Obesity as a Risk Factor for Complications After... : Obstetrics & Gynecology (original) (raw)

Original Research

Obesity as a Risk Factor for Complications After Second-Trimester Abortion by Dilation and Evacuation

Lederle, Lauren MD; Steinauer, Jody E. MD, MAS; Montgomery, Anne BA; Aksel, Sarp MD; Drey, Eleanor A. MD, EdM; Kerns, Jennifer L. MD, MPH

University of California, San Francisco, School of Medicine, the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; and Albert Einstein College of Medicine, New York, New York.

Corresponding author: Jennifer L. Kerns, MD, MPH, San Francisco General Hospital, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110; e-mail: [email protected].

Supported by the National Center for Advancing Translational Sciences, National Institutes of Health through UCSF-CTSI Grant Number KL2 TR000143. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. This publication was made possible in part by the Clinical and Translational Research Fellowship Program (CTRFP), a program of the University of California, San Francisco's (UCSF's) Clinical and Translational Science Institute (CTSI) that is sponsored in part by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number TL1 TR000144 and the Doris Duke Charitable Foundation (DDCF). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH, UCSF, or the DDCF. Additional funding for statistical assistance was obtained from UCSF Resource Allocation Program Pilot for Established Investigators in Basic and Clinical/Translational Sciences 2013 grant.

Presented as a poster at the North American Forum on Family Planning 2014, October 10–13, 2014, Miami, Florida.

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

The authors thank Rachel Deming, BA (UCSF School of Medicine), Anna Yap, BA, Ishika Arora, BS, BA (UCSF Department of Family & Community Medicine); Vidita Chopra, MPH (UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Family Planning Research) for data acquisition, and Dr. Peter Bacchetti at UCSF-CTSI for aiding in the analysis phase of this study through the CTSI grant listed.

OBJECTIVE:

To evaluate the association between obesity (body mass index [BMI] 30 or higher) and dilation and evacuation (D&E) complications.

METHODS:

We conducted a retrospective cohort study of women who underwent D&E abortion from February 2009 to April 2013 at a hospital-based abortion practice in California. We evaluated the association between obesity and risk of complication after D&E using logistic regression. We defined complications a priori as cervical laceration, hemorrhage, uterine atony, anesthesia complications, uterine perforation, disseminated intravascular coagulation, and retained products of conception. We defined major complications as those requiring hospitalization, transfusion, or further surgical intervention.

RESULTS:

Complications occurred in 442 of 4,520 D&Es (9.8%), with equal proportions in obese and nonobese women (9.8%). Major complications occurred in 78 (1.7%) patients. After adjustment for age, ethnicity, prior vaginal delivery, prior cesarean delivery, and gestational duration, there was no association between BMI and D&E complications. Any individual complication was associated with each additional week of gestation (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.3–1.4), prior vaginal delivery (OR 1.5, 95% CI 1.2–1.9) and prior cesarean delivery (OR 1.8, 95% CI 1.4–2.3). Major complications were associated with each additional week of gestation (OR 1.3, 95% CI 1.1–1.4) and cesarean delivery (OR 1.8, 95% CI 1.1–3.1).

CONCLUSION: