Prescribing abortion pills without ectopic pregnancy screening puts women's lives at risk: doctor
Emergency room doctors have been advised to be on the lookout for patients who took abortion pills without first receiving a screening for an ectopic pregnancy, a concern some pro-life groups have also raised after the Food and Drug Administration loosened restrictions on the use of abortion-inducing drugs.
Dr. Ingrid Skop, an OB-GYN who serves as a senior fellow and the director of medical affairs for the pro-life research group, the Charlotte Lozier Institute, said this type of situation has been a concern for a long time, going back to the FDA's removal of the in-person requirements for the abortion pills in December 2021.
Addressing concerns about safety following a published article in The New England Journal of Medicine, titled "Discovery of an Ectopic Pregnancy after Attempted Self-Managed Abortion," Skop said the doctors who wrote the article published in NEJM "seemed to miss the point by saying emergency room physicians be aware that this could happen."
“Rather than saying, wait a minute, let's back this up. If we're going to provide chemical abortion pills, let's make sure we do it in the safest way for women by requiring the woman to have in-person medical supervision, where she receives an ultrasound before her abortion, so that we know for sure that we are not treating a woman with a chemical abortion who, in fact, has an ectopic pregnancy.”
Skop, an OBGYN with over 25 years of experience, explained that mifepristone and misoprostol, the two drugs used in the chemical abortion regimen, “exert their action on the uterus.” The drugs do not have an effect on an ectopic pregnancy, which takes place outside of the uterus.
The pro-life doctor noted that a woman might think the pain and bleeding she’s experiencing are a sign that the chemical abortion drugs are working, but it could actually be a sign that her life is in danger. Skop said that when a tube ruptures in an ectopic pregnancy, it cannot contract and cut off the flow of blood, and a woman can bleed to death.
“So, it's very cavalier to say, 'Oh, watch out for this in a woman who presents to the emergency room,” Skop said. “By the time she's in the emergency room, she may be in very dire straits. The time to be concerned about this is prior to prescribing the chemical abortion pills.”
The NEJM article published Thursday describes the case of a 22-year-old female patient showing signs of an ectopic pregnancy. The woman had previously taken the abortion pills before arriving at the emergency room for care.
“A history of recent medical abortion (including self-managed abortion) without previous confirmation of intrauterine pregnancy, a history of previous ectopic pregnancy or previous tubal surgery, the presence of an intrauterine device, or ultrasound findings of abdominal free fluid should increase concern for ectopic pregnancy,” the NEJM article states.
Isabel Beshar, a resident at Stanford Medical school, authored the NEJM paper alongside several of her colleagues. In the article, they advise that “Clinicians should routinely assess beta human chorionic gonadotropin (hCG) in patients of reproductive age presenting with abdominal pain and consider the possibility of ectopic pregnancy.”
Beshar and other medical professionals behind the article advise physicians to maintain a “high index of suspicion” for patients experiencing ectopic pregnancy symptoms, particularly among women who underwent a chemical abortion without first receiving a diagnosis.
Skop, however, raised concerns that Beshar and her colleagues did not make a more emphatic and “reasonable call” for medical supervision and screening for ectopic pregnancy before prescribing abortion-inducing drugs.
The pro-life OBGYN called for the FDA to “do its job,” which is to “protect the American public from dangerous medication.”
“And the loosening of these restrictions in a way that clearly will put women's lives at risk while seeking a chemical abortion is a dereliction of their duty,” Skop said. “And I think they can reexamine the evidence, and they can back up, and they can put these in-person restrictions back in place.”
As The Christian Post previously reported, the FDA announced earlier this month that it had modified restrictions on abortion pills after reviewing the Mifepristone REMS Program, which the agency started in 2021. Under the new regulation, certified pharmacies can dispense abortion-inducing drugs and women can also obtain them via a telehealth appointment or through the mail.
According to a 2021 peer-reviewed longitudinal study conducted by the Charlotte Lozier Institute, the rate of emergency room visits after a chemical abortion increased by over 500% from 2002 through 2015. The researchers also noted that by 2015, 60.9% of emergency room visits due to complications from the use of chemical abortion pills were miscoded as miscarriages.
Samantha Kamman is a reporter for The Christian Post. She can be reached at: firstname.lastname@example.org. Follower her on Twitter: @Samantha_Kamman