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Objectives
To identify if quantitative blood loss with dilation and evacuation procedures correlates
with clinically relevant outcomes.
Methods
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.
Results
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.
Conclusions
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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Copyright
© 2022 Published by Elsevier Inc.
