Abstract
Objective
The objective was to report pregnancy outcomes and potentially related complications
among 13 patients who had osmotic dilators placed for second-trimester dilation and
evacuation (D&E) followed by subsequent removal with the intention to continue their
pregnancies.
Study design
We reviewed billing and scheduling data between 2005 and 2017 to identify the total
number of women seen for D&E and to identify the individuals who had dilators placed
without a subsequent scheduled dilation and evacuation. We then performed chart reviews
to determine pregnancy outcomes.
Results
Between 2005 and 2017, we treated 2532 patients who presented for second-trimester
abortions by D&E and received osmotic dilators for cervical preparation. Twenty (0.8%)
of these women had cervical dilators removed with the intention of continuing their
pregnancies. We could obtain outcome data for 13 of these pregnancies; one of these
women ultimately elected to have an abortion. Eight of the remaining 12 women (66%)
experienced complications which included premature preterm rupture of membranes, preterm
delivery, maternal infection and hemorrhage. Six (50%) pregnancies ended in spontaneous
abortion or fetal or neonatal death.
Conclusion
Continuation of pregnancy after placement and removal of osmotic dilators may increase
the risk of adverse pregnancy outcomes.
Implications
Of the women who had outcome data available, 50% who had cervical dilators removed
experienced spontaneous abortion or fetal or neonatal death. Conservatively assuming
that all women lost to follow-up had healthy pregnancies, 30% of women experienced
fetal or neonatal death and 40% had an adverse pregnancy outcome.
Keywords
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References
- Induced abortion in the United States: fact sheet January 2018.https://www.guttmacher.org/fact-sheet/induced-abortion-united-statesDate accessed: May 16, 2018
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- Cervical preparation before dilation and evacuation using adjunctive misoprostol or mifepristone compared with overnight osmotic dilators along: a randomized controlled trial.Obstet Gynecol. 2015; 126: 599-609
Article info
Publication history
Published online: January 25, 2019
Accepted:
September 25,
2018
Received in revised form:
September 20,
2018
Received:
March 27,
2018
Footnotes
☆The authors have no financial disclosures.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
