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To identify if quantitative blood loss with dilation and evacuation procedures correlates with clinically relevant outcomes.
We used a de-identified family planning database to identify dilation and evacuation procedures performed at UC Davis Health from April 2019 through March 2020. Surgeons determined quantitative blood loss during procedures and estimated blood loss if excessive post-procedure (during recovery). We extracted patient demographic and procedure-related information. We defined clinically relevant bleeding as cases with use of ≥2 uterotonics or any of the following interventions: tranexamic acid administration, uterine balloon tamponade, blood transfusion, hospitalization, return to operating room, or other bleeding-related interventions within 24 hours post-procedure. We used chi-square test for trend to evaluate bleeding outcomes.
We evaluated 431 procedures with a mean gestational age of 19±3 weeks. Clinically significant bleeding outcomes occurred in 6/305 (2%), 14/109 (13%) and 8/17 (47%) patients with total blood loss <250mL, ≥250mL and ≥500mL, respectively (p<0.0001). Seventeen patients had uterine etiologies and 11 had cervical injuries, with QBLs ranging from 150-1800mL (median QBL 312.5mL, interquartile range [IQR] 250-500mL). Patients without clinically relevant bleeding had median QBL of 150 mL (interquartile range [IQR] 75-200mL). Among patients who received no or 1 uterotonics, median QBLs were 115 mL (IQR 50-200mL) and 200 mL (IQR 150-300mL), respectively.
More than half of patients with quantitative blood loss ≥500 mL do not have clinically relevant bleeding outcomes. Although higher blood loss correlates with clinical interventions, the need for intervention rather than a single amount of blood loss should be used to define hemorrhage with dilation and evacuation procedures.
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