Northwest Samar State University Lesson 5: Abortion and Assisted Reproduction PDF

LESSON 5: ABORTION AND ASSISTED REPRODUCTION A Narrative Report in partial fulfilment on the course subject GE-Elective 3: Human Reproduction...

LESSON 5: ABORTION AND ASSISTED REPRODUCTION A Narrative Report in partial fulfilment on the course subject GE-Elective 3: Human Reproduction Submitted by: Cuevas, Mylene Delabajan, Francine Mae Deguino, Danica Mae Escobar, Yasmien B. (BSED Social Studies 3A) Submitted to: Dr. Leonida S. Bernadit Professor S.Y. 2024-2025 Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]  - Reproductive rights are essential for women to enjoy their human rights. These rights are centered on women’s ability to make the best choices for their lives, including around the number of children they have, if any, and the spacing between their children’s births. Reproductive rights include prenatal services, safe childbirth, and access to contraception. They also include legal access to abortion. Definition of Abortion  Abortion is the expulsion of a fetus from the uterus before it has reached the stage of viability (in human beings, usually about the 20th week of gestation). - An abortion may occur spontaneously, in which case it is also called a miscarriage, or it may be brought on purposefully, in which case it is often called an induced abortion. Spontaneous Abortion (Miscarriage) - Miscarriage, also known in medical terms as a spontaneous abortion, is the death and expulsion of an embryo or fetus before it can survive independently. - The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation. - The most common symptom of a miscarriage is vaginal bleeding with or without pain, Sadness, anxiety, and guilt may occur afterwards. - Risk factors for miscarriage include being an older parent, previous miscarriage, exposure to tobacco smoke, obesity, diabetes, thyroid problems, and drug or alcohol use.  This is defined as the delivery of a nonviable embryo or fetus (the fetus cannot survive) before the 20th week of pregnancy due to fetal or maternal factors.  Spontaneous abortions, or miscarriages, occur for many reasons, including disease, trauma, genetic defect, or biochemical incompatibility of mother and fetus.  Spontaneous abortion is often caused by chromosomal abnormalities or maternal reproductive tract abnormalities (eg, bicornuate uterus, fibroids), but etiology in an individual case is usually not confirmed.  It is estimated that at least 20% of all pregnancies end in miscarriage. Most occur in the first two weeks after conception, and in many cases the mother is not aware of the pregnancy. Therapeutic Abortion - In medical terminology an abortion may be therapeutic or elective (voluntarily).  A therapeutic abortion is the interruption of a pregnancy before the 20th week of gestation because it endangers the mother’s life or health or because the baby presumably would not be normal. People may have a therapeutic abortion because;  They’re at high risk of dying during pregnancy or childbirth.  The pregnancy is causing serious medical complications.  There’s a high risk of fetal death during pregnancy (miscarriage) or shortly after birth (stillbirth). Elective (Induced) Abortion - The term elective abortion or ''voluntary abortion'' describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons. Most abortions done today are elective, and thus, it is one of the most frequently performed medical procedures.  An elective abortion is the interruption of a pregnancy before the 20th week of gestation at the woman’s request for reasons other than maternal health or fetal disease. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   Induced abortions may be performed for reasons that fall into four general categories: to preserve the life or physical or mental well-being of the mother; to prevent the completion of a pregnancy that has resulted from rape or incest; to prevent the birth of a child with serious deformity, mental deficiency, or genetic abnormality; or to prevent a birth for social or economic reasons. By some definitions, abortions that are performed to preserve the well-being of the female or in cases of rape or incest are therapeutic, or justifiable,abortions. People may choose to have an abortion because;  They don’t want to be pregnant or have a child.  They aren’t financially or emotionally ready for parenthood.  They don’t want to increase their family size.  They’re in an unstable or abusive relationship. There’s no medical difference between an elective abortion and a therapeutic abortion. These terms are used in law to categorize how abortions are legislated and whether they’re covered by health insurance. Methods of Conducting Abortion 1. Suction (Vacuum Aspiration) Abortion  Suction Abortion is a procedure that can be done in the early stages of pregnancy.  