Characteristics and outcomes of patients undergoing second-trimester dilation and evacuation for intrauterine fetal demise versus induced abortion

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 versus induced abortion, with a goal of identifying associated risk factors for complications. We conducted a retrospective matched cohort study of patients undergoing nonemergent D&Es for singleton ≥14-0/7-week IUFD 1/1/2019-5/31/2021, 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 rank sum tests. 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 75.0mL (50, 162.5) for patients with IUFD versus 110.0mL (50, 200) for those undergoing induced D&E (p=0.083). Twelve (18.8%) patients with IUFD versus seven (5.5%) undergoing induced D&E received at least one intervention due to bleeding complications (p=0.004). We 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. Our 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.