Life-affirming medical professionals share the objective of promoting optimal healthcare for both
pregnant women and preborn children. To achieve this goal, it is essential that we use precise,
medically accurate language to describe the pregnancy-related practices which intentionally harm
our patients. It is especially necessary to distinguish these practices from medical interventions
that separate a mother and her preborn child in the case of life-threatening pregnancy
complications. We need to use this factual language consistently with our patients, with colleagues
and in the public square. Failure to do so may result in confusion about the legality of lifesaving
medical care and ultimately hurt the very people we endeavor to protect.
(Source: AAPLOG Glossary of Medical Terms for Life-Affirming Medical Professionals)
Use this Instead of this
| Intentional Feticide any drug, device or procedure used to ensure the death of preborn human being before, during or in the process of separation of the mother and her embryo or fetus. Can further clarify by adding the means used to affect the death:
-Intentional feticide by chemical agent
-Intentional feticide by vacuum disruption
-Intentional feticide by dismemberment
-Intentional feticide by lethal injection
-Intentional feticide by labor induction
|Abortion – this is a vague term with a multitude of definitions depending on the context in which it is being used. Also has the potential to be conflated with miscarriage and is often distressing for patients in this scenario.
– If “abortion” used, preface with “induced” (consistent with CDC definition used to collect surveillance data) and, if possible, use a clarifier from the list to the left
|Endpoint or completion of pregnancy
|Termination of Pregnancy
|Miscarriage, fetal death, embryonic death Referencing a spontaneous loss of embryonic/fetal life. Qualifiers can include marriage with retained tissue or inevitable/impending miscarriage
|Spontaneous/incomplete/inevitable/missed abortion Nonviable embryo – (it is inaccurate but common for this word to be used to mean “unable to survive” and “already dead,” which are very different concepts but are synthesized in a utilitarian view of embryos of fetuses)
|Vaginal bleeding in the first/second trimester
|Fetal/embryonic tissue, other pregnancy tissue Tissue remaining after an incomplete miscarriage or incomplete intentional feticidal procedure
|Products of conception
|Medically-indicated maternal-fetal separation Done to prevent the mother’s death or immediate, irreversible bodily harm, which cannot be mitigated in any other way. Examples include treatment of ectopic pregnancy, previable delivery for early pre-eclampsia with severe features, or previable delivery for other life- threatening conditions in pregnancy.
|Medically-indicated or therapeutic abortion
|(Potentially) Life-limiting prenatal diagnosis, (potentially) like-limiting fetal anomaly Considerations of what constitutes a potentially life-limiting prenatal diagnosis:
-There are several different ways to interpret the description of a fetal anomaly or condition as lethal (see below). A review of the published literature on “lethal malformations” revealed no consensus on which of these definitions should be applied.
-Possible definitions of a life-limiting prenatal condition:
– Causing fetal death: a condition that invariable leads to death in utero
– Causing fetal death/neonatal death: a condition that invariably leads to death either in utero or in the newborn period regardless of treatment
– Usually causing fetal/neonatal death: a condition that leads to death in utero or in the newborn period in some cases
– Associated with death: a condition that leads to fetal or neonatal death in some cases
-Must consider what the threshold is for percent lethality of a condition – many conditions with up to 50% survival rates have been labeled as “lethal”
|Lethal Incompatible with life (the fetus being diagnosed is alive, so this is not incompatible with being alive!)
|Pre-Viable Indicates preborn child has not yet reached the gestational age of viability
|Human zygote/ embryo New human life that comes into existence at the moment of fertilization
|Embryonical or embryotoxic A procedure or pharmaceutical agent that causes death of a human embryo (before or after implantation)
|Fertilization Pregnancy and a new human life begin at fertilization
|Conception Avoid using as this (along with pregnancy) has been redefined as being with implantation
|Intentional embryo-/feticide (or induced abortion) by chemical or pharmacologic agent or via mifepristone
|Medication abortion Medication implies that an illness is being treated and that there is therapeutic benefit
|Continuing viable pregnancy When a preborn human being survives an attempt to intentionally end his/her life Intentional feticide with retained tissue When fetal or other pregnancy tissue remains but feticide was successful
|Embryonic/Fetal heartbeat, cardiac activity or cardiac motion
|Abortion regulation Laws that protect the health/safety of women as well as preborn human beings
|Abortion ban/restriction, restrictive law
|Physician, medical/healthcare professional, Advanced Practice Practitioner (APP)
|Provider Implies that our role is to provide a service if it is technologically available, legal, and the patient chooses it
|Healthcare To preserve and restore health, never to act in contradiction to that. Health can be defined at “the well-working of the organism as a whole, realized and manifested in the characteristic activities of the living body in accordance with its species-specific life-form”
|Medical Emergency A medical condition of sufficient severity, such that the absence of medical attention could reasonably be expected to result in either of the following: 1. Jeopardy to the life of a patient, including a pregnancy or a fetus. 2. Serious and irreversible impairment to major bodily functions.