In most cases, your cervix doesn’t need to be prepped or dilated for this procedure. But if you’re more than about 10 to 12 weeks pregnant, your health care provider may take steps to open your cervix before getting started so that the medical tools can access your uterus.  The cervix is stretched to allow passage of a hollow suction tube with a sharp-edged openings near its tip into the uterus.  Powerful suction force is then applied, allowing the fetus to be ripped apart then suctioned out of the uterus into a collection container.  Vacuum aspiration is the most frequently used method to perform first trimester abortions in the United States. - FIGURE 14.5. A vacuum aspiration abortion. A tube (vacurette) is inserted through the cervix and into the uterus, after the vagina is opened using a speculum (top). The embryo and uterine lining are then suctioned into a bottle (not shown) using a suction pump (bottom). - The first trimester – conception to 12 weeks. The second trimester – 13 to 27 weeks and the third trimester is from – 28 to 40 weeks. 2. Dilation and Evacuation Abortion  This procedure is typically used for second-trimester abortions (14-23 weeks). Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   It is one of the methods available to completely remove the fetus and all of the placental tissue in the uterus after the first trimester of pregnancy. - While doctors can do vacuum aspirations until about 14 weeks, the most common type of second-trimester abortion is called dilation and evacuation, or D&E. - In addition to using vacuum suction in your uterus, they’ll also use forceps and other medical tools, including one called a curette to scrape the inside of your uterus.  Cervical preparation with osmotic dilators can be achieved after several hours or by placement the day prior. - Because a greater volume of fetal tissue is present than in the first trimester, preoperative cervical dilation is needed to allow for safe, appropriate instrumentation. - Cervical preparation with osmotic dilators can be achieved after several hours or by placement the day prior. Osmotic Dilators Osmotic dilators are medical implements used to dilate the uterine cervix, such as laminaria and Dilapan-S, are established, safe, and effective ways to dilate a cervix; both require overnight placement. Osmotic dilators Osmotic dilators prior to expansion. after soaking in water for 24 hours. Dilapan-S (left). Laminaria (right) Dilapan-S (left). Laminaria (right). Before After Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   If this material is not completely removed by suction, the endometrium can then be scraped with a curette (a metal scraper).  This procedure takes 10 to 20 minutes and then you’ll rest for 30 minutes to an hour 3. Salt Poisoning Abortion  Otherwise known as "saline amniocentesis," "salting out," or a "hypertonic saline" abortion.  This technique is used after 16 weeks of pregnancy.  This abortion method involves injecting hypertonic saline, a type of concentrated salt water, into your uterus. - When enough fluid has accumulated in the amniotic fluid sac surrounding the baby. Procedure  A syringe of a concentrated salt solution is injected into the amniotic fluid via a long needle through the mother’s abdomen.  The baby breathes in, swallowing the salt, and is poisoned. The chemical solution also causes painful burning and deterioration of the baby’s skin.  After about an hour, the child dies.  The mother goes into labor about 33 to 35 hours after instillation. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected] Compared with other methods, saline abortions:  Had a higher risk of causing health complication.  Took longer to perform, often requiring overnight hospitalizations  Caused more physical discomfort  Were less effective  Hypertonic saline may initiate a condition in the mother called "consumption coagulopathy" with severe hemorrhage as well as other serious side effects on the central nervous system. - Seizures, coma, or death may also result from saline inadvertently injected into the woman’s vascular system. The health risks of hypertonic-saline-induced abortion include:  Hypernatraemia (too much salt in your body)  Severe bleeding  Seizures  Coma  Death Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected] 4. Hysterotomy Abortion  “Hysterotomy” means to cut open the uterus.  It is a surgical procedure that removes an intact fetus from the uterus in a process similar to a cesarean section.  