Saturday, January 29, 2011

Taking Abby Johnson's lead -- Let the abortion docs speak for themselves

HT: Big Blue Wave

A randomized pilot study on the effectiveness and side-effect profiles of two doses of digoxin as fetocide when administered intraamniotically or intrafetally prior to second-trimester surgical abortion., Nucatola D, Roth N, Gatter M., Planned Parenthood, Los Angeles

This study is about the digoxin injection technique Kermit Gosnell tried to use before he gave up due to lack of skill and went back to just "snipping" the live-born babies' spines.

BACKGROUND: Digoxin is commonly used to facilitate second-trimester surgical abortion despite limited data regarding its safety and effectiveness for this indication.

1. Isn't it interesting that they've been using it all these years, until it's common practice, "despite limited data regarding its safety and effectiveness"?

2. The way it facilitates the abortions is ... well, I'll take the words directly from Martin Haskell of the National Abortion Federation: "Fetal death and ensuing autolysis soften the tissues." And why does the noble physician need to do this? "Classic D&E is accomplished by dismembering the fetus inside the uterus with instruments and removing the pieces through an adequately dilated cervix. However, most surgeons find dismemberment at twenty weeks and beyond to be difficult due to the toughness of fetal tissues at this stage of development."

STUDY DESIGN: Fifty-two women presenting for elective termination of pregnancy between 18 and 24 weeks' gestation were randomized to one of four digoxin treatment groups:

"Elective" between 18 and 24 weeks. Not serious maternal health concerns. Not babies with congenital problems. Elective abortions for social reasons.

They divided the women into four groups. Two groups got injections of different doses of digoxin into the amniotic fluid. Two got different doses of digoxin injected directly into their unborn babies' hearts.

Ultrasound was used to assess for the presence of fetal cardiac activity prior to the abortion procedure. Data on the presence and severity of pain, nausea and other potential side effects were collected before digoxin injection, immediately following digoxin injection and on the day after digoxin injection.

So they used an ultrasound to make sure the babies' hearts had stopped. The "pain, nausea, and other potential side effects" were measured in the mother, since nobody cared if the babies suffered any pain as they were either bathed in a digoxin solution or had cardiac syringes full of digoxin poked into their hearts.

Digoxin toxicity, which of course can be fatal, was being deliberately induced in the babies, and they were trying to avoid inflicting on the mother.

RESULTS: Digoxin effectively induced fetal death in 87% of women. The failure rate did not vary by route of administration (IA or IF) and was not lowered by increasing the dose from 1.0 to 1.5 mg. IF injections induced fetal death more rapidly than IA injections. Digoxin administration did not result in increased pain or nausea.

CONCLUSIONS: IA or IF injection of digoxin is safe and effective for inducing fetal death prior to second-trimester surgical abortion. Doses greater than 1.0 mg may not be necessary.

Translation: Injecting the digoxin directly into the baby kills him faster, but not any more effectively. Thirteen percent will survive the overdose.

The abstract doesn't say what they do to fetuses who survive the injections, but I'm assuming that they're just dismembered alive.

Could they have survived if they'd just been delivered and not attacked with malice aforethought?

I found preemie survival rates here:

  • 22 weeks: 0-10% survival rate
  • 23 weeks: 10-35% survival rate
  • 24 weeks: 40-70% survival rate
  • 25 weeks: 50-80% survival rate
  • 26 weeks: 80-90% survival rate
  • 27 weeks: greater than 90% survival rate

    This page addresses errors in estimating gestational age: "The accuracy of ultrasound in predicting gestational age gets worse as the pregnancy advances. By 20 weeks, ultrasound is accurate only to within plus or minus two weeks, and by the third trimester, its accuracy falls to plus or minus 3 weeks." Which means that some of those fetuses could have actually been as old as 27 weeks.

    Katie said...

    Sick. Just sick.

    L. said...

    Abortion of babies with congenital problems is "elective" -- so are abortions for maternal health (if not immediately life-threatening).

    I think the phrase "elective abortion" is just as loaded as "elective c-section" -- the latter always makes a few women immediately hate me when I say I had one. If I ever had the former, I imagine I would get similar reactions, from different people.

    Christina Dunigan said...

