AUSTIN, Texas – Texas law defines abortion as the intent to cause the death of an unborn child. There are a few exceptions, including removing an ectopic pregnancy. An ectopic pregnancy is one in which a fertilized egg implants and grows outside of the uterus, according to the Mayo Clinic. Some doctors are hesitant to remove ectopic pregnancies since most abortions are now illegal in Texas.
“Ectopic pregnancy is still a leading cause of maternal death in the first trimester, if not the leading cause,” said Dr. Lisa Hansard, a reproductive endocrinologist with the Texas Fertility Center. “So treating an ectopic pregnancy is potentially preserving the life of the pregnant patient and clearly treating the risk of substantial bodily injury. So I’m not exactly sure where that fear is, except that it hasn’t been contested and ectopic pregnancy is something that is not completely understood, particularly by non-medical lawmakers.”
Dr. Hansard said an ectopic pregnancy is a failed pregnancy every time. Doctors cannot move the fertilized egg into the uterus.
“We hear questions all the time from patients saying, ‘Well if it’s in the tube, but it’s ok, why can’t you just move it to the uterus?’ without understanding the physiology and the impossibility of achieving that,” Dr. Hansard said. “Once a pregnancy is implanted, whatever location that is, that’s where it’s staying. The risk of rupture and significant morbidity is truly substantial.”
Ectopic pregnancies can be managed surgically or medically with a prescription. Per Dr. Hansard, doctors commonly prescribe methotrexate, which can also treat certain types of cancer.
“The concern [among doctors] is, how will I prove that methotrexate was being utilized for an ectopic pregnancy? Again, physicians are challenged, for the first time in our career, with the government coming into the examination room, and having access potentially to medical records... to having to justify medical decisions that we’re making with our patients,” Dr. Hansard said. “And so there’s a fear that this will be potentially misinterpreted by someone that doesn’t have any kind of a medical background but has some degree of legal standing.”
Anti-abortion advocates say the Texas law clearly outlines what is not considered an abortion: If the act is intended to save an unborn child; remove a dead, unborn child if the mother had a miscarriage; or remove an ectopic pregnancy. Kyleen Wright, the president of Texans for Life, says doctors who fear penalties for removing an ectopic pregnancy might not know the law.
“An ectopic pregnancy only has one treatment, and that is to remove it. There isn’t a viable way to save the baby,” Wright said. “So what we’re hoping is the Texas Medical Association and some of the state agencies will offer more guidance and clarity. I realize that not all these doctors have a copy of the statute, but it is very clear in law. It’s not ambiguous at all. I don’t think it’s going to be a threat to them.”
Dr. Hansard agrees, saying Texas doctors should not hesitate to help patients with ectopic pregnancies.
“This should not be changing the way that we practice medicine in terms of dealing with an ectopic pregnancy,” Dr. Hansard said. “An ectopic pregnancy is never, ever viable. Therefore, the decision has to be what is going to help resolve this abnormal pregnancy as quickly as possible to keep the patient safe.”
To Dr. Hansard, the end of Roe means “forced birth” for many Texas women. An ectopic pregnancy is just one of three exceptions to the state’s abortion ban. Many women who have unplanned pregnancies will no longer have the option to end them if they want to.
“Women deserve a choice in all their reproductive decisions,” Dr. Hansard said. “And I feel like that should be between a woman, her partner, and her health care provider for whatever that looks like. And none of these decisions are easy. The frustration is that I’m not able to necessarily do what I’ve spent my entire life committed to doing. And just because I am pro-choice, doesn’t mean I’m pro-abortion. Pro-choice means the ability to make those decisions without outside influences.”