As with other abortion procedures, the purpose of a hysterotomy abortion is to end a pregnancy by removing the fetus and placenta. - In rare cases where the induction method fails or cannot be used, a surgical method called "hysterotomy" must be used or when such a procedure would be medically inadvisable. - This method is the most dangerous of any conventional abortion procedure, and has the highest complication rate. - It is like a Cesarean delivery and has the same risks. - 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 ASSISTED REPRODUCTION  Assisted reproductive technology (ART) is the technology used to achieve pregnancy in procedures such as fertility medication, artificial insemination, in vitro fertilization and surrogacy. - ART encompasses several techniques to assist with conception. Fertility medication stimulates ovulation. Artificial insemination involves placing sperm directly into the uterus. In vitro fertilization (IVF) involves fertilizing eggs outside the body and then implanting them into the uterus. Surrogacy involves a surrogate carrying the baby for another person or couple. Each method targets different challenges in achieving pregnancy.  Fertility therapies where eggs and sperm are manipulated. - Fertility therapies where eggs and sperm are manipulated typically involve advanced techniques to enhance the chances of conception when traditional methods have not been successful. Procedures such as fertility medication, artificial insemination, in vitro fertilization, and surrogacy, each of these methods involves manipulating eggs and sperm in specific ways to overcome fertility challenges and help achieve a successful pregnancy. The choice of technique depends on the underlying fertility issues, personal circumstances, and the advice of a fertility specialist. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   Involve surgically removing eggs from women and combining them with sperm in the laboratory. - The process referring especially to a key component of In Vitro Fertilization (IVF). Methods of Assisted Reproductive Technology  INF  ICSI  IUI  GIFT  ZIFT  Surrogacy Why ART? - ART provides the ultimate opportunity for those struggling with infertility to build their families. Infertility: Extremely Prevalent  Definition: Infertility refers to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term.  7-26% of couples worldwide (90 million women). - Infertility is typically defined in two main contexts: 1. Male Infertility: Refers to a biological inability of a male to contribute to conception. This can involve issues with sperm production, quality, or delivery. Common causes include: o Low Sperm Count: Insufficient sperm in the ejaculate. o Poor Sperm Motility: Sperm that do not swim properly. o Abnormal Sperm Morphology: Abnormal shape of sperm. o Ejaculation Issues: Problems with ejaculation or delivery of sperm. 2. Female Infertility: Refers to a female's inability to carry a pregnancy to full term, or to conceive at all. This can include a range of issues: o Ovulation Disorders: Irregular or absent ovulation that prevents the release of eggs. o Fallopian Tube Blockage: Blocked or damaged fallopian tubes can prevent eggs from meeting sperm. o Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, affecting fertility. o Uterine Abnormalities: Issues such as fibroids or congenital abnormalities that can hinder implantation or pregnancy. o Premature Ovarian Failure: Early loss of normal ovarian function before age 40. o Hormonal Imbalances: Disruptions in hormones that regulate the menstrual cycle and ovulation Causes of Infertility  Delayed marriage and childbearing - As people delay marriage and childbearing to pursue education or careers, they often face age-related fertility declines. Women’s egg quality and quantity decrease with age, particularly after 35, while men may experience reduced sperm quality and quantity. Delayed childbearing can lead to increased difficulty in conceiving and a higher risk of pregnancy complications. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   Sexually transmitted diseases - STDs can affect fertility by causing damage to reproductive organs. For example: Chlamydia and Gonorrhea: Can lead to pelvic inflammatory disease (PID), which can cause scarring and blockages in the fallopian tubes, affecting a woman’s ability to conceive.  Hormonal contraception - Hormonal contraceptives, such as birth control pills, patches, or injections, prevent ovulation and manage menstrual cycles. While they are highly effective in preventing pregnancy, their effects on fertility are typically temporary. Once discontinued, normal ovulation and menstrual cycles usually resume, but in some cases, fertility may take longer to return to baseline.  