Difference in Time to Delivery Between Dilation and Evacuation (D&E) Versus Induction of Labor for Medical Indications [ID: 1380391

Abstract

INTRODUCTION: Pregnancy termination may be the safest management option among pregnancies with medical conditions that arise during the second trimester and are associated with elevated risk of maternal morbidity and mortality. Termination can be done by dilation and evacuation (D&E) or induction. Each method carries different risk and benefit profiles; however, variations in time to delivery have not been established. We assess the difference in time from diagnosis to delivery between D&E and induction for medically indicated second-trimester terminations. METHODS: Electronic medical records of 85 adult patients who underwent a D&E and 19 who underwent an induction between July 1, 2020, and December 31, 2020, within Kaiser Permanente Northern California were retrospectively surveyed for patient demographics and clinical characteristics, including indication for and method of termination, time of diagnosis and delivery, cervical preparation method, and perioperative complications. RESULTS: Patient demographic and clinical characteristics were similar across groups. The median time from diagnosis to delivery was 74 hours (interquartile range [IQR]: 18–141 hours) in the D&E cohort and 9 hours (IQR: 4–45 hours) in the induction cohort (P<.01). In the induction cohort, there were 21.1% (n=4) complications versus 4.7% (n=4) in the D&E cohort (P=.04). In the induction group, 10.5% (n=2) of patients required an additional procedure to complete the termination. CONCLUSION: The median time from diagnosis to delivery was 65 hours shorter in the induction group compared to D&E. This difference may be deemed clinically significant for patients who weigh time to delivery in their decision-making.