A first-of-its-kind analysis by ProPublica found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased by more than 50% after Texas’ near-total abortion ban went into effect in September 2021. The analysis also identified at least 120 in-hospital deaths of pregnant or postpartum women in 2022 and 2023 — an increase of dozens of deaths from a comparable period before the COVID-19 pandemic.
Nothing screams pro-life more than sacrificing women to maintain the image that you care about babies
Since Texas banned abortion, no one has studied the statewide effects on pregnant women experiencing complications. Here’s how we sifted thr
Since Texas banned abortion, no one has studied the statewide effects on pregnant women experiencing complications. Here’s how we sifted through data on millions of pregnancy hospitalizations and analyzed the outcomes before and after the ban.
Sepsis rates for women hospitalized during second trimester pregnancy loss spiked after Texas’ abortion ban. Note: For hospitalizations involving a pregnancy loss between 13 weeks’ gestation and the end of the 21st week. Rates are annual. Credit:Lucas Waldron/ProPublic
by Andrea Suozzo, Sophie Chou and Lizzie PresserFeb. 20, 2025,
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
A first-of-its-kind analysis by ProPublica found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased by more than 50% after Texas’ near-total abortion ban went into effect in September 2021. The analysis also identified at least 120 in-hospital deaths of pregnant or postpartum women in 2022 and 2023 — an increase of dozens of deaths from a comparable period before the COVID-19 pandemic.
Neither the CDC nor states are investigating deaths or severe maternal complications related to abortion bans. And although the federal government and many states track severe complications in birth events using a federally established methodology, far less is known about complications that arise during a pregnancy loss. There is no federal methodology for doing this, so we consulted with experts to craft one.
We acquired Texas hospitalization data from 2017 through 2023, giving us more than two years of data after the implementation of the state’s six-week abortion ban in September 2021, and more than a year of data following its full abortion ban, which went into effect in August 2022.
We spoke with dozens of researchers and clinicians to adapt the federal algorithm for birth complications to focus on severe complications in early pregnancy, before fetal viability.
This methodology lays out the steps we took to complete this analysis, to help experts and interested readers understand our approach and its limitations.
Identifying Second-Trimester Hospitalizations
We purchased seven years of inpatient discharge records for all hospitals from the Texas Department of State Health Services. These records contain de-identified data for all hospital stays longer than a day, with information about the stay, including diagnoses recorded and procedures performed during the stay, as well as some patient demographic information and billing data.
Within this dataset, we opted to focus on second-trimester pregnancy loss, because first-trimester miscarriage management often occurs in an outpatient setting. In the future, we plan to look at outpatient data as well.
To examine outcomes in the second trimester, we first identified hospitalizations where a pregnancy ended. We used a methodology to identify severe complications in birth events developed by the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Alliance for Innovation on Maternal Health, an initiative of the American College of Obstetricians and Gynecologists. The method is outlined in statistical code published by HRSA, and it first identifies every hospitalization with a live birth, stillbirth or an “abortive outcome” (which refers to an intended or unintended pregnancy loss before 20 weeks). Rather than excluding those abortive outcomes to focus on birth, as the HRSA code directs, we included them to look at all hospitalizations where a pregnancy ended. This narrowed our list of hospitalizations to an average of 370,000 per year.
The HRSA methodology further filters hospitalizations to only patients who are female and between the ages of 12 and 54. Our dataset had five-year age ranges, so we filtered to ages between 10 and 54. This brought our hospitalization list to 364,000 each year, on average.
For each hospitalization where a pregnancy ended, we looked for a diagnosis code recording the gestational age of the fetus. In cases where a long hospitalization had multiple gestational week codes recorded over the course of the stay, we took the latest one.
We excluded pregnancy-end hospitalizations without a gestational week code from our analysis — removing about 49,500 hospitalizations, or 1.9% of our dataset. More than two-thirds had coding that indicated a birth, likely to have occurred after 20 weeks.
Based on conversations with doctors and researchers, we narrowed our focus to hospitalizations where a pregnancy ended in the second trimester before fetal viability, from the start of the 13th week through 21 weeks and six days. While pregnancies that end at 20 and 21 weeks are often coded as births, rather than abortive outcomes, we included those weeks in our definition of pregnancy loss because experts told us it’s extremely unlikely that a baby born at 21 weeks could survive. This brought our list of hospitalizations to 15,188.
