Ectopic Pregnancy

[yochumjy]

Here is some more info about percentages of reacurring ectopic pregnancies.

chclibrary.org/micromed/00046310.html

Note that with surgery, the reacurrance can be as high as 60%.

Also noted:

The chances of having a successful pregnancy are lower after an ectopic pregnancy, but depend on the extent of permanent fallopian tube damage.

The statement above does not make any mention of surgery, although they note that surgery increases the risks.

Blindly taking a drug and not knowing why an ectopic pregnancy occurred is playing russian roulette with future pregnancies.

 

[Ham1]

Will everyone on this thread please read the section of the Catechism on the Principle of Double Effect as well as the section on the Moral Act in Veritatis Splendor?

There is a detailed and systematic and long developed moral theology that has been handed to us by the Catholic Church and it is filled with razor-thin distinctions. Sometimes those distinctions only seem to make a tiny difference (like the ectopic pregnancy example), other times those distinctions are more apparent (like the bombing of Hiroshima).

Proportionalism is a dangerous and erroneous philosophy. Don’t fall prey to it. It rejects concepts of objective morality and introduces relativism by disregarding the concept of intrinsically evil acts.

 

[vern_humphrey]

Ham1:

Will everyone on this thread please read the section of the Catechism on the Principle of Double Effect as well as the section on the Moral Act in Veritatis Splendor?

There is a detailed and systematic and long developed moral theology that has been handed to us by the Catholic Church and it is filled with razor-thin distinctions. Sometimes those distinctions only seem to make a tiny difference (like the ectopic pregnancy example), other times those distinctions are more apparent (like the bombing of Hiroshima).

Proportionalism is a dangerous and erroneous philosophy. Don’t fall prey to it. It rejects concepts of objective morality and introduces relativism by disregarding the concept of intrinsically evil acts.

The Principle of Double Effect is mentioned in Paragraph 2263:

**2263 **The legitimate defense of persons and societies is not an exception to the prohibition against the murder of the innocent that constitutes intentional killing. “The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not.”

We can use it by anology here. If the mother’s life is to be saved, the child MUST be removed from the fallopian tube. That is a double effect.

It is a fallacy to say that we can cover that act with the fiction that removing the tube is necessary for some future reason (for example, to prevent another ectopic pregnancy.)

Imagine the doctor saying, “We have to remove the baby or you will both die. But we don’t have to remove the fallopian tube.”

Does the Church say the mother must choose death in this case?

Anyone who wishes can give a simple yes or no to this question.

 

[vern_humphrey]

SHEMP:

Principle of double effect:

1. The good result be proportionate to the bad result.

In all cases removing the ectopic pregnancy results in a good (saving the mother) that is proportionate to the bad result (loosing the child). **If nothing is done then both the mother and child will likely die so the good is proportionately better than the bad result if nothing is done./**QUOTE]

And that’s the crux of the whole argument – in the case AS PRESENTED, our choice is both die or only the developing child dies. Clearly the moral choice is to save the mother.

Now with current medical technology there is no way I know of to save the child after removing it from the fallopian tube. The child will die upon removal – and there’s nothing we can do about it.

Since we are justified in our choice (we choose only one death instead of two), we don’t need a fictional cover that “all we’re REALLY doing is removing a diseased fallopian tube.”

 

[Ham1]

vern humphrey:

SHEMP:

Principle of double effect:

1. The good result be proportionate to the bad result.

In all cases removing the ectopic pregnancy results in a good (saving the mother) that is proportionate to the bad result (loosing the child). If nothing is done then both the mother and child will likely die so the good is proportionately better than the bad result if nothing is done./

QUOTE]

And that’s the crux of the whole argument – in the case AS PRESENTED, our choice is both die or only the developing child dies. Clearly the moral choice is to save the mother.

Now with current medical technology there is no way I know of to save the child after removing it from the fallopian tube. The child will die upon removal – and there’s nothing we can do about it.

Since we are justified in our choice (we choose only one death instead of two), we don’t need a fictional cover that “all we’re REALLY doing is removing a diseased fallopian tube.”

Ummm…your logic is the clearly denounced theory of proportionalism. It’s a form of relativism whereby one balances the outcomes of any action to determine the morality of the action. It seems to work in many cases, but it is a flawed theological premise. This line of reasoning is NOT in keeping with Catholic teaching.

