By Dr. Anthony Policastro

One of the topics that has arisen after the recent Supreme Court decision about abortion is risk to a mother’s life from a pregnancy. There are two terms that are relevant. One is the definition of elective abortion. That refers to a voluntary termination of pregnancy. The other is a therapeutic abortion. That refers to a procedure that is dictated by medical circumstances.

This is a medical topic that is not often understood by the average person. Part of that is because it is rare. There are over 3.5 million births every year in this country. Of that number about 700 of the mothers die related to pregnancy complications.

About 69 percent of those deaths occur during delivery or soon after delivery. That means that the 31 percent of mothers who die during pregnancy comes out to a little over 200 deaths per year.

We know that delivery will soon follow ruptured membranes (water breaking) in a pregnant woman. If the mother is well into the pregnancy, we usually wait 24 hours for her to go into labor. 

If during that period, she shows signs of infection from the leaking fluid being contaminated we proceed with delivery. That might mean induction. It might mean C-section. In any case it results in a baby being born. It might result in a premature infant being born but we still have a live infant and a live mother.

There is more of an issue when the membranes rupture early in pregnancy. We know that infection will occur. We know that the infection will result in a miscarriage. If we wait until the miscarriage occurs, the mother may also die from the infection. If the infant is aborted, the mother will survive. This is an example of an instance where the mother’s life is at risk.

In some cases the placenta starts to separate early in pregnancy. When that happens the infant will not get enough nutrition. It will result in a miscarriage. It is associated with maternal hemorrhaging. If we wait for the miscarriage to occur, the hemorrhaging can cause the mother to die. If it happens late in pregnancy, we do a C-section. It might result in a premature infant being born but we have a live infant and a live mother. 

When it happens early in pregnancy the infant will not survive because there is no placenta to provide nutrition. If we wait for the miscarriage to occur, the mother may hemorrhage to death in the meantime. This is an example of an instance where a mother’s life is at risk.

There are other situations where the embryo stops in the mother’s Fallopian tube and does not get to the uterus. Ultimately, the tube will rupture and the baby will die. The mother will die as well if the tube and infant are not removed.

These are examples of situations where the choice is to save the mother or to lose both the mother and the infant. There is not a way for the infant to survive the situation. A miscarriage will occur regardless of what is done. They are known as therapeutic abortions to distinguish them from the elective abortions that women with normal pregnancies choose to have.

These occurrences happen about 200 times a year. It is not usually a choice as to whether the baby or mother should survive. The infant will die in each instance as an early pregnancy miscarriage. It is more often a choice of deciding whether both should die or the mother should be saved.

COVID update- The total number of cases in Sussex County has gone from 139.61 per 100,000 people to 175.9 per 100,000 people. As far as actual numbers go, Sussex County has gone from 318 last week to 433 this week. That is the first time we have been back over 400 since June 10.

The number of inpatient beds with COVID patients has gone from 5.1 percent last week up to 5.9 percent this week. That keeps us in the low risk range (less than 10 percent) for that measurement.  

New COVID admissions have gone from 10.4 per 100,000 people up to 15.8 per 100,000 people. That keeps us within the medium risk zone (between 10 and 19.9 admissions per 100,000 people) for that measurement.

In the meantime, Sussex County has stayed in the medium risk category because of inpatient admissions for COVID-19. However all three metrics are rising suggesting another local surge is likely coming. 

If we move to more than 200 cases per 100,000 people or to 20 or more admissions per 100,000 people, that would put us back into the high risk zone. If either measurement goes up at the same rate it did this week, then we will be in the high risk zone next week. The suggestion when that happens is to wear masks in indoor locations.

Nationally, the numbers were 803,000 last week. This week they sit at  937,000 cases. That is the highest number since the Omicron wave on Feb. 14. It would appear that we are well on our way to the next surge with the current BA5 variant. 

This one appeared to start on July 11, right after the end of the 78 day period for the last surge. If this one follows the same 78 day course as those last three surges, it should taper by Sept. 18.