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NuclearWarfare/Abortion notes sandbox

Abortion is the termination of a pregnancy by the removal or expulsion of a fetus or embryo from the uterus, resulting in, or caused by its death.[note 1] An abortion can occur spontaneously due to complications during pregnancy, or can be induced, in humans and in other species. In the context of human pregnancies, an abortion may be referred to as either therapeutic or elective. The term abortion most commonly refers to the induced abortion of a human pregnancy; spontaneous abortions are usually termed miscarriages.

Abortion, when performed in the developed world in countries where the procedure is legal, is among the safest procedures in medicine.[1][2] However, unsafe abortions (those performed by persons without proper training or outside of a medical environment) result in approximately 70 thousand maternal deaths and 5 million disabilities per year globally.[3] An estimated 42 million abortions are performed globally each year, with 20 million of those performed unsafely.[3] Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.[4]

Induced abortion has a long history and has been facilitated by various methods including herbal abortifacients, the use of sharpened tools, physical trauma, and other traditional methods. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, prevalence, cultural status, and religious status of abortion vary substantially around the world. In many parts of the world there is prominent and divisive public controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing pro-life and pro-choice worldwide social movements (both self-named). Incidence of abortion has declined worldwide as access to family planning education and contraceptive services has increased.[5]

Types

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Induced

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Approximately 205 million pregnancies occur each year worldwide. Over a third are unintended and about a fifth end in induced abortion.[6] A pregnancy can be intentionally aborted in several ways. The manner selected often depends upon the gestational age of the embryo or fetus,[7] which increases in size as the pregnancy progresses.[8] Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference.

Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as a therapeutic abortion when it is performed to save the life of the pregnant woman; prevent harm to the woman's physical or mental health; terminate a pregnancy where indications are that the child will have a significantly increased chance of premature morbidity or mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.[9][10] An abortion is referred to as an elective or voluntary abortion when it is performed at the request of the woman for non-medical reasons.[10]

Spontaneous

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Main article: Miscarriage

Spontaneous abortion, also known as miscarriage, is the unintentional expulsion of an embryo or fetus before the 20th to 22nd week of gestation.[note 2] A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth" or a "preterm birth".[11] When a fetus dies in utero after viability, or during delivery, it is usually termed "stillborn".[12] Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.[citation needed]

Between 15% and 30% of known pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[13] Over 80% of spontaneous abortions occur within the first 12 weeks of pregnancy.[10][14] Most occur very early in pregnancy, in the majority of cases they occur so early in the pregnancy that the woman is not even aware that she was pregnant.[10]

The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,[10][15] accounting for at least 50% of sampled early pregnancy losses.[16] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[15] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[16] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[17]

Notes

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  1. ^ While "death" has negative connotations, this is appropriate for the subject matter and acknowledges the controversial and bio-ethically difficult nature of abortion. It makes no judgement -- morally or legally -- regarding personhood. Alternatives with medical consensus have been proposed, why they were not chosen is outlined below. The majority of medical sources define abortion as a procedure occurring before viability:
    • The National Center for Health Statistics defines an "abortus" as "[a] fetus or embryo removed or expelled from the uterus during the first half of gestation—20 weeks or less, or in the absence of accurate dating criteria, born weighing < 500 g." Cunningham, FG; Leveno, KJ; Bloom, SL; Hauth, JC; Rouse, DJ; Spong, CY, eds. (2010). "1. Overview of Obstetrics". Williams Obstetrics (23 ed.). McGraw-Hill Medical. ISBN 978-0-07-149701-5.
    • "[T]he standard medical definition of abortion [is] termination of a pregnancy when the fetus is not viable". Annas, George J.; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. ISBN 978-0-443-06930-7.
    • "Termination of a pregnancy, whether spontaneous or induced." Kottke, Melissa J.; Zieman, Mimi (2008). "33. Management of Abortion". In Rock, John A.; Jones III, Howard W. (eds.). TeLinde's Operative Gynecology (10 ed.). Lippincott Williams & Wilkins. ISBN 978-0-7817-7234-1.
    • "Expulsion from the uterus an embryo or fetus prior to the stage of viability (20 weeks' gestation or fetal weight <500g). A distinction made between [abortion] and premature birth: premature infants are those born after the stage of viability but prior to 37 weeks." Stedman's Medical Dictionary (27 ed.). Lippincott Williams & Wilkins. ISBN 0683400088.
    Viability is, by its nature, not verifiable on a case by case basis.
    • "Loosely defined, the term viability is the fetus' ability to survive extrauterine life with or without life support. A number of landmark US Supreme Court decisions dealt with this question. In Webster v Reproductive Health Services (1989), the court upheld the state of Missouri's requirement for preabortion viability testing after 20 weeks' gestation. However, there are no reliable or medically acceptable tests for this prior to 28 weeks' gestation." Trupin, Suzanne. "Elective Abortion". Retrieved 26 June 2011. {{cite web}}: Unknown parameter |middle= ignored (help)
    Abortions -- both elective and medical -- do occur after 20 weeks gestation (trying to find direct stat page, ideally with sex selection tied in): As an embryo / fetus is an organism, its demise/termination can be accurately described as death:
  2. ^ Note that the defining line between miscarriage and premature birth or stillbirth varies among jurisdictions.[citation needed]

