Complications of Dilation and Evacuation and Induction of Labor for Second-Trimester Fetal Demise [31J

Abstract

INTRODUCTION: We compared the frequency of complications for dilation and evacuation (D&E) and induction of labor (IOL) for treatment of second-trimester intrauterine fetal demise (IUFD). METHODS: We performed a retrospective cohort study of women with an IUFD between 14-24 weeks who underwent D&E or IOL at a university hospital between June 2009 and June 2019. We defined complications a priori as: 1) infection, 2) uterine atony, 3) retained products of conception, 4) hemorrhage, 5) uterine perforation (D&E only), 6) uterine aspiration (IOL only), 7) cervical laceration (D&E only), 8) uterine rupture, 9) unplanned admission, 10) readmission within 14 days, 11) blood transfusion, 12) intensive care unit admission, 13) removal or injury to an organ, 14) uterine rupture, 15) cardiopulmonary arrest, 16) any other unplanned surgery, and 17) death. We also assessed a composite of major complications, defined as complications 8-17. We assessed differences in composite complication frequency with chi-squared and Fisher’s exact tests. RESULTS: Of the 119 women who met inclusion criteria, 41 underwent D&E and 78 underwent IOL. In our preliminary analysis, 29.2% (12/41) women in the D&E group and 24.4% (19/78) in the IOL group (P=.56) experienced any complication. No women in the D&E group experienced a major complication and 3 women in the IOL group experienced a major complication (3.8%, P=.55). CONCLUSION: D&E and IOL had comparable complication rates for women in our study. Patients should be offered both options in the treatment of a second-trimester IUFD.