Disseminated intravascular coagulopathy with dilation and evacuation for fetal demise

OBJECTIVE: To evaluate disseminated intravascular coagulopathy (DIC) during dilation and evacuation (D&E) for second trimester fetal demise. STUDY DESIGN: We compared rates of DIC in women with fetal demise under-going D&E at (1) 14 weeks to 20 weeks +6 days and (2) 21 weeks to 26 weeks + 6 days of gestation. The primary of DIC is higoutcome was the rate of DIC in the two groups. RESULTS: From January 2003 to December 2016, 442 women underwent D&E for fetal demise: 365 women (82.6%) at 14–20 weeks and 77 women (17.4%) at 21–26 weeks of gestation. Six cases of DIC occurred in the earlier group, and 7 cases occurred in the later group. The odds ratio for DIC at 21–26 weeks versus 14–20 weeks was 5.99 (95% confidence interval 1.95–18.34). Hemorrhage and transfusion occurred more frequently in the later group. The interval between fetal demise and surgery was ≤28 days in 374 women (84.6%) and >28 days in 66 women (14.9%). An interval>28 days was associated with DIC (p=0.02). Preoperative coagulation studies were normal in all except one woman. CONCLUSION: DIC during D&E for fetal demise is uncommon. D&E at 21–26 weeks of gestation was associated with increased odds of DIC as compared with cases at 14–20 weeks of gestation.