The Society for Maternal-Fetal Medicine (SMFM) has issued new guidance declaring that abortion care and counseling are inseparable from high-risk pregnancy care. Published in Pregnancy, the guidance states that all patients at elevated risk for pregnancy complications must receive accurate, evidence-based information about all treatment options — including abortion — regardless of where they live.

The guidance comes amid a patchwork of state abortion restrictions following Dobbs v. Jackson Women's Health Organization, which has created significant uncertainty for physicians managing complex pregnancies. Conditions like preterm premature rupture of membranes (PPROM) at very early gestational ages have become particularly fraught, with data from states like Texas showing severe clinical deterioration in patients forced to continue high-risk pregnancies.

Key Takeaways:

• Physicians retain First Amendment protections to counsel patients on all options, including abortion referrals, even in restrictive states
• Institutions should establish multidisciplinary task forces — including clinical, administrative, and legal leaders — to interpret local abortion laws and define care protocols
• Transfer networks to abortion-providing states should be pre-established to prevent life-threatening delays
• Thorough documentation of high-risk encounters, diagnoses, and treatment options discussed is strongly recommended

Why it matters: As abortion laws continue to vary dramatically by state, SMFM's guidance gives maternal-fetal medicine specialists a clinical and institutional roadmap to ensure patients receive timely, comprehensive care — and helps reduce preventable maternal morbidity and mortality.