November 3, 2022
Texas’ “Human Life Protection Act” states an exception is allowed if a medical emergency is present, defined as, “in the exercise of reasonable medical judgment, the pregnant female…has a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.”
Previable, premature rupture of membranes (PPROM) as described in this article is a complicated situation. The prognosis for the fetus is poor: the risk of stillbirth is 36% and about 46% of liveborn babies will die within the first month. Even if he reaches the point of viability, the lack of amniotic fluid may cause his lungs to fail to mature, leaving him unable to breathe when delivered. Additionally, the risk of infection (chorioamnionitis) for the mother is very high. Even if she does not show obvious evidence of infection, it is likely that a subclinical infection is already present and may have been the event that caused the membranes to rupture. Microscopic examination documents evidence of infection in 94% of placentas in the setting of PPROM between 21-24 weeks gestation. The risk to the mother of developing a more serious infection, if the pregnancy continues, is high (up to 71%), and may progress to sepsis (overwhelming blood infection) or even maternal death.
Refusing to offer the option of intervention in this circumstance is not supported by any medical guidance or by the Texas law, which would permit intervention because of the likelihood that PPROM could become life-threatening for the mother. The American College of Obstetricians and Gynecologists (ACOG) addresses this situation in their 2020 Practice Bulletin Prelabor Rupture of Membranes, “Women presenting with PROM before neonatal viability should be counseled regarding the risks and benefits of expectant management versus immediate delivery. Counseling should include a realistic appraisal of neonatal outcomes (which it documents elsewhere are uniformly poor). Immediate delivery (termination of pregnancy by induction of labor or dilation and evacuation) and expectant management should be offered. Physicians should provide patients with the most current and accurate information possible.”
The physicians caring for this unfortunate woman were not following the medical standard of care, nor state law. As reported in the article, this led to the life-threatening complication of sepsis. Confusion abounds in Texas today, even though it has been more than 14 months since the Texas Heartbeat Act was implemented. Why has this type of guidance been so slow in coming from organizations tasked with supporting doctors? Are pro-choice ideologues intentionally using confusion to turn the Texas public against pro-life legislation, to the detriment of quality care for women? It is imperative that organizations tasked with supporting physicians — the Texas Medical Board, the Texas Medical Society, and local hospital quality committees — which have remained silent, provide guidance for physicians about these laws, so they may use their “reasonable medical judgment” to provide quality care for women.
Ingrid Pfanstiel Skop, M.D., attended Oklahoma State University and the Washington University School of Medicine, and she trained in obstetrics and gynecology at the University of Texas Health Science Center in San Antonio. She has been caring for women and delivering babies for 25 years in Texas. Dr. Skop is married to Brian, a psychiatrist, and has three children: Ian, Eli, and Sophie.