On June 24, 2022, Roe v. Wade was overturned by the U.S. Supreme Court, leaving regulation of abortion to the discretion of the states. Since then, many states have enacted laws to strictly regulate abortion, resulting in complex legal considerations for medical professionals.^1,2 This article reviews key statutes in the states with the strongest prohibitions against abortion and offers documentation principles for treating patients with ectopic pregnancies, spontaneous miscarriages, and other pregnancy-related emergencies.

Summary

New state laws aim to reduce elective abortions and exempt treatment of ectopic pregnancies, spontaneous miscarriages, fetal demise, and fetal nonviability from prosecution. They do not, or should not, affect care in the emergency department. Current literature suggests criminal and civil actions against emergency clinicians under these strict laws remains low.^3,4 However, there have been multiple lawsuits claiming that emergency care was not given because of these new laws or misunderstandings of the laws by clinicians.^3,4 Thus, legal problems are more likely to arise from not providing routine emergency care than from altering the standard of care out of fear of prosecution.⁵

Note

Contraception, implantation prevention (“morning after”), RU-486, and other medications intended to end an otherwise viable pregnancy (which poses no threat to the pregnant woman’s health) are beyond the scope of this article. Treatment of ectopic pregnancy with medications or surgery is within the scope of this article, as are standard medical and surgical treatments for spontaneous abortion, septic abortion, and any related conditions that threaten the mother’s life and health.

General Principles

In the care of any acute pregnancy-related emergency, provide usual, appropriate care.

Document specific legal exemptions in cases of ectopic pregnancy, spontaneous miscarriage (full or incomplete), nonviable fetus, or fetal demise.

In cases where treatment may likely or possibly result in the loss of a potentially viable fetus, document an understanding of the risk and that the risk to the mother’s life, health, or bodily function outweighed the risk to the fetus.

RELEVANT STATE STATUTES, EXEMPTIONS, AND DOCUMENTATION SUGGESTIONS

Alabama

Statute: Alabama Code § 26-23H-1, et seq.

Exemptions: Ectopic pregnancy, lethal anomaly, the child would not survive birth, would die shortly after, be stillborn, or a medical emergency where the condition presents serious health risk to the pregnant woman, such as severe bleeding or sepsis.

Suggestions: This suggests that ectopic pregnancies and life-threatening miscarriages are exempt. A second physician’s sign-off is required within 180 days for treatment of incomplete miscarriages threatening the mother’s life or body organ dysfunction.