BACKGROUND AND PURPOSE:

• Kerns et al. (Obstetrics & Gynecology, 2019) assessed the association between fetal death and risk of hemorrhage and disseminated intravascular coagulation (DIC) following D&E procedures

METHODS:

• Retrospective cohort study
• Participant data
  • All D&E data from one academic center (2009 to 2013)
• Study design
  • Maternal and fetal data abstracted including complications  
  • Compared risk of hemorrhage and DIC among women undergoing D&E with fetal death and those without
  • Unadjusted and adjusted analyses were performed for the outcomes of hemorrhage, DIC, and other complications
    • Unadjusted analyses only was performed for DIC as there were insufficient cases for adjustment of covariates

RESULTS:

• 92 cases of D&E for fetal death | 4,428 cases of D&E for other indications

Hemorrhage in Women Undergoing D&E

• Incidence similar between groups
  • Fetal death: 10% of women
  • Other indications: 7% of women
• Associations with hemorrhage included
  • Fetal death: Adjusted odds ratio (OR) 2.9 (95% CI, 1.4 to 6.0; P=.006)
  • Prior vaginal delivery: aOR 1.7 (95% CI, 1.3 to 2.2: P<.001)
  • Prior cesarean delivery aOR 2.2 (95% CI, 1.7 to 3.0; P<.001)
  • Each additional week of gestation aOR 1.3 (95% CI, 1.3 to 1.4; P<.001)
• Results remained the same using two different definitions for hemorrhage: 500 cc or as needing to apply interventions

DIC in Women Undergoing D&E

• There was an increased incidence in the fetal death cohort (p<0.001)

• In an unadjusted analysis, fetal death was associated with
  • 12.3 times higher odds of DIC (95% CI, 2.6 to 58.6)

Any Complications

• The following were associated with any procedural complications (adjusted)
  • Fetal death: OR 3.0 (95% CI, 1.6 to 5.9, P=.001)
  • Prior vaginal delivery: OR 1.5 (95% CI 1.2 to 1.9; P<.001)
  • Prior cesarean delivery OR 1.8 (95% C,I 1.4 to 2.3; P<.001)
  • Each additional week of gestation OR 1.4 (95% CI, 1.3 to 1.4; P<.001)

CONCLUSION:

• Fetal death was associated with 2.9 times higher odds of hemorrhage, 12.3 times higher for DIC and 3 times higher odds of any complication
• Absolute risk for DIC still remains very low (2%)

Learn More – Primary Sources:

Disseminated Intravascular Coagulation and Hemorrhage After Dilation and Evacuation Abortion for Fetal Death

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Stillbirth Risks from 37 Weeks and Beyond

Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines

Are Large-for-Gestational Age Pregnancies at an Increased Risk of Stillbirth?