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A federal judge on Monday upheld the Texas law requiring women to have a sonogram before having an abortion, saying an appeals court had forced him to declare the law constitutional.

District Judge Sam Sparks had previously struck down parts of the law, but his latest ruling said he's bound to follow the direction of the New Orleans-based appeals court.

A spokeswoman for the state Department of Health Services said the ruling clears the way for full-enforcement of the law, which was supposed to take effect Oct. 1 but has ping-ponged through the federal courts in legal challenges.

The agency posted guidance letters and information for doctors and patients on its website Monday. Spokeswoman Carrie Williams said officials would be checking to make sure abortion providers were following procedures during facility inspections.

The law requires doctors to show women images from sonograms, play fetal heartbeats aloud and describe the features of fetuses at least 24 hours before abortions. There are exceptions in cases of rape, incest, fetal deformity and for women who travel great distances to a doctor.

A group of doctors had sued to block the law, arguing it infringed on their First Amendment rights and is unconstitutionally vague regarding enforcement. The doctors claimed the law requires them to perform a procedure that is not medically necessary and that women may not want to have done.

Doctors who do not comply with the law could lose their medical license, be charged with a misdemeanor and face fines of up to $10,000.

In 2011, Sparks struck down provisions that requiring doctors to describe the images and others that required victims of sexual assault or incest to sign statements attesting to that fact. The judge said the state was trying to "permanently brand" those women.

The lawsuit bounced around federal courts in the last month.

First, a three judge panel of the 5th U.S. Circuit Court of Appeals overturned Sparks' temporary ban. A few days later, the appeals court issued another opinion outlining why it considered the law constitutional.

The appeals court said disclosures of a sonogram, the fetal heartbeat and their medical descriptions "are the epitome of truthful, non-misleading information."

The appeals court specifically said it expected Sparks to follow its lead when issuing any future rulings. That ruling also put the sonogram requirements into place while state officials drew up rules on how to enforce them.

The lawsuit returned to Sparks' court on Jan. 20 when the doctors asked for a permanent block on the law. Sparks warned them he had few options but to uphold the law. Monday's ruling made it clear he strongly disagreed with the appeals court.

"There can be little doubt (the law) is an attempt to discourage women from exercising their constitutional rights by making it more difficult for caring and competent physicians to perform abortions," Sparks wrote. "It appears (the appeals court) has effectively eviscerated the protections of the First Amendment in the abortion context."

Officials at the New York-based Center for Reproductive Rights, which sued on behalf of the Texas doctors, said they will continue to appeal to block the law and hope Sparks' opinion criticizing it will bolster their argument.

Supporters say the law ensures women will fully understand what abortion entails and will lead to fewer abortions. About 81,000 abortions are performed every year in Texas.

Joe Pojman, executive director of Texas Alliance for Life, called Sparks' ruling "a big victory" for anti-abortion activists.

"The state cannot ban abortion, but at least we can give women all the information they need to make an informed decision," Pojman said. "They didn't have that before."