Slow Harm After Dobbs v. Jackson Women’s Health Organization: An Analytic Scoping Review of How Data and Surveillance Infrastructures Reshape Emergency Obstetric Care

Following Dobbs v. Jackson Women’s Health Organization on June 24, 2022, abortion criminalization in the United States has converged with interoperable health data systems, making reproductive health documentation more portable and legally legible across jurisdictions. This analytic scoping review, guided by Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), examined U.S. literature published from June 2022 through October 2025 in PubMed, OpenAlex, Google Scholar, and HeinOnline. Sources were organized by evidentiary role into Tier C (legal and analytic conditions), Tier B (organizational adaptations), and Tier A (clinical impacts). The review mapped how surveillance pathways, including electronic health record and health information exchange interoperability, cloud hosting, billing and claims systems, and non-Health Insurance Portability and Accountability Act (HIPAA) consumer and law enforcement data, expand perceived liability and drive documentation and communication chill. Reported responses included vague documentation, reduced data capture, segmented records, and restricted information exchange. These adaptations may fragment care and delay intervention for emergency obstetric conditions. Tier A evidence included delays and higher diagnostic thresholds in ectopic pregnancy management, as well as increased maternal morbidity under mandated expectant management of previable preterm prelabor rupture of membranes and related second-trimester complications. These harms disproportionately affect patients experiencing structural racism, poverty, and intensified surveillance. We argue that these pathways constitute a form of slow harm, in which cumulative injury is produced through delay, fear, and institutional paralysis. Privacy-protective, equity-centered data governance and clearer clinical-legal guidance are needed to preserve safe documentation and coordinated emergency obstetric care.