Departments of Obstetrics, Gynecology and Reproductive Sciences, Family and Community Medicine, and Medicine, University of California, San Francisco, San Francisco, California; and Montefiore Medical Center, New York, New York.
Obstet Gynecol. 2019 Oct;134(4):708-713. doi: 10.1097/AOG.0000000000003460.
To examine the association between fetal death and risk of hemorrhage and disseminated intravascular coagulation (DIC) among women undergoing dilation and evacuation (D&E) procedures.
We conducted a retrospective cohort study of all D&Es at one academic abortion clinic in San Francisco between 2009 and 2013. We abstracted data on fetal death status, demographic characteristics, and complications including hemorrhage and DIC. We examined the risk of hemorrhage and DIC among women with fetal death compared with those without. We conducted unadjusted and adjusted analyses for the outcomes of hemorrhage, DIC, and any complication.
Among 92 cases of D&E for fetal death and 4,428 cases of D&E for other reasons, hemorrhage occurred in 10% and 7%, respectively (P=.28), and DIC occurred in 2.0% and 0.2% of the fetal death and nonfetal death cohorts (P<.001). In adjusted analysis, fetal death was associated with 2.9 times higher odds of hemorrhage (95% CI 1.4-6.0). In an unadjusted analysis, fetal death was associated with 12.3 times higher odds of DIC (95% CI 2.6-58.6) and 3.0 times higher odds of any complication (95% CI 1.6-5.9).
Women undergoing D&E for fetal death are far more likely to experience DIC and hemorrhage than are women without fetal death, yet the absolute risk is low (2%). Although D&E providers should be prepared for DIC and hemorrhage, we do not recommend any specific preoperative preparation because the vast majority of D&E abortions for fetal death are uncomplicated.
探讨行扩张和刮宫术（D&E）的妇女中胎儿死亡与出血和弥散性血管内凝血（DIC）风险的相关性。
我们对 2009 年至 2013 年间旧金山一家学术堕胎诊所的所有 D&E 进行了回顾性队列研究。我们提取了胎儿死亡状态、人口统计学特征以及出血和 DIC 等并发症的数据。我们比较了有胎儿死亡和无胎儿死亡的妇女发生出血和 DIC 的风险。我们对出血、DIC 和任何并发症的结局进行了未调整和调整分析。
在 92 例因胎儿死亡而行 D&E 术和 4428 例因其他原因而行 D&E 术的病例中，分别有 10%和 7%发生出血（P=.28），胎儿死亡组和非胎儿死亡组 DIC 的发生率分别为 2.0%和 0.2%（P<.001）。调整分析后，胎儿死亡与出血的比值比（OR）为 2.9（95% CI 1.4-6.0）。在未调整分析中，胎儿死亡与 DIC 的比值比（OR）为 12.3（95% CI 2.6-58.6），与任何并发症的比值比（OR）为 3.0（95% CI 1.6-5.9）。
与无胎儿死亡的妇女相比，因胎儿死亡而行 D&E 的妇女更有可能发生 DIC 和出血，但绝对风险较低（2%）。尽管 D&E 提供者应做好 DIC 和出血的准备，但我们不建议进行任何特定的术前准备，因为绝大多数因胎儿死亡而行的 D&E 流产都是无并发症的。
