From: rescorla@rtnmr.chem.yale.edu (Eric Rescorla)
Subject: Re: Abortion and Infanticide
Organization: Rescorla for himself.
Date: Mon, 27 Jul 1992 00:00:47 GMT

In article <1992Jul26.225727.596@ncsu.edu> dsh@csl36h.csl.ncsu.edu (Doug Holtsinger) writes:
>I have seen claims that a D&E is safer for the woman and that
>it's the "preferred" procedure for late second-trimester abortions,
>but I have not seen anything to suggest that it is "much" safer
>for the woman than prostaglandin.
From "Abortion and Sterilization: Medical
and Social Aspects" which is really a series of monographs 
edited by Jane E. Hodgson of the Department of Obstetrics and
Gynecology, Department of Minnesota, Minnesota, USA.

The specific monograph with the Statistics in it is called:
"Morbidity and Mortality of abortion in the United States"
by Willard Cates, Jr. and David A. Grimes

Type of Procedure         Death to case rate(usa, per 100000 cases)
----------------------------------------(1972-77)----------------
Uterine evacuation                        1.5
 Curettage(<=12 wks)                      1.2
 D&E(>=13 wks)                            8.3
Instillation
 Saline                                   15.5
 Prostaglandin and others                 20.6
Hysterototomy/Hysterectomy                45.3

Type of procedure                           wks of gestation
                     <=8    9-10  11-12   13-15    16-20  >=21
curettage            .5      1.6   2.9
D&E                                        6.7      12.9   16.7
Saline                                     2.5      19.3   20.6
Prostaglandin/other                        62.2     11.6   77.3
Hysterototomy/Hysterectomy   58.8  39.7    70.8     47.8   157.5

---Quote ends here.

So, in weeks 13-15 D+E is ~10x safer than Prostaglandin.
16-20 it's actually less safe. >=21 it's ~4x safer.

I'd say that those numbers are significant.

>medical texts which I've perused, they often list "possible
>fetal survival" as a disadvantage of a prostaglandin abortion,
>indicating that a physician might select a D&E over prostaglandin
>since a D&E ensures fetal death.
That's probably true. Does prostaglandin usually cause significant
damage to a fetus? If so, I can see how survival might be a negative.
If the possibility is of healthy fetal survival, choosing
a D+E merely to ensure fetal death is reprehensible, IMHO.

>Even if the D&E is a safer procedure, I don't see why the 
>fetus should have to be killed. There is a certain risk of
>death to both parties using any method of removal, and in the
>case of prostaglandin abortions, there's more risk to the
>fetus than to the woman. It seems grossly unfair to the fetus
>to sacrifice its life during a D&E so that the woman can 
>enjoy an insignificant reduction in the risk to her own
>life, especially when the risk is already low.
The numbers don't seem insignificant to me.

>And it still doesn't explain why a woman should be entitled
>to kill a fetus with Down's syndrome. The Down's syndrome 
>child is killed because the child is retarded, not because
>the abortion procedure is safer for the woman. 
Agreed.

I think that a woman SHOULD be entitled to have an abortion
of a child with Down syndrome, however, the justification is
certainly not one of risk to the mother. [I would consider this
to be merely a special case of the more general right to abortion.]

I must admit, the fact that the risk for prostaglandin is SO low
in the middle period makes me nervous about the validity of
these statistics for prostaglandin. I don't have the reference
near me, and the sample size may well be quite low.
Would someone care to come up with some better data?

-Ekr



-- 
-------------------------------------------------------------------------------
Eric Rescorla, DoD#431 (Nighthawk S)              rescorla@rtnmr.chem.yale.edu
Former chemist now CM400 mechanic                     We hack anything.
              Golden Anniversary: It's bad beer, but it's beer.