TRACY JAFFE: What does it means to be the first physician to diagnose a live pregnancy?

EDITOR'S NOTE: Tracy Jaffe is a professor of radiology at Duke University School of Medicine.

“What do we do now, Dr. Jaffe?”

Several of our Radiology trainees asked me this question the Monday after the overturning of Roe v. Wade. These anxious young doctors wanted to know how the U.S. Supreme Court decision would affect our reporting of first trimester ultrasounds. Prior to this jarring departure from precedent, I hadn’t given this aspect of reproductive care much thought.

Radiologists are physicians who use medical imaging like ultrasound, CT and MRI to diagnose and treat disease. As an abdominal radiologist at an academic medical school, I work side by side with residents who are learning this specialty. Our job is to provide care alongside our trainees and prepare them for independent work in their future.

Often, we are the first physicians to diagnose a live pregnancy. The first trimester ultrasound is used to confirm that the pregnancy is in the uterus, where it’s supposed to be, and verify that the embryo is healthy. At six weeks gestation, an embryo should have a heartbeat.

My residents were asking what it means to be the first physician to diagnose a live pregnancy and what kind of risk are we putting the patient in when we document a heartbeat?

It is a great question. Right now, after we report the first trimester ultrasound, a patient decides for herself what happens next (often with support from her health care providers). But across the country, when radiologists describe the presence of a heartbeat on an ultrasound, it now has new meaning for patients, because politicians and the judicial system have stripped that autonomy from the patient. In many parts of the country, what she wants or what is right for her health doesn’t matter anymore.

Will we be putting a patient in harm’s way after we sign our radiology report? North Carolina has a 20-week abortion ban, but no heartbeat ban, at least not yet. We have tight state legislative races in November that could usher in or stave off a conservative veto-proof majority.

If the former happens, we may find ourselves in the same place as the 9 states that ban all abortion and the 4 states that ban abortion when a heartbeat is present. What will that look like for our patients?

The answer is: I’m not sure. But what I anticipate is a lot more crying in ultrasound rooms. I foresee much more confusion about what happens next for the patient. And that confusion will be dangerous.

First trimester ultrasound is also used to diagnose pregnancy-related complications. I worry about fear driving pregnant patients to postpone medical care and possibly increase the complexity and severity of their symptoms.  And delay can mean a life and death difference in the presence of ectopic pregnancy (the medical condition when a live embryo implants outside of the uterus).  If not diagnosed early, ectopic pregnancies will rupture and cause catastrophic bleeding.  And that is a true emergency.

On one recent day, we saw two patients with ectopic pregnancies. The first pregnancy had already ruptured and was bleeding, and she was rushed to emergency surgery. The second had not yet ruptured, and the embryo had a heartbeat.  That embryo cannot survive outside the uterus and left untreated, will cause massive bleeding.

In this case, the patient got the care she needed quickly. What happens if North Carolina legislators pass a veto-proof heartbeat ban and it becomes impossible to care for patients quickly without checking for permission with the lawyers? What happens if doing the correct thing for patient safety becomes criminalized?

Here’s what I told our residents: Our responsibilities as radiologists don’t change. We continue to take care of patients. But we advocate outside of the hospital.

We remind the country that health care providers are the medical experts, not the politicians. We stand in opposition to legislative and judicial obstruction of healthcare.

Others have already picked up the torch. In a joint statement of 75 health care organizations opposing legislative interference, experts remind us that “Keeping the patient-clinician relationship safe and private is essential not only to quality of individualized care but also to the fabric of our communities and the integrity of our health care infrastructure.”

The ability to choose what happens to your body is a fundamental right, regardless of political affiliation. Reproductive freedom is not a political issue, it’s a health care issue. We won’t change the way we practice medicine, at least not in radiology.

But when we leave the hospital, we will advocate for the health and welfare of our patients. We will lobby, provide our expertise, and share our experiences. And to protect the health of women and their loved ones, we will get out the vote.

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