Epner J E, Jonas H S, Seckinger D L
Group on Science, Technology, and Public Health, American Medical Association, Chicago, Ill 60610, USA.
JAMA. 1998 Aug 26;280(8):724-9. doi: 10.1001/jama.280.8.724.
Recent proposed federal legislation banning certain abortion procedures, particularly intact dilatation and extraction, would modify the US Criminal Code such that physicians performing these procedures would be liable for monetary and statutory damages. Clarification of medical procedures is important because some of the procedures used to induce abortion prior to viability are identical or similar to postviability procedures. This article reviews the scientific and medical information on late-term abortion and late-term abortion techniques and includes data on the prevalence of late-term abortion, abortion-related mortality and morbidity rates, and legal issues regarding fetal viability and the balance of maternal and fetal interests. According to enacted American Medical Association (AMA) policy, the use of appropriate medical terminology is critical in defining late-term abortion procedures, particularly intact dilatation and extraction, which is a variant of but distinct from dilatation and evacuation. The AMA recommends that the intact dilatation and extraction procedure not be used unless alternative procedures pose materially greater risk to the woman and that abortions not be performed in the third trimester except in cases of serious fetal anomalies incompatible with life. Major medical societies are urged to collaborate on clinical guidelines on late-term abortion techniques and circumstances that conform to standards of good medical practice. More research on the advantages and disadvantages of specific abortion procedures would help physicians make informed choices about specific abortion procedures. Expanded ongoing data surveillance systems estimating the prevalence of abortion are also needed.
最近提议的联邦立法禁止某些堕胎程序,尤其是完整扩张刮宫术,这将修改美国刑法典,使得实施这些程序的医生需承担金钱赔偿和法定损害赔偿责任。明确医疗程序很重要,因为一些在胎儿存活能力之前用于引产的程序与胎儿存活能力之后的程序相同或相似。本文回顾了关于晚期堕胎和晚期堕胎技术的科学和医学信息,包括晚期堕胎的发生率、与堕胎相关的死亡率和发病率数据,以及关于胎儿存活能力和母胎利益平衡的法律问题。根据美国医学协会(AMA)已颁布的政策,使用恰当的医学术语对于界定晚期堕胎程序至关重要,尤其是完整扩张刮宫术,它是扩张和排空术的一种变体,但又与之不同。AMA建议,除非替代程序对女性构成更大风险,否则不应使用完整扩张刮宫术,并且除非存在严重的、与生命不相容的胎儿畸形情况,否则不应在妊娠晚期进行堕胎。敦促主要医学协会就符合良好医疗实践标准的晚期堕胎技术和情况的临床指南展开合作。对特定堕胎程序的利弊进行更多研究将有助于医生对特定堕胎程序做出明智选择。还需要扩大现有的数据监测系统以估计堕胎的发生率。