used to diagnose these conditions. Diabetes generally can be well-managed during pregnancy, if a woman and her doctor work closely together. However, if the diabetes is insufficiently controlled, not only is the risk of miscarriages higher, but the baby can have major birth defects. Other problems can also occur in relation to diabetes during pregnancy. Good control of blood sugars during pregnancy is

Patrick B. San Luis A2D3 Health Ethics 8-9:30pm very important. Hormonal factors may be associated with an increased risk of miscarriage, including Cushing's Syndrome, thyroid disease, and polycystic ovary syndrome. It has also been suggested that inadequate function of the corpus luteum in the ovary (which produced progesterone necessary for maintenance of the very early stages of pregnancy) may lead to miscarriage. Termed luteal phase defect, this is a controversial issue, since several studies have not supported the theory of luteal phase defect as a cause of pregnancy loss. Maternal infection with a large number of different organisms has been associated with an increased risk of miscarriage. Fetal or placental infection by the offending organism then leads to pregnancy loss. Examples of infections that have been associated with miscarriage include infections by Listeria monocytogenes, Toxoplasma gondii, parvovirus B19, rubella, herpes simplex, cytomegalovirus, and lymphocytic choriomeningitis virus. Abnormal anatomy of the uterus can also cause miscarriages. In some women there can be a tissue bridge (uterine septum), that acts like a partial wall dividing the uterine cavity into sections. The septum usually has a very poor blood supply, and is not well suited for placental attachment and growth. Therefore, an embryo implanting on the septum would be at increased risk of miscarriage. Other structural abnormalities can result from benign growths in the uterus called fibroids. Fibroid tumors (leiomyomata) are benign growths of muscle cells in the uterus. While most fibroid tumors do not cause miscarriages, (in fact, they are a rare cause of infertility), some can interfere with the embryo implantation and the embryo's blood supply, thereby causing miscarriage. Invasive surgical procedures in the uterus, such as amniocentesis and chorionic villus sampling, also slightly increase the risk of miscarriage