Safety of first-trimester uterine evacuation in the outpatient setting for women with common chronic conditions

OBJECTIVE

We compared complications of outpatient first-trimester uterine evacuation between women with medical comorbidities and healthy peers.

STUDY DESIGN

We examined the medical histories and procedure outcomes of women receiving first-trimester uterine evacuations between 01/02/2009 and 03/07/2014. We compared women without medical problems to those reporting diabetes, hypertension, obesity (body mass index ≥30.0 or weight ≥200 lbs), HIV, epilepsy, asthma, thyroid disease and/or bleeding/clotting disorders. We compared incidence of any of the following: resuction, uterine perforation, estimated blood loss >100 cc and cervical laceration.

RESULTS

A total of 1960 women met inclusion criteria; 597 (30%) had ≥1 comorbidity. When compared to women without medical morbidities, women with common chronic conditions were older (28.3±6.7 vs. 27.3±6.7 years, p<.01), less likely to be primigravid (29.1% vs. 35.7%, p<.01) and more likely to have had a prior cesarean delivery (24.9% vs. 15.7%, p<.001). Gestational age and indication for evacuation were similar for the groups. The overall complication rate was 2.9%. There was no difference in complications between the group of patients with at least one comorbidity compared to the group of women without any comorbidity (OR=0.9, 95% CI 0.5, 1.6). Additionally, there were no specific medical comorbidities that led to an increased complication rate. The only significant predictor of complication was history of cesarean delivery (OR=1.9, 95% CI 1.1, 3.4).

CONCLUSION

Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared to healthy peers. While a careful medical history is always required, providers may feel reassured that complications remain infrequent.

IMPLICATIONS

Women with common chronic conditions undergoing outpatient first-trimester uterine evacuation do not appear to be at greater risk of complications compared to healthy peers.

Use and impact of cardiac medication during pregnancy

ABSTRACT 

Cardiovascular disease is the most encountered cause of maternal death during pregnancy in the western world and an increase in maternal mortality due to cardiac causes has been observed. More women with congenital or acquired heart disease have the desire to become pregnant. Pregnancy is known to impose a major hemodynamic burden and also has impacts on the coagulation system. The risk of developing complications is clearly increased as compared with the normal population. For optimal management, it is crucial to have information on the effects of cardiac medications on the fetus. The focus of this article is to discuss the management of cardiac disease in pregnancy, as well as the known safety of cardiac medications for the mother and/or fetus.

The pregnant woman with heart disease: management of pregnancy and delivery

Women with heart disease are at risk of cardiac complications during pregnancy and delivery. Risk assessment should be performed in these women, and the management of pregnancy and delivery should be planned accordingly. Depending on the risk, women should be cared for in specialised centres, regional centres or a combination of both. Multidisciplinary teams must be involved in the care of these women. Adequate organisation of care and communication between the team members is important to prevent complications.