Department of Obstetrics and Gynecology, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
Eur J Obstet Gynecol Reprod Biol. 2022 Oct;277:16-20. doi: 10.1016/j.ejogrb.2022.08.003. Epub 2022 Aug 9.
To evaluate clinical differences in the safety of dilation and evacuation (D&E) and induction of labor (IOL) for the treatment of intrauterine fetal demise (IUFD) between 14 and 24 weeks gestation.
A retrospective chart review was conducted at a single institution comparing rates of major and minor complications between patients who undergo D&E and those that undergo IOL in the treatment of IUFD between 14 and 24 weeks gestation. Demographic and medical variables were stratified by management method and analyzed using chi-squared and t-tests where appropriate.
Patients who underwent IOL were of a more advanced gestational age and more likely to be uninsured. Patients who underwent D&E were more likely to be privately insured. Hospital time for an IOL was significantly longer than for D&E. Composite rates of complication did not differ significantly between management groups. Patients treated with D&E were more likely to require uterine aspiration.
D&E and IOL are equally safe methods for the management of IUFD between 14 and 24 weeks gestation. Both options should be made available to patients who experience this rare pregnancy outcome.
评估 14 至 24 孕周宫内胎儿死亡（IUFD）治疗中扩张和排空（D&E）与引产（IOL）的安全性临床差异。
在一家单中心进行回顾性图表审查，比较 14 至 24 孕周 IUFD 治疗中 D&E 与 IOL 患者之间主要和次要并发症的发生率。按管理方法对人口统计学和医学变量进行分层，并在适当情况下使用卡方检验和 t 检验进行分析。
行 IOL 的患者的妊娠周数更晚，且更可能没有保险。行 D&E 的患者更可能有私人保险。IOL 的住院时间明显长于 D&E。两组管理方法的并发症综合发生率无显著差异。行 D&E 的患者更可能需要子宫抽吸。
D&E 和 IOL 是 14 至 24 孕周 IUFD 管理的同等安全方法。对于经历这种罕见妊娠结局的患者，应提供这两种选择。
