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Disseminated Intravascular Coagulation and Hemorrhage After Dilation and Evacuation Abortion for Fetal Death

Kerns, Jennifer L. MD, MPH; Ti, Angeline MD, MPH; Aksel, Sarp MD; Lederle, Lauren MD; Sokoloff, Abby MPH; Steinauer, Jody MD, MAS

doi: 10.1097/AOG.0000000000003460
Contents: Medical Disorders of Pregnancy: Original Research

OBJECTIVE: To examine the association between fetal death and risk of hemorrhage and disseminated intravascular coagulation (DIC) among women undergoing dilation and evacuation (D&E) procedures.

METHODS: We conducted a retrospective cohort study of all D&Es at one academic abortion clinic in San Francisco between 2009 and 2013. We abstracted data on fetal death status, demographic characteristics, and complications including hemorrhage and DIC. We examined the risk of hemorrhage and DIC among women with fetal death compared with those without. We conducted unadjusted and adjusted analyses for the outcomes of hemorrhage, DIC, and any complication.

RESULTS: Among 92 cases of D&E for fetal death and 4,428 cases of D&E for other reasons, hemorrhage occurred in 10% and 7%, respectively (P=.28), and DIC occurred in 2.0% and 0.2% of the fetal death and nonfetal death cohorts (P<.001). In adjusted analysis, fetal death was associated with 2.9 times higher odds of hemorrhage (95% CI 1.4–6.0). In an unadjusted analysis, fetal death was associated with 12.3 times higher odds of DIC (95% CI 2.6–58.6) and 3.0 times higher odds of any complication (95% CI 1.6–5.9).

CONCLUSION: Women undergoing D&E for fetal death are far more likely to experience DIC and hemorrhage than are women without fetal death, yet the absolute risk is low (2%). Although D&E providers should be prepared for DIC and hemorrhage, we do not recommend any specific preoperative preparation because the vast majority of D&E abortions for fetal death are uncomplicated.

Although the risk of disseminated intravascular coagulation is higher with dilation and evacuation for fetal death compared with pregnancy termination, the absolute risk is low.

Departments of Obstetrics, Gynecology and Reproductive Sciences, Family and Community Medicine, and Medicine, University of California, San Francisco, San Francisco, California; and Montefiore Medical Center, New York, New York.

Corresponding author: Jennifer L. Kerns, MD, MPH, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; email:

Jennifer Kerns was supported by NIH grant number K23HD067222-03 when she conducted this study.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Jennifer Monroe Zakaras, MPH, for manuscript preparation.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.