Dude, read section 75 of Veritatis Splendor. It clearly defines the theological importance of the object of the act. And it clearly condemns the theory you are using.

 

[vern_humphrey]

Ham1:

vern humphrey:

Ummm…your logic is the clearly denounced theory of proportionalism. It’s a form of relativism whereby one balances the outcomes of any action to determine the morality of the action. It seems to work in many cases, but it is a flawed theological premise. This line of reasoning is NOT in keeping with Catholic teaching.

Dude, read section 75 of Veritatis Splendor. It clearly defines the theological importance of the object of the act. And it clearly condemns the theory you are using.

So give me a simple yes or no – does the Church say a woman diagnosed with an ectopic pregnancy (the child developing in the fallopian tube) have to choose death?

 

[yochumjy]

vern humphrey:

We can use it by anology here. If the mother’s life is to be saved, the child MUST be removed from the fallopian tube. That is a double effect.

It is a fallacy to say that we can cover that act with the fiction that removing the tube is necessary for some future reason (for example, to prevent another ectopic pregnancy.)

Imagine the doctor saying, “We have to remove the baby or you will both die. But we don’t have to remove the fallopian tube.”

Does the Church say the mother must choose death in this case?

Anyone who wishes can give a simple yes or no to this question.

:clapping: :clapping: :clapping: :clapping:

CONGRATULATIONS, YOU ARE NOW THE WINNER OF THE “I’M JUST ARGUEING WITH MYSELF” AWARD.

Please, feel free to continue to stick your head in the sand.

You know the answer is no, and you know that you have changed the subject, again.

Try staying on topic. The question is not that the child will die, but the method by which you save the mother. You either kill the child by saying that the child is the fundamental problem or you acknowledge that a problem occured in the transferal of the child from the ovary to the uterous and remove the fallopian tube which results in the death of the child. Your method is to say that the child creates this problem, when in reality a problem existed/exists in the fallopian tube by which the child implanted too soon.

Stop blaming the child, it is innocent. A biological malfunction occurred and you seem blind to the facts that I have presented.

 

[SHEMP]

TAS2000:

It was also said that removing the tube before it ruptures is that same as directly killing the child, thus the only choice is death for both. It is not. The intent is to remove a life threatening malfunction. The tube itself may or may not be damaged at that particular moment, but it will certainly become damaged if nothing is done. It is similar to the practice of removing seemingly healthy tissue along with a cancerous part. It is not certain if the area is damaged yet, but it will become so if nothing is done. Thus its removal is not considered unnecessary mutilation.

When there is a tubal prengancy, a child begins to develp in a healthy fallopian tube. Is the child diseased? Is the tube diseased? I would argue that neither are diseased. The child is in the wrong place. If the child is left to develop in this place then the tube will eventually become irreversibly damaged and the mother and child will die. The principle of double effect argues that you can remove a diseased organ (the good intent) and indirectly cause the death of a child.

If a surgeon removes both a fallopian tube and the child when in fact the child could have been removed and the fallopian tube would have remained healthy, then was it moral to remove both a healthy child AND a healthy fallopian tube? Now we know that with time both the child AND the tube will become diseased. Eventually the child will die and eventually the fallopian tube will become diseased. Eventually the mother and child will die. Does this probable event justify removing the child? Does it justify removing a healthy tube with a child? I don’t understand the logic that it would be ok to remove both the child and the tube when the child could have been removed alone and the same end is achieved. To argue that the intent was to remove the diseased tube and not the child is at best ignorance and at worse a lie. It is the child that is causing the problem NOT the tube. The tube does not need to come out until there is irreversible damage. Therefore until there is irreversible damage, whether both the tube and the child or whether the child alone is removed, the intent is to remove the developing child so that it does not cause the death of the mother! I don’t believe that removing a healthy child and tube satisfies the principle of double effect unless you use deception!!

 

[Antigen]

fix:

Great points. What about so-called molar pregnancies where there may be an “empty” egg fertilized? How many chromosomes does it take to make a human?

Tootsie > Candy find out, one, two-o-o-, 46 chromosomes to be a neurologically typical human being. Human Beings can have plus or minus 3 additional chromasomes.

Molar Pregnancies are not in fact “pregnancies” because there is not a enough genetic material their to have life.

