Clinical interventions are more accurate than quantitative measurements for defining hemorrhage with dilation and evacuation

Objectives: To assess if quantitative blood loss (QBL) with dilation and evacuation (D&E) procedures cor-related 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, hos-pitalization, or return to operating room; the latter 5 criteria defined hemorrhage. We used chi 2 test for trend to evaluate bleeding outcomes.Results: We evaluated 431 procedures with a mean gestational age of 19 weeks and 3 days. Clinically rel-evant bleeding outcomes occurred in 6/319 (2%), 15/97 (15%) and 7/12 (58%) patients with total blood loss < 250mL, 250 -50 0mL and > 50 0mL, 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 < 0.0 0 01). Patients with rel-evant bleeding outcomes had QBLs ranging from 150 -180 0mL (median QBL 312.5mL, interquartile range [IQR] 250 -550mL) while those without clinically relevant bleeding ranged from 10 -90 0mL (median QBL 150mL, IQR 75 -20 0mL).Conclusion: Most patients (75%) with clinically relevant bleeding outcomes had QBL <= 50 0mL. Although higher QBL correlates with clinical interventions, the need for significant interventions rather than a sin-gle 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 man-age bleeding rather than any quantified amount of blood loss.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study aimed to assess the correlation between quantitative blood loss (QBL) and clinically relevant outcomes or hemorrhage in dilation and evacuation (D&E) procedures. The findings showed that the majority of patients (75%) with clinically relevant bleeding outcomes had a QBL of 500mL or less. Therefore, the need for clinical interventions should be used to define hemorrhage in D&E procedures, rather than a specific amount of blood loss.