Nevada: Reproductive Care in the Silver State

The US state of Nevada is famous for its silver mines, its casinos, and maybe for a system of fairly unrestrictive laws on a whole lot of topics. The situation when it comes to pregnancy, reproductive care, and abortion, also fits in with this general Nevada live-free environment. Nevada is a pro-choice state, which makes the state also friendly to pregnancy.

Ever since the Supreme Court of the United States (SCOTUS) decided the Dobbs versus Jackson Women’s Health Organization abortion case, we have been comparing the laws related to abortion and similar issues from US state to US state, region by region. SCOTUS decided the Dobbs case in a way that overturned the 1973 Roe v Wade decision, with a 5-4 majority. In the aftermath of this decision, the United States is now a patchwork of very different laws when it comes to reproduction and abortion in particular. In some states, reactions to the Dobbs decision affects, not only abortion care, but other, related issues, such as fertility treatment and contraception. In many cases, pregnancy care itself is not optimal, because laws that criminalize elective abortion could be applied against those who perform or receive medically necessary abortions, or even in cases of procedures to treat ectopic pregnancy or that remove dead products of conception following missed abortions (a type of miscarriage). Tragically, there have been a growing number of cases of antiabortion pharmacists denying women, men, and children medications that they must take for chronic diseases, such as systemic lupus erythematosus or rheumatoid arthritis, due to the fact that certain medications could be used as abortifacients, agents that provoke abortion. But such extreme cases have occurred, only in certain locations. States, such as Tennessee, Georgia, Alabama, Arizona, and Missouri are extremely hostile to the right to choose, while various pro-choice states. Various other states, such as New York, Connecticut, Illinois, Oregon, and Washington are very supportive of the right to choose.

Nevada, the Silver State, falls into this latter category. You can have an elective abortion in Nevada up to 24 weeks gestation, which aligns with the fetal viability (24-26 weeks gestation), which mostly relates to the maturity of the fetal lungs. The 24 week limit, of course, does not apply to cases in which the mother’s life is in danger, in which case you can have an abortion later too. Generally, women who choose late term abortions do so because prenatal testing revealed some very severe problem with the fetus, indicating that the child will be very sick and will suffer and have a very short life. Along with being able to have an abortion in peace, if you suffer an ectopic pregnancy, or if you suffer a spontaneous abortion, it goes without saying that doctors and nurses in Nevada will have no concern that somebody might prosecute them for saving your life by getting an inviable fetus or dead products of conception out of you.

Unlike in many other states, including many pro-choice states, Nevada does not require parental notification or parental permission in order for a minor to undergo an abortion. If you’re in Nevada and want to terminate your pregnancy, you can have a procedural abortion at any point, you also can have a medication abortion up to 77 days (11 weeks) gestation. One type of procedure that can be used for an abortion is called a D&C, which stands for dilatation and curettage. Curettage is a kind of scraping of the inner lining of the uterus. Extracting a pregnancy, either viable or not, is only one of several reasons for performing a D&C. D&Cs can be performed for diagnostic reasons, such as when there’s a suspicion of abnormal cell growth in the endometrium. Therapeutic D&Cs can be performed for removing products of conception, but also for removing overgrowth of the uterine lining.

D&C by itself is adequate only early in pregnancy, so after a certain point the next option is dilatation and suction. This means that, after the cervix is dilated, the doctor suctions out the products of conception. Sometimes this can be done with a syringe, but often it requires power suction. A tube called a cannula is inserted through the opened cervix. Cannulae come in a range of sizes that are chosen based on how far along the pregnancy is, or was before it became inviable. In some cases, following suction, the doctor may then perform some curettage to extract any remaining products of conception.

At some point during pregnancy, generally around the midpoint, suction is not enough to extract either a viable or inviable fetus. In such cases, the OB/GYN must use instruments to grab onto the fetus, or parts of the fetus. Such a procedure is known as a D&E, which stands for dilatation and extraction. The extraction includes not only the fetus, but also the placenta, as well as the membranes. All the products of conception must be removed and accounted for, because products that remain inside the uterus can become infected. In discussing these techniques, notice how we have switched back and forth between mentioning elective and non-elective procedures. That’s because performing any of these procedures requires the same set of skills regardless of whether it’s a medical necessity, such as removal of retained products after a missed abortion, or it’s an unwanted pregnancy.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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