Intact dilation and extraction

Intact Dilation and Extraction (IDX), also known as intact D&E, intrauterine cranial decompression, and partial-birth abortion, is a surgical procedure that removes an intact fetus from the uterus. The procedure is used both in late-term miscarriages and in abortions in the second and third trimesters of pregnancy. It has been a subject of significant legal, ethical, and medical debate.

Procedure

Intact dilation and extraction involves the dilation of the cervix, followed by the extraction of the fetus through the cervix and vagina. The procedure is typically performed under general anesthesia or deep sedation. It begins with the dilation of the cervix, which is achieved through the insertion of laminaria (dried seaweed sticks) or synthetic dilators a day or two before the procedure. Once the cervix is sufficiently dilated, the fetus is extracted in a manner that preserves the integrity of the fetal body. This is often achieved by reducing the cranial volume of the fetus, allowing its head to pass through the cervix.

Indications

IDX is performed for various reasons, including fetal anomalies, health risks to the mother, and cases where the fetus is not expected to survive after birth. It is considered by some medical professionals to be safer for the woman than a standard D&E, where the fetus is dismembered within the uterus and then removed in pieces, because it minimizes the risk of uterine perforation and infection.

Legal and Ethical Considerations

The legality of intact dilation and extraction has been a contentious issue in many countries, particularly in the United States. In 2003, the U.S. Congress passed the Partial-Birth Abortion Ban Act, which specifically targeted this procedure. The Act defines partial-birth abortion as an abortion in which the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus. The Supreme Court upheld the ban in 2007 in Gonzales v. Carhart.

Medical and Public Opinion

Medical opinion on IDX is divided. Proponents argue that in certain cases, it may be the safest option for the woman, particularly in late-term pregnancies where other methods pose greater risks. Critics, however, argue that the procedure is rarely medically necessary and that it crosses ethical boundaries.

Public opinion on IDX is similarly divided, often reflecting broader societal views on abortion. Debates around IDX frequently touch on issues of fetal viability, women's rights, and medical ethics.

See Also

• Abortion
• Dilation and Evacuation
• Fetal Viability
• Late Termination of Pregnancy