Pro-life doctors: Despite Ohio bill, there is no procedure to save ectopic pregnancies
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An Ohio bill seeking to limit insurance coverage of non-lifesaving abortions erroneously states that a procedure exists in which a doctor can reimplant an ectopic pregnancy in a woman's uterus. No such procedure yet exists that has been proven safe and effective, two pro-life OB-GYNs told CNA.
Cincinnati, Ohio, (CNA) - "It astounds me that people would be writing law like this who don't know the basics," Dr. Lorna Cvetkovich, an OB-GYN with the pro-life medical practice Tepeyac Center, told CNA.
An ectopic pregnancy occurs when an embryo implants somewhere other than the uterus - usually in a fallopian tube. Ectopic pregnancies cannot survive outside of the uterus and pose a serious threat to the mother's life, Cvetkovich said.
The legislation in question in Ohio is HB182, a bill that was introduced in April by state Rep. John Becker (R), and was co-sponsored by 19 other state legislators.
The bill seeks to limit insurance coverage for "nontherapuetic abortions" - elective abortions that are not performed when a doctor determines that the mother's life is at risk.
The legislation states that it would still allow insurance companies to cover certain exempted procedures, including: "A procedure for an ectopic pregnancy, that is intended to reimplant the fertilized ovum into the pregnant woman's uterus."
"I don't know of any way that we can technologically, surgically put that embryo through the trauma (of reimplantation)," Cvetkovich said.
The doctor said the procedure has reportedly been tried three times, but it has not worked, and there is no approved, standard medical procedure for reimplantation that has undergone the appropriate steps to ensure it is safe and effective.
Journals reporting on two such cases are posted on John Becker's Facebook page. One case occurred in 1915, before ultrasounds were invented, and another in 1980.
Cvetkovich said of the 1915 case that not enough documentation of the procedure exists to confirm its scientific validity, and that the 1980 case was found to have used falsified research.
The reason reimplantations have yet been impossible for doctors, Cvetkovich said, is that once an embryo implants into either the uterine or the tubal lining, it begins creating microscopic blood vessel connections with the mother.
"It's like a microscopic heart-lung machine, and you can't just disrupt that and redo it," she said.
In rare cases, ectopic pregnancies have reimplanted themselves in the liver or bowel, causing an abdominal pregnancy, but there has not been a successful surgical reimplantation in a uterus, Cvetkovich noted.
Dr. Donna Harrison is an OB-GYN with the American Association of Pro-Life OB-GYNs (AAPLOG).
Harrison told CNA that AAPLOG would support an ectopic transfer procedure if it "were scientifically validated through the usual channels of animal studies to prove safety and efficacy, and then human trials to prove safety and efficacy. If such a procedure followed that protocol, and if such a procedure were then validated to be safe and effective in a human being, AAPLOG would support that," she said.
"We would love to be able to save the baby if we could," she said.
But to date, an ectopic pregnancy transfer procedure does not yet exist that has gone through the required safety and efficacy procedures to Harrison's knowledge, she said.
However, she added, Dr. Stephen Sammut at the Franciscan University of Steubenville, Ohio is currently investigating such a transfer in animal models.
"So there is research being conducted in animal models right now, but it is very preliminary right now and there are no conclusions of that research yet," she said. "And as far as I know that is the only research being conducted so far in the animal model."
Because ectopic pregnancies can pose a serious threat to the life of a mother, pro-life doctors can morally perform a procedure in which they remove the fallopian tube or other organ where an ectopic pregnancy has implanted, Cvetkovich said.
This allows doctors to remove a malfunctioning organ of the mother in order to save her life, which has the secondary but unintended effect of terminating the pregnancy, she added.
"It's what we call the principle of double effect," she said. "You can go in to do the procedure that will save the mother's life. Your intent is not to destroy that pregnancy, your intent is to keep her healthy. In the process of doing that, you accept but do not want that there's a fetal demise. So that's how we would handle this rare, rare situation where you would have...a viable fetus with a heartbeat in the tube."
This kind of procedure is permitted by the Catholic Church, she said, which states that abortion is never permissible, though a procedure to save a woman's life that has the unintended effect of an unborn baby's death is morally permissible.
"Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child," the U.S. Catholic bishops state in the fifth edition of their Ethical and Religious Directives for Catholic Health Care Services.
This kind of procedure would also be exempted under the Ohio bill, which states that insurance companies could still cover: "A procedure, in an emergency situation, that is medically necessary to save the pregnant woman's life."
Cvetkovich added that it was concerning that the Ohio legislators apparently did not consult with medical experts or research before writing the bill.
Legislation that contains erroneous scientific statements makes the pro-life movement "look bad, it makes us look silly, it makes us look stupid," she said.
"I wish these guys would do some consultation before they wrote this," she added.
On the other hand, Harrison said the bill could spur further research into developing a scientifically valid transfer procedure.
"I think the bill could encourage the appropriate research needed to develop such a procedure," she said.
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