Intact dilation and extraction

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Intact dilation and extraction (IDX or Intact D&X), is a surgical abortion procedure wherein an intact fetus is removed from the womb via the cervix. The procedure may also be used to remove a deceased fetus, resulting from a miscarriage, that is developed enough to require dilation of the cervix for extraction. As an abortion procedure, its methodology – removing the fetus from the womb fully intact – has made it highly controversial. Though the procedure has an extremely low rate of usage <ref>Guttmacher.org Abortion Incidence and Services in the United States in 2000</ref> it has developed into a focal point of protest in the greater context of the abortion debate. The term partial-birth abortion largely refers to this procedure, though they are not equivalent.

Etymology

The term "dilation and extraction", or "D&X", was coined in 1992 by Dr. Martin Haskell. Haskell's term was a variation on "intact dilation and evacuation (intact D&E)", the term preferred by Dr. James McMahon, who is largely credited with developing the procedure as an alternative to dilation and evacuation or D&E. The American College of Obstetricians and Gynecologists would later settle on a hybrid of the two terms, "intact D&X". "Intrauterine cranial decompression" is another medical term sometimes used in reference to the procedure.

Intact D&X Surgery

Preliminary procedures are performed over a period of 2-3 days, to gradually dilate the cervix using laminaria tents, sticks of seaweed which absorb fluid and swell. Sometimes hormones are used to induce the process of labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and forceps to grasp the fetus' leg. The fetus is turned to a breech position, if necessary, and the doctor pulls one or both legs out of the birth canal, causing what is referred to by some people as the 'partial birth' of the fetus. The doctor subsequently extracts the rest of the fetus, usually without the aid of forceps, leaving only the head still inside the birth canal. An incision is made at the base of the skull and a suction catheter is inserted into the cut. The brain tissue is removed which then allows the rest of the fetus to pass easily.<ref>"Surgical Abortion Procedures" American Pregnancy Association. Accessed April 14, 2006.</ref>

Circumstances in which the procedure is performed

Intact D&X procedures are rare, carried out in roughly 0.2% (two per thousand) abortions in the USA. This calculates to between 2,500 and 3,000 per year, using data from the Alan Guttmacher Institute for the year 2000 (out of 1.3 million abortions annually). They are typically performed between the twentieth and twenty-fourth week of gestation.<ref>Abortion Incidence and Services in the United States, 1995-1996. Accessed April 17, 2006.</ref> Reasons for the procedure to be performed include:

• The fetus is dead (in which case the procedure is not an abortion).
• Fetal abnormality or other medical complications to pregnancy.
• The woman wishes to terminate her pregnancy for other reasons.

Some of the fetuses which fall into the second category have developed hydrocephalus, a generally untreatable condition usually leading to fatal abnormalities or permanent and severe deformity and disability. Approximately 1 in 2,000 fetuses develop hydrocephalus while in the womb; this is about 5,000 a year in the United States. The defect is not usually discovered until late in the second trimester of pregnancy. If a fetus develops hydrocephalus, the head may expand to a radius of up to 250% of a normal skull at birth, making it impossible for it to pass through the cervix. In such cases the physician may drain the excess fluid in utero using a syringe, thereby enabling a normal, vaginal live birth. Alternately, a caesarian section can be used for the safe delivery of a hydrocephalic fetus, but with a larger than usual incision. Another option is abortion by intact D&X, collapsing the fetal skull before withdrawing the dead fetus.

Intact D&X procedures are not performed during the first trimester, as the fetal head is quite small at this stage of gestation, allowing easy removal from the uterus.

Legal and political situation in the United States

Template:See also Image:PBAsigning.jpg Since 1995, led by Congressional Republicans, the United States House of Representatives and U.S. Senate have moved several times to pass measures banning the procedure. Congress passed two such measures by wide margins during Bill Clinton's presidency, but Clinton vetoed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Subsequent Congressional attempts at overriding the veto were unsuccessful.

In 2003, however, opponents of the procedure succeeded in getting the Partial-Birth Abortion Ban Act (HR 760, S 3) signed into law; the House passed it on October 2 with a vote of 281-142, the Senate passed it on October 21 with a vote of 64-34, and President George W. Bush signed it into law on November 5.

Beginning in early 2004, the Planned Parenthood Federation of America, the National Abortion Federation, and abortion doctors in Nebraska challenged the ban in United States District Courts in San Francisco, New York, and Lincoln, Nebraska, respectively. All three District Courts ruled the ban unconstitutional that same year, and their respective appellate courts (Ninth, Second, and Eighth) affirmed these rulings on appeal. In upholding the Nebraska court's ruling in 2005, the Eighth Circuit states that the law is facially unconstitutional, meaning the ban is unconstitutional in all circumstances. This decision awaits further appeal, as the U.S. Department of Justice has requested the Supreme Court to review the lower court's decision. That request was granted on February 21, 2006.

Legal and political situation in the United Kingdom

Questioned about UK government policy on the issue in Parliament, Baroness Andrews stated that "We are not aware of the procedure referred to as 'partial-birth abortion' being used in Great Britain. It is the Royal College of Obstetricians and Gynaecologists' (RCOG) belief that this method of abortion is never used as a primary or pro-active technique and is only ever likely to be performed in unforeseen circumstances in order to reduce maternal mortality or severe morbidity."

References

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