Contraception · 2026
Fetal demise duration and bleeding outcomes at the time of dilation and evacuation.
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Sulger Elisabeth, Levandowski Brooke A, Fronk Emily, Stuehling Dana, Sun Stacy, Betstadt Sarah
Аннотация
OBJECTIVES: To examine associations between time from second trimester intrauterine fetal demise (IUFD) to dilation and evacuation (D&E) and bleeding complications.
STUDY DESIGN: We identified 197 patients scheduled for D&E for IUFD at a single academic institution between March 2011 to March 2025. IUFD duration was calculated by subtracting gestational age by fetal biometry from gestational age by obstetric dating, categorized into 0-14 days, 15-28 days, and > 28 days. We examined the associations between IUFD duration and bleeding outcomes of disseminated intravascular coagulopathy (DIC) and hemorrhage (EBL >1000 mL) using logistic regression.
RESULTS: Of the 189 patients included, durations of fetal demise were 0-14 days (n = 61, 32.3%), 15-28 days (n = 77, 40.7%), and > 28 days (n = 51, 27.0%). Bleeding outcomes were 3.2% DIC (n = 6) and 2.2% hemorrhage (n = 4). Due to low bleeding outcomes, neither were significantly associated with IUFD duration. However, patients > 28 days from IUFD had 2.45 higher odds of developing DIC (95% CI 0.2-27.8) and 2.45 higher odds of developing hemorrhage (95% CI 0.2-27.8) compared to patients 0-14 days from IUFD.
CONCLUSION: Estimated time from IUFD to D&E is not significantly associated with DIC or hemorrhage. We emphasize the safety of D&E for second trimester IUFDs, especially through the first four weeks of management.
STUDY DESIGN: We identified 197 patients scheduled for D&E for IUFD at a single academic institution between March 2011 to March 2025. IUFD duration was calculated by subtracting gestational age by fetal biometry from gestational age by obstetric dating, categorized into 0-14 days, 15-28 days, and > 28 days. We examined the associations between IUFD duration and bleeding outcomes of disseminated intravascular coagulopathy (DIC) and hemorrhage (EBL >1000 mL) using logistic regression.
RESULTS: Of the 189 patients included, durations of fetal demise were 0-14 days (n = 61, 32.3%), 15-28 days (n = 77, 40.7%), and > 28 days (n = 51, 27.0%). Bleeding outcomes were 3.2% DIC (n = 6) and 2.2% hemorrhage (n = 4). Due to low bleeding outcomes, neither were significantly associated with IUFD duration. However, patients > 28 days from IUFD had 2.45 higher odds of developing DIC (95% CI 0.2-27.8) and 2.45 higher odds of developing hemorrhage (95% CI 0.2-27.8) compared to patients 0-14 days from IUFD.
CONCLUSION: Estimated time from IUFD to D&E is not significantly associated with DIC or hemorrhage. We emphasize the safety of D&E for second trimester IUFDs, especially through the first four weeks of management.