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A woman with a life-threatening ectopic pregnancy sought emergency care at the University of Michigan Hospital after a doctor in her home state worried that the presence of a fetal heartbeat meant treating her might run afoul of new restrictions on abortion.

At one Kansas City, Mo., hospital, administrators temporarily required “pharmacist approval” before dispensing medications used to stop postpartum hemorrhages, because they can also be also used for abortions.

And in Wisconsin, a woman bled for more than 10 days from an incomplete miscarriage after emergency room staff would not remove the fetal tissue.

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Carley Zeal, an OB/GYN in southern Wisconsin and a fellow with Physicians for Reproductive Health, said she recently treated a woman at risk of infection after a miscarriage. Zeal said providers at another hospital had wrestled with what services they could perform — with an 1849 law banning almost all abortions back in effect — and ultimately refused to remove the fetal tissue from the patient’s uterus.

“It really delayed her care,” Zeal said. “I saw her a week and a half later with an ongoing miscarriage and bleeding, increasing the risk of severe bleeding as well as infections.”

Zeal gave the patient abortion medication to expel the fetal tissue.

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Zeal said another physician in her practice contacted her the week after the Supreme Court decision as she treated a patient with a ruptured ectopic pregnancy. “She knew exactly what she had to do because [the woman] was bleeding and was clearly going to die if nothing was done,” Zeal said. “But she wasn’t sure what she needed to document to be sure she wouldn’t be charged with a felony.”

[...]

To protect herself from criminal prosecution, Zeal’s colleague Elana Wistrom turned to an emergency room physician who treated the patient and a radiologist who reviewed the ultrasound showing the rupture — a process that took more than an hour.

“It turned my attention away from the bedside of the critical-care patient toward documentation,” Wistrom said.

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“People are running scared,” said Mae Winchester, a specialist in maternal-fetal medicine in Ohio who, days after the state’s new restrictions went into effect, sought legal advice before she performed an abortion on a pregnant woman with a uterine infection. “There’s a lot of unknowns still left out there.”

The need to intervene in a pregnancy with the same medication or surgical procedure used in elective abortions is not unusual.

As many as 30 percent of pregnancies end in miscarriage, the spontaneous demise of a fetus, commonly because of chromosomal abnormalities. The methods of managing a miscarriage are the same as for abortion, using a combination of drugs — mifepristone and misoprostol — or a brief surgery known as dilation and curettage, or D&C, to dilate the cervix and scrape tissue from the uterus. Left untreated, some miscarriages resolve naturally; others lead to complications such as infection or profuse bleeding.

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Patricia Nahn, another OB/GYN in Zeal’s practice, said she recently had a patient displaying signs of an ectopic pregnancy, including abdominal pain. But because this was not a clear-cut case in which an ultrasound showed the fetus developing outside the uterus, Nahn faced the potential of terminating a fetus that was in the uterus and violating Wisconsin’s abortion ban.

Instead of prescribing medication to terminate the pregnancy in the safest manner, as she would have done before last month’s ruling, Nahn said, she was forced to perform a riskier, invasive surgical procedure to confirm the location of the ectopic pregnancy before ending it.

“If you had just waited and done nothing because you were afraid, she could have died,” Nahn said.

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Delaying treatment for an ectopic pregnancy is so dangerous it would amount to malpractice, said Pamela Parker, an OB/GYN in Texas’s Rio Grande Valley, who has decided to practice in Arizona because of Texas’s restrictions and the overturning of Roe.

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Lisa Harris, associate chair of obstetrics and gynecology at the University of Michigan, said doctors are discussing creating a national registry of cases ranging from ectopic pregnancy to cancer and heart disease in which “people may not get what is currently standard of care in counseling or treatment.”

  WaPo

And let's not forget the 10-year-old rape victim who had to cross state lines from Ohio to Indiana and whose abortion doctor is under scrutiny even though abortion was still legal in that state. That's soon to change.

Indiana lawmakers are considering new restrictions on abortion in a special session in late July. At least one legislator has floated a total ban with no exceptions to save the patient’s life.