Other Important Considerations
|Medically-indicated maternal-fetal separation
|This may be done prior to or after fetal viability. It is preferably done in a way that does not directly induce fetal death and respects the fetus’ bodily integrity (unless doing so would further endanger the life of the mother).
Medically indicated separation of the mother from her embryo or fetus in the previable period should not be referred to as “abortion”. Such separations fall under two broad categories:
1. Ethically and legally appropriate to prevent the mother’s death. Some examples of this would include an intrauterine infection, severe hemorrhage, or severe hypertensive disorders. If there exists a true threat to the mother’s life, then the separation is considered ethically appropriate because the risk the mother faces is proportional to the impact on the fetus. Moreover, as a practical matter, a previable fetus cannot possibly survive in the mother dies.
2. Legally appropriate to avoid a significant risk for permanent injury to a maternal organ system. Some examples of this would include previable PROM without infection, WHO Class 3 cardiac lesions, pre-eclampsia without severe features. Ending the pregnancy in these types of situations would be truly ethical. The most common scenario is PROM in the previable period. A stable patient would have around 10 to 15% change for the fetus to remain in utero long enough to survive. A number of factors affect the precise odds. Attempting to maintaining the pregnancy would also involve maternal risk for infection, hemorrhage, and damage to her reproductive organs. Those maternal risks can be mitigates (but clearly not eliminates) by separating the fetus from the mother.
|Informed Consent is critical
|Includes knowing the reality of fetal development, the risks of intentional feticide/induced abortion and the availability/benefits of perinatal palliative care (in cases of life-limiting diagnoses)
|Always use person-first language
|For example, a “fetus with a life-limiting diagnosis,” rather than “the life-limited fetus”
Research Language Considerations
|Use “relationship”, “correlation,” or “association” (e.g. “prior abortion is associated with a higher relative risk of preterm birth”)
|Avoid using “link” (e.g. abortion-breast cancer link, abortion-preterm birth link)
|“Adverse events” and “significant adverse events”
– Defined as an unanticipated problem that arises following, and is a result of, a procedure, treatment or illness
– Mental health adverse events- requiring medical evaluation, medication, therapy, hospitalization, or resulting in self-herm or accident from substance abuse
– Common Terminology Criteria for Adverse Events (CTCAEv3) . The five levels of coding are:
Grade 1 “Mild”: asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated-bleeding, pain and gastrointestinal. Grade 2 “Moderate”: minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental ADL-outpatient clinic or telemedicine management for bleeding, pain, or low-grade infection.
Grade 3 “Severe or medically significant but not immediately life-threatening”: hospitalization or prolongation of hospitalization indicated due to grade 2 AE; disabling; limiting self-care or ADL; emergency room evaluation, surgical aspiration procedure (clinic or hospital), intravenous antibiotics.
Grade 4 “Life-threatening consequences”: urgent intervention, indicated hospital or ICU admission from grade 4 AE, transfusion, surgical laparoscopy or laparotomy, adjacent organ repair.
Grade 5 “Death related to AE”
Side effects – Unwanted, undesirable effects that are possible related to a drug “Physical sides effects”- unpleasant but anticipated physiologic responses to medications “Emotional side effects” – transient mood symptoms, do not require treatment
Long-term sequelae Permanent physical disability, infertility, future pregnancy complications including incompetent cervix/preterm delivery and abnormal placentation
|Hemorrhage Quantifies by 500 cc EBL, drop in H/H by 1 g/3%, post-abortion H/H 9 g/27% if prior H/H unknown, or transfusion required
|Infection Quantified by requiring oral antibiotics (genital vs other sources; urinary, respiratory), requiring intravenous antibiotics, sepsis, or ICU admission
|Embolus Amniotic fluid or air, venous thrombosis (DVT, PE, cerebrovascular)
|Discussion of Complication Incidence:
– Very common – 1 in to 1 in 10 (incomplete chemical abortion in second trimester)
– Common – 1 to 10 to 1 to 100 (incomplete chemical abortion first trimester requiring surgery, hemorrhage, infection, continuing viable pregnancy)
– Uncommon – 1 to 100 to 1 in 1000 (significant adverse events)
– Rare – 1 to 1000 to 1 in 10,000 (ruptured ectopic pregnancies)
– Very rare – Less than 1 in 10,000 (death – as reported by CDC, excludes mental heath deaths)
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