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D&C Procedure after miscarriage
Question from Concerned Husband and Dad on 6/15/2009:

Judie,

My wife and I just found out we are pregnant again. It is apparently very early in the pregnancy because her period late in April was the first she missed. Sort of: She had a brief period, literally about a day and one half at that time. Her May period time came and went without anything and so we started to think we might be pregnant. She took an at-home test and it said we were. Then she started another period several days ago. She called her OBGYN and went in last Thursday and they confirmed her blood work showed she was pregnant but that her “levels were not good” – indicating this meant this might not be a viable pregnancy. Over the last three or four days the bleeding has gotten to scary levels. She went back in again today because of the increased bleeding and they indicated to her she is in the process of a miscarriage.

My question is this: They are saying that if the bleeding keeps up at these levels for much longer, it could be a problem for her, anemia and other possible problems. They said if she does not quit bleeding within a couple of weeks, or if the bleeding increases at all from the current heavy levels, they may want her to come in for a D&C. I thought this sounded like an abortion. I looked up the procedure and it says:

What is a D&C Procedure? D&C, also known as dilation and curettage, is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; curettage means to remove the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration), using a vacuum-type instrument.

It certainly sounds like an abortion, unless they are positive the fetus has passed or is definitely dead. My question is whether she can undergo the procedure, from a stand point of Church teaching, if the bleeding does not stop within a couple of weeks if they are certain the baby has passed or is dead? If not what alternatives are there for stopping the bleeding and making sure she does not develop an infection if there is anything left in her?

Thanks for any insight you can offer.

Answer by Judie Brown on 6/23/2009:

Dear Concerned Husband and Dad

I forwarded your question and case to Anthony Dardano, M.D. and here is his response:

The ethical treatment of miscarriage is one of the biggest problems the conscientious physician has to face. The final treatment depends on one issue. Is the fetus still alive and can one be certain that fetal death has occurred. This is one area where technology over the years has helped a great deal Hormonal levels are of value but they are only a test. In general the hormone level doubles every few days in a healthy first trimester pregnancy. A drastic fall in the level instead of a rise could mean miscarriage and that is why the term "threatened miscarriage" is preferred. Sonogram is valuable as well if for example the fetal heart is seen but is not beating. Furthermore, the fetal pole as it is called would lose volume, etc. The time honored test is the physical exam where the opening to the uterus (cervix) is dilated and there is fetal tissue coming thru trying to be expelled. In any event, the term D&C does not only apply to miscarriage, but to any time the uterine cavity is entered (dilatation) and scraped clean (currettage) or D&C. Non obstetrical uses are diagnostic in treating heavy bleeding or diagnosing uterine malignancies. D&C is also used to remove the "products of conception" after miscarriage has been confirmed. The term "abortion" is used medically here not to be confused with the procedure done electively on unwanted pregnancies. A spontaneous natural miscarriage is called a "complete abortion" when nature itself expels the nonviable fetus. The term "incomplete abortion" is used when there are retained placental pieces or fetal tissue incompletely expelled. This is where the D&C is used. Leaving this tissue behind invites severe hemorrhage or serious infection and rarely, a malignant transformation called a choriocarcinoma. I only have one point to stress emphatically. It is ethically permissible to surgically empty the uterus after a miscarriage, providing the operator is certain that fetal death has occurred beforehand. In fact, not to do so would be doing the patient a disservice. Over the years I have seen women bleed excessively and go on to deliver normally and I have seen those who had only spotting go on to lose the pregnancy. That is why every situation must be assessed individually by a physician who embraces prolife principles. There are some conservative measures which should be initiated as soon as bleeding starts. The most important is bedrest with legs elevated. Some believe that progesterone given helps the implantation process if its deficiency is a possibility and I myself have used it numerous times over the years. So as you can see, the problem can be quite complex for those with a prolife conscience. For those without such a conscience the solution is easy as they tend to simply end the process with a D&C when many are not indicated and are outright immoral. Seek a prolife physician. Pray for the strength to be firm in your belief. Most physicians will honor your convictions.

God bless you.

Anthony N. Dardano, M.D.

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