Abstract
Objectives
To assess if quantitative blood loss (QBL) with dilation and evacuation (D&E) procedures
correlated with clinically relevant outcomes or hemorrhage.
Study design
We used a de-identified database to review D&E procedures performed at UC Davis Health
from April 2019 through March 2020. Surgeons determined QBL during procedures and
estimated blood loss, when excessive, during post-procedure recovery. We extracted
patient demographic and procedure-related information. We defined clinically relevant
bleeding as cases with bleeding-related interventions within 24 hours post-procedure
including use of ≥2 uterotonics, tranexamic acid administration, cervical injury requiring
repair, uterine balloon tamponade, blood transfusion, uterine artery embolization,
hospitalization, or return to operating room; the latter 5 criteria defined hemorrhage.
We used χ2 test for trend to evaluate bleeding outcomes.
Results
We evaluated 431 procedures with a mean gestational age of 19 weeks and 3 days. Clinically
relevant bleeding outcomes occurred in 6/319 (2%), 15/97 (15%) and 7/12 (58%) patients
with total blood loss <250mL, 250−500mL and >500mL, respectively (p<0.0001); 11 had bleeding related to cervical injuries. Hemorrhage occurred in 0,
4/97 (4%) and 5/12 (42%) patients, respectively (p<0.0001). Patients with relevant bleeding outcomes had QBLs ranging from 150−1800mL
(median QBL 312.5mL, interquartile range [IQR] 250−550mL) while those without clinically
relevant bleeding ranged from 10−900mL (median QBL 150mL, IQR 75−200mL).
Conclusion
Most patients (75%) with clinically relevant bleeding outcomes had QBL ≤500mL. Although
higher QBL correlates with clinical interventions, the need for significant interventions
rather than a single blood loss amount should be used to define hemorrhage with D&E
procedures.
Implications
Clinical hemorrhage is best defined by the necessary clinical interventions required
to manage bleeding rather than any quantified amount of blood loss.
Keywords
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Article info
Publication history
Published online: December 02, 2022
Accepted:
November 17,
2022
Received in revised form:
November 15,
2022
Received:
August 15,
2022
Publication stage
In Press Corrected ProofFootnotes
Presented in part as a poster abstract at the Society of Family Planning 2022 Annual Meeting.
Editor: Carolyn Westhoff
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