The number of second trimester hospitalizations, and characteristics of the women hospitalized, was largely stable from 2017 through 2023, the years of our analysis. In 2023, however, as the number of births in the state increased, the number of hospitalizations in our window declined to 2,036, below the yearly average of 2,169.
The race and ethnicity of patients each year, as well as the proportion of these hospitalizations in which the patients were covered by Medicaid or uninsured, did not change significantly after the state’s 2021 abortion ban, known as SB 8, went into effect.
Determining Sepsis Rates
Within these hospitalizations, we looked for diagnoses of sepsis, a life-threatening complication that can follow delays in emptying the uterus. The CDC defines a list of sepsis codes associated with severe maternal complications, which formed the basis of our definition. However, that list of codes is developed to look at sepsis in birth events, the vast majority of which occur much later in a pregnancy than our hospitalizations. We identified five sepsis codes associated with early pregnancy events like ectopic pregnancy and miscarriage, adding them to the existing list of sepsis codes to develop a definition that more fully captured early pregnancy complications.
To compare rates before and after the implementation of SB 8, we grouped the nine quarters of data we had after the implementation of the ban (October 2021 through December 2023) and compared it with the nine quarters immediately before (July 2019 through September 2021). Our dataset gives us the quarter in which a patient was discharged from the hospital but not the exact date, so the “before” group contains one month of data from after SB 8 went into effect on Sept. 1, 2021.
Identifying Fetal Demise
The standard of care for second-trimester miscarriage or rupture of membranes prior to fetal viability is to offer patients a dilation and evacuation or an induction to end the pregnancy — even if there is still a fetal heartbeat. In our reporting, we’d heard that because of the language of Texas’ abortion law, some hospitals and doctors were waiting for the fetal heartbeat to stop or the mother to develop a life-threatening illness, whichever occurred first. To look into this, we wanted to separate hospitalizations in which doctors would have theoretically been able to offer a termination immediately under the law — ones where the patient had a diagnosis indicating that there was no fetal heartbeat at the time of admission to the hospital — from ones where doctors may have waited to provide care.
We determined that about half of our second-trimester hospitalizations did not have a fetal heartbeat on admission. We identified these cases by focusing on two sets of diagnosis codes: Prior to 20 weeks gestation, a diagnosis of “missed abortion” refers to a miscarriage where the fetus has stopped developing, but the body has not yet expelled the tissue. After 20 weeks, a diagnosis of “intrauterine death” indicates that the fetus has died. For both diagnoses, we included only those that were marked as “present on admission.”
Sepsis Rate Findings
Our analysis found that the sepsis rate in second-trimester pregnancy loss hospitalizations increased after the state’s ban went into effect, and the surge was most pronounced in cases in which the fetus may still have had a heartbeat when the patient arrived at the hospital.
In the nine quarters before SB 8 went into effect, the sepsis rate in second-trimester pregnancy loss hospitalizations was 2.9%. In the nine quarters after SB 8 went into effect, the sepsis rate was 4.5%, an increase of 55%.
Since our total number of sepsis cases was relatively small, we measured whether the two groups of data were significantly different using a t-test. We calculated sepsis rates for second-trimester hospitalizations in the nine quarters after SB 8 went into effect and compared that with sepsis rates during the nine quarters immediately prior. We found that increase to be statistically significant (p-value < 0.05).
Sepsis Rate Increased Over 50% for Second-Trimester Pregnancy Loss Hospitalizations After SB 8
We compared the nine quarters after SB 8 went into effect — from October 2021 through December 2023 — to the nine quarters before the ban went into effect — July 2019 to September 2021.
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Features communicate you a bit more legation till evolve your drama-writing with color, adjectives and vignettes.<\p>
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The strong point to try long articles is through better design. Photographs and detached visual elements can be used to bankrupt up enduringly text, and navigation buttons can offer readers a way to broad jump in transit to different armhole relative to the article, Manjoo suggests.<\p>
It may be worth a verification.<\p>
In reference to WebBoxDesigners.co.uk:<\p>
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