    L, it would be bad research if they included "fetal indications" abortions in a study designed to see if the routine use of digoxin kills the fetus, since a routine abortion involves a healthy mother and a healthy fetus. To include sick fetuses would skew the results.

    And let's look at other sources that describe "elective abortion":


    elective abortion,
    induced termination of a pregnancy (TOP), usually before the fetus has developed enough to live if born, deemed necessary by the woman carrying it and performed at her request. Commonly (but incorrectly) called therapeutic abortion. See also induced abortion. (Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.)

    elective abortion
    Therapeutic abortion Obstetrics A voluntary interruption of pregnancy before fetal viability, which is performed voluntarily at the request of the mother for reasons unrelated to concerns for maternal or fetal health or welfare; most abortions are elective; there is 1 EA per 3 live births in the US. (McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.)

    eMedicine Most providers consider all terminations to be elective, or a voluntary decision made by the patient herself. There are medical factors both maternal and fetal that contribute to the decision. These factors have been termed therapeutic abortion, defined as the termination of pregnancy for medical indications, including the following: Medical illness in the mother, cancer, rape or incest, fetal anomalies

    Britannica Online: the link teaser says, "An elective abortion is the interruption of a pregnancy before the 20th week of gestation at the woman's request for reasons other than maternal health or ..." but the actual page just brings me to link loops

    and Within the broader area of induced abortions, there are two basic classifications: therapeutic abortion and elective abortion. A therapeutic abortion is done to save the life of a pregnant woman, preserve a pregnant woman's mental or physical health, terminate a pregnancy that would result in a child with a fatal congenital disorder, or selectively reduce the number of fetuses born as the result of a high-risk multiple pregnancy. An elective abortion is an abortion performed for any other reason - most commonly occurring after contraceptive failure results in an unplanned pregnancy.

    Christina Dunigan said...

    And thanks for sending me on that definition chase, L. It gave me a good source for another post.

    L. said...

    "Most providers consider all terminations to be elective, or a voluntary decision made by the patient herself." -->

    I guess insurance companies have a very different definition of "elective" than medical researchers!

    Christina Dunigan said...

    That's part of the problem, L. Lack of uniform definitions. The page I'm writing a post about considers naturally occurring fetal demise as an indication for
    "elective" abortion. But an elective abortion is one that kills a living fetus; if the fetus dies spontaneously, that's a spontaneous abortion. If it fails to be expelled, that's a missed abortion. But here we have writers lumping them in with induced abortions.

    We don't even have uniform definitions of "legal" versus "illegal". The ICD doesn't define the terms at all. The CDC definition hinges on whether or not the doctor was licensed, or if performed by a non-physician, was the non-physician clinician supervised in a way that made the abortion legal in that jurisdiction? Thus if one of Kermit Gosnell's illegal third-tri abortions resulted in a patient death, the CDC would count it as a LEGAL abortion death. But in Myrta Baptiste's case, because upon investigation it was discovered that Dr. Zaldivar's license was suspended, the CDC counted her death as due to illegal abortion.

    Confused yet?

    My distinction is in how the woman perceived her abortion. If she went to an openly operating facility and had every reason to believe her abortion was legal, I count it as a legal abortion death. If she knew her doctor was breaking the law by performing the abortion, I count it as illegal.

    Kathy said...


    The other night, I was looking at MS's definition of live birth vs still birth vs abortion, and the legal definition of an induced abortion *excludes* inducing labor to deliver a fetus that died (i.e., inducing a "missed abortion" is not an "induced abortion" in state law). [I can get you the link if you want it.]

    Re: Gosnell, I was under the impression that any negative maternal consequences of these illegal abortions would have been counted as "illegal abortion deaths" by the CDC simply because they were illegally performed -- i.e.,
    *done at or after 24 weeks of pregnancy
    *no OB/GYN working with or at the clinic, in accordance with state law
    *unlicensed workers administering the abortifacient medicines
    *unlicensed workers pretending to be doctors, performing abortions

    I agree with you on your definition, but figured that the CDC would try to count as many deaths and injuries as "illegal abortion" to keep up the appearance that legal abortion is safe.

    Anonymous said...

    of course that last paragraph, again just reveals what a fallacy the cut off point is for legal abortions.