Physicians cite concerning cases of patient outcomes post-Roe: UCSF study

Nearly 11 months after Roe v. Wade was overturned, new data has emerged from a University of California, San Francisco study depicting how abortion bans can negatively affect patient health outcomes.

Increasingly, the university heard of reports from physicians throughout the country where individuals were being instructed to not speak with the press about cases of patient care that were negatively affected by the overturn of Roe, which prompted researchers to launch the Care Post-Roe Study in September 2022. 

UCSF invited providers from states where abortion bans and restrictions are in place to submit stories of these cases with the option to remain anonymous and received 50 submissions from 14 different states between September 2022 and March 2023. Without sharing personal information, the submissions described instances of how abortion bans affected patient outcomes ranging from ectopic pregnancies, severe fetal anomalies, miscarriages and delays in obtaining abortion care or healthcare in general. 

Analysis of those cases revealed the following insights about care amid a post-Roe landscape: 

  • Patients between the ages of 18 and 24 accounted for 38 percent of the affected individuals in situations that physicians shared for this research, followed by individuals between 25 and 30 at 28 percent.

  • Thirty-six percent of affected patients were white followed by 24 percent who were Latino/Hispanic and 22 percent were Black.

  • Obstetric complications in the second trimester of pregnancy was the most commonly reported event and affected 18 of the 50 reported instances described, which included 11 cases of preterm prelabor rupture of membranes. 

  • Ectopic pregnancies were the second most common experience described as a cause for eight out of the 50 described events.

  • Fetal anomalies were the third most reported experience affecting seven out of 50 patient events. 

Many of the reported instances above were preventable conditions, researchers described, but without abortion being a legal form of care in certain states, patients often endured additional complications that sometimes led to severe or dangerous outcomes.

In one case, a physician shared that a patient who had an unwanted pregnancy was experiencing severe bleeding, but  "Our hands are tied. She is hemodynamically stable. This is a threatened, not inevitable, abortion. The pregnancy may continue. So we have to simply wait, either for bleeding to get worse or for her to get to viability [when she could be delivered]. … She may get to be cared for out of state, but she has social circumstances which seem to make that untenable," they explained. 

In another, a patient developed a severe infection during her pregnancy in a state with an abortion ban, but was sent home after an initial diagnosis of a preterm premature rupture of the membranes.

A physician who worked with the patient told UCSF researchers that she met the patient "two days later in the ICU. She was admitted from the ER with severe sepsis…and bacteremia. Her fetus delivers; she is able to hold [the fetus]. We try every medical protocol we can find to help her placenta deliver; none are successful. She is now on three pressors and in [disseminated intravascular coagulopathy]. The anesthesiologist cries on the phone when discussing the case with me — if the patient needs to be intubated, no one thinks she will make it out of the OR." 

Further research collection around this effort is ongoing and has been approved by the UCSF Institutional Review Board, researchers noted. 

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