Kontextmaschine

26th August 2022

Post reblogged from youzicha with 30 notes

youzicha:

kontextmaschine:

So we hear that ectopic pregnancy is (can be?) fatal, so uh, how was it treated before Roe v. Wade? Just therapeutic surgical abortion? And before that?

Like, if this has always been a thing that happens to humans, it left traces on history, right? I knew that pregnancy used to be more often fatal with women dying in childbirth, but I’m trying to think of a historical, even fictional occasion of a woman getting pregnant and it just going sideways. There might well be, but still, I’m trying to think of it.

Midwives! Was this one of their things, that they had some key to recognizing and then providing abortifacient herbs?

According to The history of the diagnosis and treatment of ectopic pregnancy: a medical adventure,  

Until the 19th century, ectopic pregnancy was known only as a universally fatal accident.

Before the invention of ultrasound imaging in the late 1960s and precise measurements of hCG levels in the 1970s, early ectopic pregnancies were very difficult to diagnose accurately. The main signs are pain (particularly in the abdomen and shoulder) and vaginal bleeding, but bleeding also occurs in around 10% of normal early pregnancies so this is not specific at all. Doctors would diagnose it in the later stages, and confirm by autopsy.

Towards the end of the 19th century there was some attempts at medical management, but not successfully:

Since the ectopic fetus was thought to be responsible for killing the mother, the treatment was directed at killing the fetus. The arsenal included starvation, purging and bleeding of the mother, administration of strychnine, passage of electromagnetic, galvanic or Faradic currents through the ectopic mass and injection of morphine into the fetal sac [4,7]. Whatever the treatment, the prognosis was bad: the fatality rate towards the end of 19th century was between 72 and 99 percent [5].

The breakthrough came in 1883, when Lawson Tait successfully treated a ruptured tubal pregnancy by surgery. In the 1880s he treated a series of cases, and around 1890 this started to become generally adopted. For the next 70 years, surgery remained the only treatment. 

In the 1980s (so postdating Roe v Wade), medical treatment was developed.

Methotrexate, a folanic acid antagonist, was first reported by Li and Hertz in 1956 to be effective in the treatment of gestational trophoblastic disease [59]. The first case report of methotrexate use in therapy for abdominal ectopic pregnancy appeared in 1968 [60] and for tubal pregnancy in 1982 [61]. 

Note that the modern abortion drugs were developed in the 1980s too. At the time there were some experiments with using abortion drugs (mifepristone etc) for ectopic pregnancies, but none of them seemed to work as well as methotrexate, which remains the current standard treatment.

Ectopic pregnancy is surely not universally fatal, since some of them resolve through spontaneous abortion, but because it is hard to diagnose it is difficult to know how what the untreated fatality rate is. Conversely, I guess in the old days some deaths from internal bleeding in the first trimester might not have been understood as pregnancy-related.

Well, question answered.

Tagged: ectopic pregnancyhistory