Ectopic pregnancies are different because
the cellular material is composed of 46 chromosomes
there has been one such pregnancy that was carried close enough to term that a live birth, extracted through surgery, was the result. It happened in 1979 and was hailed as a breakthrough for men who could now be mothers.

It really ticks me off when doctors call ectopic pregnancies things like masses of tissue and product of conception. They convince a stunned and numb father that the best thing for his wife is to convince her she didn’t lose any thing at all. But the woman knows better. I have seen this interfere with and actually break up more than one marriage.:banghead:

 

[yochumjy]

SHEMP:

When there is a tubal prengancy, a child begins to develp in a healthy fallopian tube. Is the child diseased? Is the tube diseased? I would argue that neither are diseased. The child is in the wrong place. If the child is left to develop in this place then the tube will eventually become irreversibly damaged and the mother and child will die. The principle of double effect argues that you can remove a diseased organ (the good intent) and indirectly cause the death of a child.

You are assuming that the tube is completely healthy. How would you even check that? If the child implants in the tube a malfunction has occurred. Why did it occur? Well I have given various possible reasons that were taken from a website, but if you read the reasons, they include a previous ectopic pregnancy. So, not all reasons are known, and many are guessed at. So, please show me documentation that supports your assumption that with all/any ectopic pregnancies there is a healthy fallopian tube.

SHEMP:

If a surgeon removes both a fallopian tube and the child when in fact the child could have been removed and the fallopian tube would have remained healthy, then was it moral to remove both a healthy child AND a healthy fallopian tube?

See above, you are making assumptions with no evidence. At least do some due dilligence and show some evidence of someone supporting you. Prefferably evidence that you don’t create on the fly.

SHEMP:

Therefore until there is irreversible damage, whether both the tube and the child or whether the child alone is removed, the intent is to remove the developing child so that it does not cause the death of the mother! I don’t believe that removing a healthy child and tube satisfies the principle of double effect unless you use deception!!

The intent is not to remove the child, that is ABORTION! The child is NOT the problem. The problem is that implantation occurred in the wrong part of the system, it isn’t the child’s fault, period.

 

[vern_humphrey]

:clapping: :clapping: :clapping: :clapping:

CONGRATULATIONS, YOU ARE NOW THE WINNER OF THE “I’M JUST ARGUEING WITH MYSELF” AWARD.

Please, feel free to continue to stick your head in the sand.

You know the answer is no, and you know that you have changed the subject, again.

Try staying on topic.

Is the above your idea of staying on topic and engaging in gentlemanly debate?

yochumjy:

The question is not that the child will die, but the method by which you save the mother.

No matter which method is used, the child dies. Are you saying that it would be wrong UNLESS we wear a fig-leaf and pretend we are performing surgery to prevent a reoccurance?

yochumjy:

You either kill the child by saying that the child is the fundamental problem or you acknowledge that a problem occured in the transferal of the child from the ovary to the uterous and remove the fallopian tube which results in the death of the child. Your method is to say that the child creates this problem, when in reality a problem existed/exists in the fallopian tube by which the child implanted too soon…

Where do I say “the child is the fundamental problem?” When did I say "the child creates this problem?’

yochumjy:

Stop blaming the child, it is innocent. A biological malfunction occurred and you seem blind to the facts that I have presented.

Where did I blame the child?

And what “facts” have you presented?

 

[SHEMP]

yochumjy:

You are assuming that the tube is completely healthy. How would you even check that? If the child implants in the tube a malfunction has occurred. Why did it occur? Well I have given various possible reasons that were taken from a website, but if you read the reasons, they include a previous ectopic pregnancy. So, not all reasons are known, and many are guessed at. So, please show me documentation that supports your assumption that with all/any ectopic pregnancies there is a healthy fallopian tube.

See above, you are making assumptions with no evidence. At least do some due dilligence and show some evidence of someone supporting you. Prefferably evidence that you don’t create on the fly.

The intent is not to remove the child, that is ABORTION! The child is NOT the problem. The problem is that implantation occurred in the wrong part of the system, it isn’t the child’s fault, period.

