Question:
Have any of the leaders in this field set forth any guidance re: providing care in restrictive states that could be deemed “providing abortions” (even though definitely not) - for ex removing an IUD following a +PT? placing an IUD more than 7 days out from LMP with a neg UPT?
Answer:
This is a timely, thought-provoking question. I have not seen new guidance for management of specific situations in states with new abortion restrictions. To your point, from a medical perspective, these are not situations that cause abortion, so I think that even if a medical organization recommends management—per the best evidence-based guidelines—that may mean nothing to a state prosecutor.
Also, each state law is so different, there might be risk in one state that doesn’t exist in another state, even though both states ban abortions. Instead of national guidance, there will probably need to be state level guidance.
Let’s look at the two situations you mention.
Removing an IUD following a positive pregnancy test: This is recommended per medical guidelinesؓ for a desired / continuing pregnancy. Guidelines advise removing the IUD as early as possible in pregnancy, especially if the string is accessible— because removing the IUD decreases the risk of miscarriage, preterm labor, infection, and other complications.
But the procedure itself has a small risk of miscarriage and if that result happened, it could be seen as causing abortion. I think this situation warrants clarification from your institution or lawyers or state medical society in a state with a total ban.
Placing an IUD more than 7 days out from LMP with a negative pregnancy test: I don’t think this practice currently puts the practitioner at risk. The patient is not pregnant, confirmed by pregnancy testing, so there is no disruption of an embryo even in a state with embryo personhood laws.
No current state has banned IUDs but if they did – then this would be the reason. Hypothetical embryos.
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