‘Abortion’ can mean many things, medically speaking

DEAR DR. ROACH: What’s the difference between a tubal pregnancy and an abortion? Are they the same thing?

ANSWER: The term “abortion” has several meanings medically, but most people think of only one type, the elective abortion. A “spontaneous abortion” is another term for a miscarriage. A “missed abortion” is when the fetus is no longer alive, but the placenta and nonviable fetal tissue remain in the uterus.

A tubal pregnancy refers to a pregnancy outside the uterus, the vast majority of which are in the Fallopian tube, which carries the ovum (egg) from the ovary to the uterus. Rather than implanting in the uterus, occasionally the fertilized egg will implant in the tube, hence the term “tubal” pregnancy. This is a potentially life-threatening condition for the mother, and there is virtually no chance of a successful pregnancy. In these cases, medical treatment or surgery is almost always required.

In a few cases, when the embryo in the Fallopian tube is very small and the blood levels of HCG are low and falling, the tubal pregnancy is allowed to spontaneously miscarry. However, most of the time, treatment is required and sometimes lifesaving. When caught early, medication treatment is as effective as surgery, but there are times when surgery is the only option. In this case, the procedure is sometimes called a “therapeutic abortion.”

Physicians must be careful to use the correct terms, as the implications differ greatly.

DEAR DR. ROACH: I recently read your comments to the patient who had taken tramadol for many years safely, but had a new physician unwilling to prescribe it. Many states have implemented new rules and guidelines regarding the prescribing of any controlled substance to help with the opiate overdose epidemic.

These rules greatly reduce the number of days and number of prescriptions that can be written. Physicians are required to check databases before prescribing. There are specific rules regarding patient follow-ups and documentation. I suspect that a chronic cough is not an allowed condition to warrant long-term opiate use. A number of physicians are now nervous and afraid of board actions and losing their license if they do not comply.

ANSWER: I have empathy for physicians who are genuinely worried about losing their licenses.

I also understand that there have been many instances in which medical providers have been complicit in overprescribing opiates, and that has a large factor in the current epidemic of prescription drug abuse.