The evidence is in the argument. Are you saying that the reason the tube needs to be removed is because the tube is not functioning properly? Certainly some people are predisposed to having ectopic pregnancies. Woman who have had multiple pelvic infections are at increased risk. I don’t believe that this type of malfunction would justify allowing a child to die. The reason to consider allowing a child to die is that the mothers life is in danger. The reason that the mothers life would be in danger is that the fallopian tube will eventially become ischemic and rupture. She can then have bleeding and infection. Prior to this ischemia and rupture the tube is NOT the problem. The child growing IN the tube IS the problem. Removing the child alone (via surgery or drug) or removing the child and tube are aimed at stopping the CHILD from growing in the tube. I believe that the intent in that situation IS to remove the child NOT just the tube. Once the tube is ischemic and or ruptured then the intent is to remove the tube.

 

[yochumjy]

vern humphrey:

Is the above your idea of staying on topic and engaging in gentlemanly debate?

No, it is my response to your continual suggestion that I want the mother to die. Is that gentlemanly? From my point of view, you are continuously misrepresenting what I say and argueing from an off topic view. In hindsight, I shouldn’t have typed that about the award, I appologize. Does that mean we can debate nice and you can stop using " you say the mother must die" debating points? Unless of course you can actually make a legitamate connection of my logic to that point, which, IMHO you have not.
vern humphrey:

No matter which method is used, the child dies. Are you saying that it would be wrong UNLESS we wear a fig-leaf and pretend we are performing surgery to prevent a reoccurance?

Is your gentlemanly debating style to make fig-leaf like remarks? You are offering nothing but opinion on the health of the tube. You don’t seem to be able to refute the website that I list below that indicates that previous ectopic pregnancies are indeed listed as causes of future ones. Please feel free to post ANY info to the contrary.
vern humphrey:

Where do I say “the child is the fundamental problem?” When did I say "the child creates this problem?’

Where did I blame the child?

While you do not say it directly, (and actually, I thought you did, it turns out I was remembering post #30, so I am sorry about that, you didn’t directly SAY it) you do imply it. You are only abdicating removing the child, which means only the child is the problem. By not looking at any solution other than removing of the child, you acknowledge no problem BUT the child.
vern humphrey:

And what “facts” have you presented?

I’ve given you two, count them two websites that support my opinions
chclibrary.org/micromed/00046310.html
and
healthsquare.com/mc/fgmc0202.htm

You have presented nothing but opinion. I have presented opinion with some support.

 

[TAS2000]

Can we try to keep it civil?

No matter which method is used, the child dies. Are you saying that it would be wrong UNLESS we wear a fig-leaf and pretend we are performing surgery to prevent a reoccurance?

Are you saying that the method DOESN’T mean anything? Check my previous post about prematurley killing a terminal patient so they won’t have to suffer through a natural death, and tell me if you think that is moral. to quote you,

No matter which method is used, the child dies.

The tube must be removed to prevent it from rupturing, a certainty, not a probability. To say that removing just the child itself isn’t outright murder, is

at best ignorance and at worse a lie.

It is direct abortion. One could say that the tube was healthy until the baby implanted there. Then it became a certain death event just waiting to happen. How can someone argue that it is ok to use a drug to kill the baby directly to spare the mother pain of surgery, but say that removing a tube before it actually ruptures to prevent those complications is splitting hairs?

Imagine the doctor saying, "We have to remove the baby or you will both die. But we don't have to remove the fallopian tube."
 
Does the Church say the mother must choose death in this case?
 
Anyone who wishes can give a simple yes or no to this question.

Simply, NO. And frankly, I can’t believe that you would even ask this Vern. Usually you use very reasoned arguments. The crux of this issue versus other analogies is that you are not talking about a disease or tumor. You are talking about a human life. The church does not advocate the taking of one human life to preserve another. It sadly admits that sometimes it might be necessary, as in the case of self defense. And in this case, the mere presence of the child in the wrong place becomes life threatening. If it were possible to open the tube, remove the child, and implant it successfully elswhere, I think the church would rejoice. The argument of double effect are being mis-stated in many cases here. Double Effect does not state that an evil can be done to cause a good. Killing a child directly is evil, even if that child would die anyway given enough time. (the same could be said for all of us.) Double Effect clearly states that a good act, can have an unintented negative effect. Not an evil act, not an evil effect. Killing the child directly is evil, so doesn’t count, even if the child would die anyway. However, removing an organ that is about to explode is a good act, to save a mother’s life. Continued fertility, shortened recovery periods, etc. are not importnant moral arguments. It is right versus wrong, and being right isn’t easy in this case, as in many cases.

