ASSOCIATION OF ABORTION RESTRICTIONS AND HYSTEROTOMY FOR PREVIABLE DELIVERY

Objectives

We aimed to determine the proportion of previable hysterotomy in the US and any differences by geographic region or state-level abortion restrictions.

Methods

Absolute numbers and proportions of previable “cesarean deliveries” from 2014 to 2023 were obtained using publicly available data from the US Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Data were analyzed by census region and state-level abortion restriction category determined by the Center for Reproductive Rights: illegal, hostile, not protected, protected, and expanded access, via chi-square test.

Results

Between 2014 and 2023 across the US, 32,165 deliveries from 17 through 21 weeks were reported as “live births.” Of those, 814 (2.5%) were delivered via hysterotomy and reported as “cesarean delivery.” The South had a higher proportion of previable hysterotomy than the rest of the US (3.1% vs. 2.1%, p<0.001). The proportion of previable hysterotomy was higher in states where abortion is illegal than in all other states (3.9% vs. 2.1%, p<0.001). Among 73,371 previable fetal deaths (20-23 weeks) between 2014 and 2022, some 2,480 (3.4%) were managed via hysterotomy, with a higher proportion occurring where abortion is illegal (4.7% vs. 3.0%, p<0.001).

Conclusions

At previable gestational ages, interventions to improve neonatal survival are futile. Hysterotomy increases the rate of maternal complications and complicates care in future pregnancies. Yet, 2.5% of previable “live births” and 3.4% of previable fetal deaths were managed with hysterotomy. Proportions were highest in the South and in states with abortion bans, representing significant preventable morbidity as a potential impact of restrictive abortion policies.