Maternal-fetal specialists publish guidance to help high-risk pregnancy care in states with abortion bans

# What the guidance is and who issued it

Medicine (SMFM) published a special statement providing standards for clinicians who care for high-risk pregnancies in states with abortion bans. The guidance is aimed at maternal-fetal medicine specialists, obstetric care teams and hospital administrators operating where state restrictions limit abortion access.

# Why the guidance was published

High-risk pregnancy specialists manage patients with conditions such as hypertension, diabetes, cancer, fetal anomalies and other complications. In states with abortion bans, those conditions can escalate into life-threatening situations when providers and systems are uncertain about when termination is legally permitted. The lack of clear, consistent policies has produced confusion, variable institutional responses and care delays.

The statement cites research comparing outcomes before and after the passage of Texas' Senate Bill 8 (2021). That research found higher complication rates in restricted settings: 57% of cases resulted in blood transfusion, intensive care admission or serious infection versus 33% in comparable settings without restrictions. In all reviewed cases, the fetus did not survive.

# Key recommendations

• Build cross-state referral networks. The guidance encourages hospitals and clinics to establish formal referral pathways so patients can access permitted care in jurisdictions where it is allowed.

• Reach agreement on permissible care. Health systems and providers should work together to define consistent interpretations of state law to reduce uneven policies that confuse frontline clinicians.

• Engage legal teams. Providers should partner with legal counsel to understand how federal laws such as the Emergency Medical Treatment and Labor Act (EMTALA) may require certain interventions even in restrictive states.

• Expand allowable services. Hospitals and clinics should provide the full range of abortion care that is legally permitted in their state and recognize maternal-fetal medicine specialists as authorities on best practices.

• Train clinicians in basic procedures. Where allowed, training for termination procedures should be part of preparedness for managing high-risk cases that may require timely intervention.

# How the guidance aims to reduce legal and clinical risk

# Context within professional recommendations

# Practical implications for patients and systems

# Takeaway

The SMFM statement translates clinical expertise into actionable system steps for regions where abortion bans complicate treatment of high-risk pregnancies. It aims to reduce inconsistent practices and delay-related harms by outlining legal coordination, referral structures, training and clearer institutional policies.