Refs

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  1. ^ Cite error: The named reference lancet-grimes was invoked but never defined (see the help page).
  2. ^ Cite error: The named reference grimes-overview was invoked but never defined (see the help page).
  3. ^ a b Shah I, Ahman E (December 2009). "Unsafe abortion: global and regional incidence, trends, consequences, and challenges" (PDF). J Obstet Gynaecol Can. 31 (12): 1149–58. doi:10.1016/S1701-2163(16)34376-6. PMID 20085681.{{cite journal}}: CS1 maint: date and year (link)
  4. ^ Culwell KR, Vekemans M, de Silva U, Hurwitz M (July 2010). "Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion". International Journal of Gynecology & Obstetrics. 110: S13–16. doi:10.1016/j.ijgo.2010.04.003. PMID 20451196.{{cite journal}}: CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link)
  5. ^ Sedgh G, Henshaw SK, Singh S, Bankole A, Drescher J (September 2007). "Legal abortion worldwide: incidence and recent trends". Int Fam Plan Perspect. 33 (3): 106–16. doi:10.1363/ifpp.33.106.07. PMID 17938093.{{cite journal}}: CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link)
  6. ^ Cheng L. (1 November 2008). "Surgical versus medical methods for second-trimester induced abortion". The WHO Reproductive Health Library. World Health Organization. Archived from the original on 17 June 2011. Retrieved 17 June 2011. {{cite web}}: Unknown parameter |deadlink= ignored (|url-status= suggested) (help)
  7. ^ Stubblefield, Phillip G. (2002). "10. Family Planning". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN 978-0781732628.
  8. ^ Menikoff, Jerry (2001). Law and Bioethics. Georgetown University Press. p. 78. ISBN 0878408398. As the fetus grows in size, however, the vacuum aspiration method becomes increasingly difficult to use.
  9. ^ Roche, Natalie E. (28 September 2004). "Therapeutic Abortion". eMedicine. Archived from the original on December 14, 2004. Retrieved June 19, 2011.
  10. ^ a b c d e Schorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M.; Hoffman, Barbara L.; Bradshaw, Karen D.; Cunningham, F. Gary, eds. (2008). "6. First-Trimester Abortion". Williams Gynecology (1 ed.). McGraw-Hill Medical. ISBN 978-0-07-147257-9.
  11. ^ Annas, George J.; Elias, Sherman (2007). "51. Legal and Ethical Issues in Obstetric Practice". In Gabbe, Steven G.; Niebyl, Jennifer R.; Simpson, Joe Leigh (eds.). Obstetrics: Normal and Problem Pregnancies (5 ed.). Churchill Livingstone. p. 669. ISBN 978-0-443-06930-7. A preterm birth is defined as one that occurs before the completion of 37 menstrual weeks of gestation, regardless of birth weight.
  12. ^ "Stillbirth". Concise Medical Dictionary. Oxford University Press. 2010. birth of a fetus that shows no evidence of life (heartbeat, respiration, or independent movement) at any time later than 24 weeks after conception {{cite web}}: Missing or empty |url= (help)
  13. ^ Stovall, Thomas G. (2002). "17. Early Pregnancy Loss and Ectopic Pregnancy". In Berek, Jonathan S. (ed.). Novak's Gynecology (13 ed.). Lippincott Williams & Wilkins. ISBN 978-0781732628.
  14. ^ Nilsson, Lennart (1990) [1965]. A Child Is Born. Garden City, New York: Doubleday. p. 91. ISBN 978-0-385-40085-5. OCLC 21412111. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  15. ^ a b Stöppler. Shiel WC Jr (ed.). "Miscarriage (Spontaneous Abortion)". MedicineNet.com. WebMD. Retrieved 2009-04-07. {{cite web}}: More than one of |author= and |last= specified (help)
  16. ^ a b Jauniaux E, Kaminopetros P, El-Rafaey H (1999). "Early pregnancy loss". In Whittle MJ,Rodeck CH (ed.). Fetal medicine: basic science and clinical practice. Edinburgh: Churchill Livingstone. p. 837. ISBN 978-0-443-05357-3. OCLC 42792567.{{cite book}}: CS1 maint: multiple names: authors list (link)
  17. ^ "Fetal Homicide Laws". National Conference of State Legislatures. Retrieved 2009-04-07.
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