Abortion - Generally, abortion does not affect long-term fertility. However, complications from abortions, especially unsafe or incomplete procedures, can lead to scarring of the uterus or infections that might impact future fertility. It’s important to ensure that abortions are performed safely and professionally to minimize risks.  Obesity - Obesity can disrupt hormonal balance and lead to conditions such as polycystic ovary syndrome (PCOS), which can affect ovulation and menstrual cycles in women. In men, obesity can reduce sperm quality and testosterone levels. Both can contribute to difficulties in conceiving. Weight management through diet and exercise can improve fertility outcomes.  Environmental Pollution - Exposure to environmental pollutants, such as pesticides, heavy metals, and industrial chemicals, can negatively impact reproductive health. These pollutants can affect hormone levels, sperm quality, and egg health. Long-term exposure has been linked to increased risk of fertility issues and reproductive health problems. In vitro fertilization  IVF (in vitro fertilization) is a method in which egg cells are fertilized by sperm cells outside the mother's womb (in vitro).  The resulting embryos are then transferred back into the uterus - In Vitro Fertilization (IVF) involves fertilizing eggs with sperm outside the body, cultivating the resulting embryos in a lab, and then transferring the embryos into the uterus to achieve pregnant. STEPS IN IVF  Follicle suppression  Controlled ovarian hyper stimulation  Aspiration of eggs from follicles  Fertilization, incubation, and selection of embryos  Embryo transfer  Pregnancy test Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected] Intra-Cytoplasmic Sperm Injection (ICSI)  involves the direct injection of sperm into eggs obtained from invitro fertilization (IVF). - It is a specialized form of IVF where a single sperm is directly injected into an egg using a fine needle, bypassing issues with sperm quality or quantity to facilitate fertilization. How Is ICSI Performed?  The mature egg is held with a specialized pipette.  A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm.  The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg.  The sperm is injected into the cytoplasm, and the needle is carefully removed.  The eggs are checked the following day for evidence of normal fertilization. Intrauterine insemination (IUI)  Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman's uterus to facilitate fertilization.  The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.  Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   It is a less invasive and less expensive option compared to in vitro fertilization. - It is a fertility treatment where sperm is placed directly into a woman's uterus to boost the chances of fertilization. By increasing the number of sperm that reach the fallopian tubes, IUI enhances the likelihood of conception. It's a less invasive and more affordable alternative to in vitro fertilization (IVF). Process of IUI  Before IUI, ovulation stimulating medications may be used.  The IUI procedure will then be performed around the time of ovulation, typically about 24-36 hours after the surge in LH hormone that indicates ovulation will occur soon.  A semen sample will be washed by the lab to separate the semen from the seminal fluid.  A catheter will then be used to insert the sperm directly into the uterus.  This process maximizes the number of sperm cells that are placed in the uterus, thus increasing the possibility of conception. GIFT (Gamete Intrafallopian Transfer)  GIFT is an assisted reproductive procedure which involves removing a woman's eggs, mixing them with sperm, and immediately placing them into a fallopian tube.  One of the main differences between this procedure and IVF and ZIFT procedures is that in GIFT the fertilization process takes place inside the fallopian tube rather than in a laboratory. - It is a fertility treatment where a woman's eggs are removed, mixed with sperm, and then immediately placed into her fallopian tube, allowing fertilization to occur naturally inside the body. Unlike IVF and ZIFT, where fertilization happens in a lab before the embryo is transferred, GIFT relies on the body for the fertilization process. How is GIFT performed?  Patients must first have an x-ray to determine the presence of at least one healthy fallopian tube. The doctor will also use a laparoscope to ensure that there is not any scar tissue on the outside of the fallopian tube.  Using a laparoscope, eggs are then retrieved from the ovaries.  The male provides a sperm sample the same day that the eggs are retrieved.  The eggs are then mixed with the sperm in a catheter. