Introduction

After the 2022 Supreme Court decision Dobbs v. Jackson Women’s Health Organization to revoke federal abortion rights, many restrictive state abortion laws took effect.1 2 Most legislation limits abortion under almost all circumstances, with exceptions for ‘life-threatening emergency’ –an ill-defined term. Pregnancy even without comorbidities can be life-threatening, particularly in the United States (US) where pregnancy-related morbidity and mortality are disproportionately high.3 Restrictive abortion legislation creates a system where physicians are expected to make clinical decisions based on legal interpretation rather than standard of care, subjecting patients to treatment delay or denial.

To better comprehend the scope of this legislation from the perspective of those interpreting and acting on it, we – a group of obstetrician-gynaecologists – evaluated language used to define legislative ‘medical exceptions’. We focused on applying exceptions to treating the condition of caesarean scar ectopic pregnancy (CSEP). CSEPs occur when an embryo implants within a caesarean hysterotomy site, making progression to a viable gestational age high risk for placenta accreta, hysterectomy and haemorrhage.4 Due to this morbidity, the Society for Maternal–Fetal Medicine (SMFM) recommends CSEP termination, which could be criminalised depending on state law.5