From attempted abortion to pregnancy continuation: ethical and clinical challenges in comprehensive hospital-based gestational support

Abstract

Argentine legislation on voluntary termination of pregnancy guarantees access to abortion within a framework that requires the provision of accurate, accessible, and non-coercive information while ensuring respect for the autonomy of the pregnant person. However, there is no evidence regarding the impact that comprehensive, non-directive counseling may have on reconsideration of an initial decision to terminate a pregnancy. In this context, the EVA Project (Supported Vulnerable Pregnancy) was developed at a university hospital in Buenos Aires with the objective of providing multidisciplinary support to women seeking pregnancy termination, prioritizing active listening, emotional support, and the delivery of comprehensive information. To illustrate the complexity of care in initiatives of this kind, we present the case of a woman who attempted to terminate her pregnancy at 11 weeks’ gestation using misoprostol. When the expected therapeutic response did not occur, she presented to the hospital intending to continue the procedure she had initiated. After voluntarily receiving support from the EVA Project team, she freely chose to continue the pregnancy. Subsequent evaluation revealed amniotic band syndrome, for which fetoscopic release was performed with favorable results, allowing the pregnancy to progress without complications. Although based on a limited number of cases, this initial experience suggests that implementing a hospital-based, multidisciplinary support model that respects autonomy, promotes informed and non-directive decision-making, and provides emotional support for women experiencing vulnerable pregnancies, regardless of pregnancy outcome, is feasible. Further studies are needed to assess its long-term impact on decision-making processes and maternal-fetal outcomes.