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Tallguy88

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Full blown eclampsia is a very serious complication of pregnancy. If not reversed, it can be fatal to the mother, or result in kidney or liver failure, or permanent brain damage. The emedicine link has more details. As I said, there is medical therapy. IV magnesium can help, along with medications to control seizures, lower blood pressure, and remove excess fluid. I was just a student at the time, so I wasn't making decisions. But this girl was getting maximal medical therapy and wasn't responding. In that case, the only possible treatment is to end the pregnancy. As I recall, she had a C-section. Her condition was so critical that the team didn't want to wait for labor to be induced. There was just no other option. And she did improve. I remember her BP came down, her kidneys started working so that she was peeing out the excess fluid, and the seizures mostly stopped. Though her mental status was still very abnormal and she wasn't yet alert or coherent. I rotated off the OB service soon after, and I never got any followup. The baby went to the NICU immediately, and I don't know the outcome. But I doubt it lived. Survival of a 22 week preemie would have made the news. It's still very unlikely, but in the mid-70s, that would have been as close to a medical miracle as anything imaginable.
Was she aware of what was happening? I'm just wondering if that can be done without explicit consent.

I've heard of 22 week survival, but don't they have severe disabilities even if they do survive?
 
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jayem

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Was she aware of what was happening? I'm just wondering if that can be done without explicit consent.

I've heard of 22 week survival, but don't they have severe disabilities even if they do survive?

She was totally out of it. And IIRC, she was maybe 17. Still a minor. (Which is an eclampsia risk factor.) I think her grandmother was giving consent for treatment.

I found a NYT piece with some recent data:

The study, involving nearly 5,000 babies born between 22 and 27 weeks gestation, found that 22-week-old babies did not survive without medical intervention. In the 78 cases where active treatment was given, 18 survived, and by the time they were young toddlers, seven of those did not have moderate or severe impairments. Six had serious problems such as blindness, deafness, or severe cerebral palsy.

http://www.nytimes.com/2015/05/07/health/premature-babies-22-weeks-viability-study.html?_r=0

18 of 78 surviving is 23%, which is better than I thought. 6 were seriously impaired. 7 did not have moderate or severe problems. That wording is confusing. Does that mean they had mild problems, or no problems? But anyway, it's much better than the outcomes from 40 years ago.

Getting back on topic, this touches on the burden this law puts on physicians. The language permits abortion if a fetal anomaly is incompatible with life outside the womb. Of course, prematurity is not an anomaly. But let's say a fetus has a cardiac, or neurologic deformity. With advances in life support, it could be a really difficult task to assess its survival chances. What would meet the test of being unable to survive outside the womb? Would a 23% chance of survival qualify? Does it have to be 0%? It's so vague. This is a big problem. These laws which regulate medical practice seem to be made by people who have no idea about how medical decision making really works, and how uncertain it can be.
 
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