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]   The egg and sperm mixture are inserted into the fallopian tubes with a catheter  The woman is then provided with medication to build up the uterine lining to support implantation of a fertilized egg. ZIFT (Zygote Intrafallopian Transfer)  ZIFT is an assisted reproductive procedure similar to in vitro fertilization and embryo transfer, the difference being that the fertilized embryo is transferred into the fallopian tube instead of the uterus.  Because the fertilized egg is transferred directly into the tubes, the procedure is also referred to as tubal embryo transfer (TET). - It is a fertility treatment similar to IVF, but instead of placing the fertilized embryo in the uterus, it's transferred into the fallopian tube. This method is also known as Tubal Embryo Transfer (TET) because the embryo is transferred directly into the tube, allowing it to naturally move to the uterus for implantation. How Is ZIFT Performed?  A woman's ovaries are stimulated with medications to increase the probability of producing multiple eggs.  Eggs are then collected through an aspiration procedure.  Those eggs are fertilized in a laboratory in a procedure identical to IVF, with the exception of the time frame. During the ZIFT procedure, fertilized eggs are transferred within 24 hours, versus 3-5 days as used in a regular IVF cycle.  The fertilized eggs are then transferred through a laparoscopic procedure where a catheter is placed deep in the fallopian tube and the fertilized eggs injected.  The final step is to watch for early pregnancy symptoms. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected] Surrogacy  Surrogacy is the practice by which a woman (called a surrogate mother) becomes pregnant and gives birth to a baby in order to give it to someone who cannot have children. - is an arrangement where a woman, known as a surrogate mother, carries and gives birth to a baby for another person or couple who are unable to conceive or carry a child themselves. After birth, the surrogate mother gives the baby to the intended parents.  In gestational surrogacy, an egg is removed from the intended mother or an anonymous donor and fertilized with the sperm of the intended father or anonymous donor. The fertilized egg, or embryo, is then transferred to a surrogate who carries the baby to term. - An embryo is created by fertilizing an egg from the intended mother or a donor with sperm from the intended father or a donor. This embryo is then implanted into a surrogate, who carries the pregnancy and delivers the baby for the intended parents. The surrogate has no genetic connection to the baby.  In traditional surrogacy, the surrogate is impregnated naturally or artificially, but the resulting child is genetically related to the surrogate. - The surrogate mother is either naturally or artificially inseminated with the intended father's sperm, making the resulting child genetically related to her. This means the surrogate's egg is used, so she shares a biological connection with the baby.  Intended parents may seek a surrogacy arrangement when either pregnancy is medically impossible, pregnancy risks present an unacceptable danger to the mother's health. Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected] REFERENCES: American Society for Reproductive Medicine (ASRM). (n.d.). American Society for Reproductive Medicine. https://www.asrm.org/ Assisted Reproductive Technology (ART) | Reproductive Health | CDC. (n.d.). https://www.cdc.gov/art/index.html American Pregnancy Association. (2024, August 9). American Pregnancy Association | Expecting with Confidence. http://americanpregnancy.org/infertility/gamete Ameenah. (2012, July 2). abortion ppt [Slide show]. SlideShare. https://www.slideshare.net/slideshow/abortion-ppt-13517253/13517253#15 Cna. (n.d.). Salt poisoning. Catholic News Agency. https://www.catholicnewsagency.com/resource/55855/salt-poisoning Methods of Abortion | SCDHEC. (n.d.). https://scdhec.gov/methodsabortion#:~:text=In%20rare%20cases%20where%20the,a%20shot %20of%20immune%20globulin. What are the types of abortion procedures? (2024, May 28). WebMD. https://www.webmd.com/women/abortion-procedures What is Assisted Reproductive Technology? | Reproductive Health | CDC. (n.d.). https://www.cdc.gov/art/whatis.html Wikipedia contributors. (2024, January 3). Hysterotomy abortion. Wikipedia. https://en.wikipedia.org/wiki/Hysterotomy_abortion Qazaz, S., & Berth-Jones, J. (2018). Rhinophyma. In Elsevier eBooks (pp. 737–738). https://doi.org/10.1016/b978-0-7020-6912-3.00219-6 Rueda Street, Calbayog City 063 055 5339857 Samar, Philippines 6710 www.nwssu.edu.ph [email protected]