Table 1 Ambiguous Cases: Patients who may have attempted to end their pregnancy on their own
From: Health care provider reporting practices related to self-managed abortion
Presentation | Specific cases | Composite cases |
|---|---|---|
Injury/ trauma | Woman, maybe “on drugs,” came into ED as an “auto verse[s] pedestrian” but it was not clear from Emergency Medical Services whether/how she got hit. “I didn’t know…if she had tried to hit herself.” | “trauma patients I suspected were either abused or purposefully caused the trauma to try to end the pregnancy, but…would not confirm” |
Woman “came into triage for…falling, and there was some suspicion that maybe it was self-inflicted.” | ||
Patient’s “husband beat her in the stomach. To try to induce an abortion.” | ||
Infection | Woman “delivered…pre-viable baby and was very sick and in the [Intensive Care Unit].” She “wouldn’t give any history of any kind or allow any records to be obtained from anyone anywhere.” She “delivered and started getting better.” “The whole consultation of things made people concerned that something might have happened potentially related to the pregnancy and trying to end it that had made her so sick.” | “All of our septic [abortions] that come in…we don’t really know what happened.” |
Suicide attempt | Suicide attempt among “college freshman from a super religious family who had started college, been pregnant over the summer, and been in denial about it;” had maybe taken some pills earlier in the pregnancy to try and “resolve it, even though she had not really admitted to herself that she was pregnant.” | Some patients early in pregnancy and “have come in suicidal and maybe taken a handful of Tylenol or something” |
Bleeding/ miscarriage | “The patient came in through the ED via [emergency medical services] with vaginal bleeding several days after reporting passing an 18 or 19-week fetus at home that she reported had like self-disposed of the remains.” Questions about pregnancy duration, as [last menstrual period] & placental size suggested it was later in gestation. “There was concern both about, you know, what might’ve gone on after what was presumed to be like a fetal demise. And/or if the patient may have induced an abortion.” | Caring for patients who reported doing something to “make my period come down” |
Patient came into ED hemorrhaging profusely, reporting a 1st -trimester miscarriage. “Maybe that truly was what was going on, but I had never seen anything like that. It was - the story was, ‘Oh, I was fine, and just like in an hour I was in a bathtub and all of the sudden I started hemorrhaging.” | ||
Person came into ED stating miscarriage at 16 weeks; her chart (from previous visit) said she had been considering abortion. Came into ED and passed “intact fetus” pretty quickly. | ||
Homeless woman, who was likely intoxicated, came into ED holding her fetus. | ||
Homeopathic | “Some of them, I think, tried homeopathic stuff.” | |
Uterine rupture | “She…had a uterine rupture and ended up in the [operating room]…she didn’t tell either me or the [obstetrician] that she had had an abortion…her pregnancy test was positive, she was unstable, and she was bleeding into her abdomen…She definitely did not tell us anything about the abortion. The [obstetrician] sonly learned later because she saw like the [unintelligible] sites.” “She was acutely ill, too. Like if she hadn’t gone to the OR she would’ve died.” | |
Alcohol/ drugs | “poor health behaviors that they were hoping would cause the baby to demise” | |
Someone early in pregnancy in ED who had “tried to overdose on something in order to have an abortion” |