{
    "abstract": "Patients with intrauterine fetal demise (IUFD) are at higher risk of complications when undergoing dilation and evacuation (D&E) compared to patients undergoing abortion for other indications. We aimed to compare baseline characteristics and describe outcomes, including frequencies of complications such as disseminated intravascular coagulation (DIC) and hemorrhage, in patients undergoing D&E for IUFD vs induced abortion, with a goal of identifying associated risk factors for complications.\nWe conducted a retrospective matched cohort study of patients undergoing nonemergent D&Es for singleton \u226514-0/7-week IUFD January 1, 2019 to May 31, 2021, matched with two patients undergoing induced second-trimester D&Es by cesarean delivery history, patient age, and gestational age (GA). We collected demographics, history, GA, coagulation studies, quantitative blood loss (QBL), and complications. We calculated descriptive statistics and tested for association using chi-square, Fisher's exact, t, and Wilcoxon's rank sum tests.\nOf 1390 procedures, 64 patients with IUFD met inclusion criteria and were matched with 128 patients undergoing induced D&E. Eight (12.5%) patients with IUFD and six (4.7%) undergoing induced D&E had hemorrhage (odds ratio [OR] = 2.90, 95% confidence interval [0.96, 8.77]). Six (9.4%) patients with IUFD and none undergoing induced D&E had DIC (OR = 28.56 [1.58, 515.38]). Median QBL was 75.0\u00a0mL (50, 162.5) for patients with IUFD vs 110.0\u00a0mL (50, 200) for those undergoing induced D&E (p\u00a0=\u00a00.083). Twelve (18.8%) patients with IUFD vs seven (5.5%) undergoing induced D&E received at least one intervention due to bleeding complications (p\u00a0=\u00a00.004).\nWe found a higher DIC frequency but no significant difference in hemorrhage or QBL in IUFD D&E compared to induced abortion. Our IUFD D&E complication frequency is higher than those previously published.\nOur results affirm current standards of care for D&E in patients with IUFD. Large referral centers may have higher proportions of complications compared to other sites.",
    "authors": [
        {
            "affiliation": "University of California, Davis School of Medicine, Sacramento, California, United States.",
            "firstname": "Laura A",
            "initials": "LA",
            "lastname": "Potter"
        },
        {
            "affiliation": "University of California, Davis School of Medicine, Sacramento, California, United States.",
            "firstname": "Serena H",
            "initials": "SH",
            "lastname": "Ly"
        },
        {
            "affiliation": "University of California, Davis School of Medicine, Sacramento, California, United States.",
            "firstname": "Xiaohe",
            "initials": "X",
            "lastname": "Pei"
        },
        {
            "affiliation": "Department of Public Health Sciences, University of California, Davis, Sacramento, California, United States.",
            "firstname": "Matthew D",
            "initials": "MD",
            "lastname": "Ponzini"
        },
        {
            "affiliation": "Department of Public Health Sciences, University of California, Davis, Sacramento, California, United States.",
            "firstname": "Machelle D",
            "initials": "MD",
            "lastname": "Wilson"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California, United States. Electronic address: myhou@ucdavis.edu.",
            "firstname": "Melody Y",
            "initials": "MY",
            "lastname": "Hou"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2023 The Author(s). Published by Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.contraception.2023.110118\n10.1097/AOG.0b013e3182051519\n10.1097/AOG.0000000000003460\n10.1016/j.contraception.2016.06.008\n10.1097/AOG.0b013e3181f903f8\n10.1097/GRF.0b013e3181eb63fc\n10.1097/AOG.0000000000002046\n10.1016/j.contraception.2012.10.024\n10.1097/AOG.0000000000003104\n10.1016/j.contraception.2022.11.005\n10.1371/journal.pone.0093240\n10.1177/1076029618806424\n10.1111/jth.14523\n10.1016/jjbi.2008.08.010\n10.1016/j.ajog.2021.11.1357\n10.1093/humrep/det277\n10.1053/beog.2001.0204\n10.1007/BF03013432\n10.1016/S0049-3848(17)30069-5\n10.1038/s41598-018-30687-0\n10.1080/14767058.2020.1716330\n10.2147/JBM.S273047\n10.1080/14767058.2017.1397125",
    "journal": "Contraception",
    "keywords": [
        "Dilation and evacuation",
        "Disseminated intravascular coagulation",
        "Hemorrhage",
        "Intrauterine fetal demise"
    ],
    "methods": null,
    "publication_date": "2023-07-16",
    "pubmed_id": "37453657\n18030283\n21252744\n31503145\n27343749\n20966697\n20661043\n28426621\n23218863\n30741801\n31135755\n36473510\n24728139\n30296833\n31218838\n18929686\n35026129\n23847112\n11586511\n11478819\n8955974\n28262236\n30143672\n31931643\n35023983\n29065752",
    "results": "Of 1390 procedures, 64 patients with IUFD met inclusion criteria and were matched with 128 patients undergoing induced D&E. Eight (12.5%) patients with IUFD and six (4.7%) undergoing induced D&E had hemorrhage (odds ratio [OR] = 2.90, 95% confidence interval [0.96, 8.77]). Six (9.4%) patients with IUFD and none undergoing induced D&E had DIC (OR = 28.56 [1.58, 515.38]). Median QBL was 75.0\u00a0mL (50, 162.5) for patients with IUFD vs 110.0\u00a0mL (50, 200) for those undergoing induced D&E (p\u00a0=\u00a00.083). Twelve (18.8%) patients with IUFD vs seven (5.5%) undergoing induced D&E received at least one intervention due to bleeding complications (p\u00a0=\u00a00.004).",
    "title": "Characteristics and outcomes of patients undergoing second-trimester dilation and evacuation for intrauterine fetal demise vs induced abortion.",
    "xml": "<Element 'PubmedArticle' at 0x78850720ffb0>"
}