 

[SHEMP]

TAS2000:

However, removing an organ that is about to explode is a good act, to save a mother’s life.

If you can either remove the organ that is “about to explode” with the child or if you remove the child and leave the tube in place and the same end is achieved, then you really are not intending to remove the tube that is “about to explode”. You are intending to remove the child that is growing in the tube and incidentally taking the tube. In fact you are taking the tube out ONLY so that you can claim that you satisfy “double effect”. It might make you feel better at the end of the day but the logic does not follow in my book.

 

[vern_humphrey]

TAS2000:

Can we try to keep it civil? \quote]

I’m doing my best – take a look at the post I replied to.

TAS2000:

OK, I don’t get the fig-leaf thing, but are saying that the method DOESN’T mean anything? Check my previous post about prematurley killing a terminal patient so they won’t have to suffer through a natural death,

The morality in in the purpose – in both over-dosing a terminally ill patient and in removing the child, the intent is moral.

In EACH case, death is hastened (both the terminally ill patient and the child in the fallopian tube will soon die.) But that is not the INTENT. In each case the intent is moral – in the one case to alleviate suffering and in the other to save the mother’s life.

In both cases, someone will die – but the death is not intended, but only seen as enivitable.

TAS2000:

The tube must be removed to prevent it from rupturing, a certainty, not a probability.

That the tube will rupture if left untreated is a certainty. It is not, however, a certainty that the only treatment is to remove it.

And there is the “fig leaf.”

TAS2000:

To say that removing just the child itself isn’t outright murder, It is direct abortion.

If that is the case, then removing the fallopian tube with the child inside is ALSO outright murder and direct abortion.

You see what I mean by the “fig leaf?”

TAS2000:

How you can argue that it is ok to use a drug to kill the baby directly to spare the mother pain of surgery, but say that removing a tube before it actually ruptures to prevent those complications is splitting hairs?

The baby dies in either case.

TAS2000:

Simply, NO. And frankly, I can’t believe that you would even ask this Vern. Usually you use very reasoned arguments. The crux of this issue versus other analogies is that you are not talking about a disease or tumor.

Any way you slice it, the baby dies. And if we are NOT willing to let the mother die also, the baby will die BEFORE the tube ruptures, by the active intervention of a doctor.

TAS2000:

You are talking about a human life. The church does not advocate the taking of one human life to preserve another. It sadly admits that sometimes it might be necessary, as in the case of self defense.

That’s very close to my position, except that:

1. We’re not taking one life to preserve another. We’re saving one life that would otherwise be lost when the child inevitably dies.
2. We are not engaging in self-defense. The child is not an unjust aggressor, and is not wilfully (or otherwise) attacking the mother.

TAS2000:

And in this case, the mere presence of the child in the wrong place becomes life threatening. If it were possible to open the tube, remove the child, and implant it successfully elswhere, I think the church would rejoice.

We all would – but with current technology, that isn’t possible.

TAS2000:

The argument of double effect are being mis-stated in many cases here. Double Effect does not state that an evil can be done to cause a good. Killing a child directly is evil, even if that child would die anyway given enough time. (the same could be said for all of us.) Double Effect clearly states that a good act, can have an unintented negative effect. Not an evil act, not an evil effect. Killing the child directly is evil, so doesn’t count, even if the child would die anyway. However, removing an organ that is about to explode is a good act, to save a mother’s life. Continued fertility, shortened recovery periods, etc. are not importnant moral arguments. It is right versus wrong, and being right isn’t easy in this case, as in many cases.

Again, I point out if we don’t HAVE to remove the tube for reasons OTHER than removing the child, then when we remove it we ARE removing (and killing) the child.

That’s the “fig leaf” – killing the child but pretending we are doing it to prevent a future problem (such as another ectopic pregnancy.)

 

[vern_humphrey]

SHEMP:

If you can either remove the organ that is “about to explode” with the child or if you remove the child and leave the tube in place and the same end is achieved, then you really are not intending to remove the tube that is “about to explode”. You are intending to remove the child that is growing in the tube and incidentally taking the tube. In fact you are taking the tube out ONLY so that you can claim that you satisfy “double effect”. It might make you feel better at the end of the day but the logic does not follow in my book.

