Novatt Hilary, Rockhill Kari, Baker Kori, Stickrath Elaine, Alston Meredith, Fabbri Stefka
Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, USA.
Epidemiology and Public Health, Rocky Mountain Poison & Drug Safety, Denver, USA.
Cureus. 2024 Mar 19;16(3):e56490. doi: 10.7759/cureus.56490. eCollection 2024 Mar.
Introduction There is no clear guidance for the optimal setting for dilation and curettage (D&C) for the management of first-trimester pregnancy failure. Identifying patients at risk of clinically significant blood loss at the time of D&C may inform a provider's decision regarding the setting for the procedure. We aimed to identify risk factors predictive for blood loss of 200mL or greater at the time of D&C. Methods This is a retrospective cohort study of patients diagnosed with first-trimester pregnancy failure at gestational age less than 11 weeks who underwent surgical management with D&C at a single safety net academic institution between 4/2016 and 4/2021. Patient characteristics and procedural outcomes were abstracted. Women with less than 200mL versus greater than or equal to 200mL blood loss were compared using descriptive statistics, chi-square for categorical variables, and Satterthwaite t-tests for continuous variables. Results A total of 350 patients were identified; 233 met inclusion criteria, and 228 had non-missing outcome data. Mean gestational age was 55 days (SD 9.4). Thirty-one percent (n=70) had estimated blood loss (EBL) ≥200mL. Younger patients (mean 28.7 years vs. 30.9, p=0.038), Latina patients (67.1% vs. 51.9%, p=0.006), patients with higher body mass index (BMI, mean 30.6 vs. 27.3 kg/m2, p=0.006), and patients with pregnancies at greater gestational age (59.5 days vs. 53.6 days, p<0.001) were more likely to have EBL ≥200mL. Additionally, patients with pregnancies dated by ultrasound (34.3% vs. 18.4%, p=0.007), those who underwent D&C in the operating room (81.4% vs. 48.7%, p<0.001), and those who underwent general anesthesia (81.4% vs. 44.3%, p<0.001) were more likely to have EBL ≥200mL. Discussion In this study, patients with EBL ≥200mL at the time of D&C differed significantly from those with EBL<200mL. This information can assist providers in planning the best setting for their patients' procedures.
引言 对于孕早期妊娠失败的处理，刮宫术（D&C）的最佳实施环境尚无明确指导。识别刮宫术时存在临床显著失血风险的患者，可能有助于医疗服务提供者做出关于手术实施环境的决策。我们旨在识别刮宫术时失血量达200毫升或更多的预测风险因素。
方法 这是一项回顾性队列研究，研究对象为孕龄小于11周、被诊断为孕早期妊娠失败且于2016年4月至2021年4月在一家安全网学术机构接受刮宫术手术治疗的患者。提取了患者特征和手术结果。对失血量小于200毫升与大于或等于200毫升的女性患者，采用描述性统计、分类变量的卡方检验以及连续变量的萨特思韦特t检验进行比较。
结果 共识别出350例患者；233例符合纳入标准，228例有非缺失的结果数据。平均孕龄为55天（标准差9.4）。31%（n = 70）的患者估计失血量（EBL）≥200毫升。更年轻的患者（平均28.7岁对30.9岁，p = 0.038）、拉丁裔患者（67.1%对51.9%，p = 0.006）、体重指数（BMI）较高的患者（平均30.6对27.3kg/m²，p = 0.006）以及孕龄较大的患者（59.5天对53.6天，p < 0.001）更有可能EBL≥200毫升。此外，经超声确定孕周的患者（34.3%对18.4%，p = 0.007）、在手术室接受刮宫术的患者（81.4%对48.7%，p < 0.001）以及接受全身麻醉的患者（81.4%对44.3%，p < 0.001）更有可能EBL≥200毫升。
讨论 在本研究中，刮宫术时EBL≥200毫升的患者与EBL < 200毫升的患者有显著差异。这些信息可帮助医疗服务提供者为其患者的手术规划最佳实施环境。
