Hysterotomy abortion is a

surgical procedure Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

that removes an intact

fetus A fetus or foetus (; : fetuses, foetuses, rarely feti or foeti) is the unborn offspring of a viviparous animal that develops from an embryo. Following the embryonic development, embryonic stage, the fetal stage of development takes place. Pren ...

from the

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

in a process similar to a

cesarean section Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would ...

. The procedure is generally indicated after another method of termination has failed, or when such a procedure would be medically inadvisable, such as in the case of

placenta accreta Placenta accreta spectrum (PAS) is a medical condition that occurs when all or part of the placenta attaches abnormally to the ''myometrium'' (the muscular layer of the uterine wall) during pregnancy. This condition was first documented in medica ...

.Roche, Natalie E. (June 16, 2006)
Surgical Management of Abortion
Retrieved July 1, 2007. In 2016, this method made up less than 0.01% of all

abortion Abortion is the early termination of a pregnancy by removal or expulsion of an embryo or fetus. Abortions that occur without intervention are known as miscarriages or "spontaneous abortions", and occur in roughly 30–40% of all pregnan ...

s in the United States, with the CDC reporting only 51 having occurred due to the invasive and complex nature of the procedure, and the availability of much simpler and safer methods. In 2022, scholars reported that in the aftermath of the overturning of ''

Roe v. Wade ''Roe v. Wade'', 410 U.S. 113 (1973),. was a List of landmark court decisions in the United States, landmark decision of the U.S. Supreme Court in which the Court ruled that the Constitution of the United States protected the right to have an ...

'' by ''

Dobbs v. Jackson Women's Health Organization ''Dobbs v. Jackson Women's Health Organization'', 597 U.S. 215 (2022), is a List of landmark court decisions in the United States, landmark decision of the Supreme Court of the United States, United States Supreme Court in which the court held ...

'',

Texas Texas ( , ; or ) is the most populous U.S. state, state in the South Central United States, South Central region of the United States. It borders Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the we ...

and other states where so called trigger laws immediately outlawed or heavily restricted reproductive healthcare, providers began performing hysterotomy abortions again. These providers have done so under the justification that such a procedure may not technically be considered an abortion under existing law.

Indications

As with other abortion procedures, the purpose of a hysterotomy abortion is to end a pregnancy by removing the fetus and placenta. This method is the most dangerous of any conventional abortion procedure, and has the highest complication rate. The procedure is specifically indicated in the management of certain medical conditions including Cesarean Scar Pregnancy,

bicornuate uterus A bicornuate uterus or bicornate uterus (from the Latin ''cornū'', meaning "horn"), is a type of müllerian anomalies, Müllerian anomaly in the human uterus, where there is a deep indentation at the Uterus#Structure, fundus (top) of the uterus. ...

uterine fibroids Uterine fibroids, also known as uterine leiomyomas, fibromyoma or fibroids, are leiomyoma, benign smooth muscle tumors of the uterus, part of the female reproductive system. Most people with fibroids have no symptoms while others may have dysm ...

, and in the case of failure of another method or methods.

Procedure

Hysterotomy is major

abdominal surgery The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (see stomach, kidney, liver, e ...

; it is generally only performed in hospitals and other advanced practice settings. The procedure is nearly identical to a cesarean section, with two main exceptions: the conduction of foeticide guaranteeing compliance with various laws on the subject, and preventing an unintended live birth; and the size of the incision, which is generally smaller than that of a cesarean section, as the fetus is generally not full term.

History

Scholarly sources place the use of this method since at least 1913. Health officials in the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

warned practitioners against performing hysterotomy abortion in an

outpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other healt ...

setting after it led to the deaths of two women in

New York New York most commonly refers to: * New York (state), a state in the northeastern United States * New York City, the most populous city in the United States, located in the state of New York New York may also refer to: Places United Kingdom * ...

during 1971. The rate of mortality of abortion by hysterotomy and

hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes ( salpi ...

reported in the United States between 1972 and 1981 was 60 per 100,000, or 0.06%.

References

{{Abortion Methods of abortion Caesarean sections