Thank you. You have succinctly illustrated the “fig leaf.”

 

[yochumjy]

vern humphrey:

Thank you. You have succinctly illustrated the “fig leaf.”

No, you are completely ignoring any conversation that you can’t answer. I have shown there IS a correlation between previous and future ectopic pregnancies. You have not shown that your opinion is valid by any outside source. Your fig leaf remark still doesn’t make any sense unless you have some data other than your personal opinion that the fallopian tube is always perfectly healthy and ectopic pregnacies are always random.

 

[yochumjy]

vern humphrey:

The morality in in the purpose – in both over-dosing a terminally ill patient and in removing the child, the intent is moral.

In EACH case, death is hastened (both the terminally ill patient and the child in the fallopian tube will soon die.) But that is not the INTENT. In each case the intent is moral – in the one case to alleviate suffering and in the other to save the mother’s life.

In both cases, someone will die – but the death is not intended, but only seen as enivitable.

That the tube will rupture if left untreated is a certainty. It is not, however, a certainty that the only treatment is to remove it.

And there is the “fig leaf.”

If that is the case, then removing the fallopian tube with the child inside is ALSO outright murder and direct abortion.

You see what I mean by the “fig leaf?”

The baby dies in either case.

Any way you slice it, the baby dies. And if we are NOT willing to let the mother die also, the baby will die BEFORE the tube ruptures, by the active intervention of a doctor.

That’s very close to my position, except that:

1. We’re not taking one life to preserve another. We’re saving one life that would otherwise be lost when the child inevitably dies.
2. We are not engaging in self-defense. The child is not an unjust aggressor, and is not wilfully (or otherwise) attacking the mother.

Again, I point out if we don’t HAVE to remove the tube for reasons OTHER than removing the child, then when we remove it we ARE removing (and killing) the child.

That’s the “fig leaf” – killing the child but pretending we are doing it to prevent a future problem (such as another ectopic pregnancy.)

First YOU have to prove that we are “pretending”. Right now all I see is your opinion. I don’t even see you try to substantiate your position.

You continue to use the morphine story, but it does not apply. The child will die not on it’s own, but because of the tube rupturing. Your MIL was going to die because of cancer, because of her body. The two are not the same. The death of the child comes as the result of a malfunction in the Mother’s body. Do you see what I’m trying to say? The cause of the deaths are not parallel. You continue to discount that the implantation was anything but some strange anomoly that could not reaccur.

I fully agree that the child will die in all cases (leaving the situation alone, aborting the child and removing the tube.) What I don’t agree with is the intent. The ultimate intent is to save the mother, but the direct action is aborting the baby when you use the drugs or even operate and remove the child. You continue to argue that removing the tube is aborting the baby. By pure medical definition, yes, but not by intent.

One other thing to ponder, if we just use drugs and don’t do surgery and remove the tube, how do we move forward with understanding how to place the child in the uterus or external womb? Why can’t we try something to save the child. Using drugs is the easy way out and it is causing abortion.

From a moral viewpoint. As soon as you okay the drug for ectopic, you have to allow it for ANY use where a doctor says the mothers health is in danger. This is why we have legalized abortion today.

 

[SHEMP]

yochumjy:

No, you are completely ignoring any conversation that you can’t answer. I have shown there IS a correlation between previous and future ectopic pregnancies. You have not shown that your opinion is valid by any outside source. Your fig leaf remark still doesn’t make any sense unless you have some data other than your personal opinion that the fallopian tube is always perfectly healthy and ectopic pregnacies are always random.

Women with one ectopic pregancy CAN have a future successful pregnancy but are at increased risk of future ectopic pregnancies. This has NOTHING to do with whether to remove the fallopian tube and or the child to save the mother’s life! Whether the fallopian tube has a functional are anatomical defect is not relevant. Removing a dysfunctional or anatomical defective fallopian tube would be a neutral or good act but this would not satisify the issue of proportionality. There is no need to remove the tube for this reason at this time. The reason that the tube is removed is because either it is diseased and therefore will cause the death of the child (ei ischemia or rupture) or you want to remove the child with the tube so as to prevent ischemia and/or rupture. You are NOT removing the tube because of a concern for future ectopic pregnancies.