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baby has no heartbeat
Question from Anonymous on 11/20/2013:

If someone is 3 or 4 months pregnant and there is no heartbeat detected and all the proper tests are done to make sure there is no heartbeat, is it standard procedure for the doctor to perform a D&C? This isn't an abortion is it?

Answer by Judie Brown on 12/7/2013:

Dear Anonymous

I submitted your question to Anthony Dardano, M.D. who responded:

This is a clinical scenario I have faced numerous times over the last 45 years and it is never easy for people of conscience. Over the years however, technology has made it much easier to correctly diagnose fetal loss. Loss of a fetal heart, negative blood flow through the cord and lack of fetal movement on real time sonography are conclusive signs of fetal loss. At the gestational age described here (3-4 months) this would be definitive. It is incumbent on the physician to perform all available studies before proceeding with any intervention. Nature usually responds to fetal loss with the onset of cramping, bleeding and an attempt to expel the non viable products of conception. This is a spontaneous miscarriage. In the event this does not occur, a D&C may be performed to complete the process. This is called a completion D&C and is morally permissible, as well as medically necessary because retained non viable tissue becomes infected resulting in a septic condition which can impair future fertility. Retained tissue can also degenerate into a hydatifiform mole which can be malignant. I only point this out to emphasize the importance of properly treating a spontaneous miscarriage.

Please rest assured there is no sin involved and this is not an abortion. To be sinful one must voluntarily interrupt a viable pregnancy with the direct intent to terminate. This is clearly not the case with spontaneous fetal loss. I do realize that some confusion does arise from the fact that the term spontaneous miscarriage and spontaneous abortion are used interchangeably in medical coding or in insurance claims and that does lead to a real sense of uneasiness in many people. In summary, when fetal loss is conclusively diagnosed and the products of conception are retained, a D&C is morally acceptable and therefore can be performed with a clear conscience.

May the peace of the Christmas Season be with you during this difficult time.

Anthony N Dardano, MD, FACS, FACOG

COPYRIGHT 2014

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