Pregnancy outcomes after removal of osmotic dilators in patients who presented for second-trimester abortion.

OBJECTIVE: To report pregnancy outcomes and potentially related complications among thirteen patients who had osmotic dilators placed for second-trimester dilation and evacuation followed by subsequent removal with the intention to continue their pregnancies.

STUDY DESIGN: We reviewed billing and scheduling data between 2005 and 2017 to identify the total number of women seen for D&E and to identify the individuals who had dilators placed without a subsequent scheduled dilation and evacuation. We then performed chart reviews to determine pregnancy outcomes.

RESULTS: Between 2005 and 2017, we treated 2532 patients who presented for second-trimester abortions by D&E and received osmotic dilators for cervical preparation. Twenty (0.8%) of these women had cervical dilators removed with the intention of continuing their pregnancies. We could obtain outcome data for 13 of these pregnancies; one of these women ultimately elected to have an abortion. Eight of the remaining 12 women (66%) experienced complications which included premature preterm rupture of membranes, preterm delivery, maternal infection and hemorrhage. Six (50%) pregnancies ended in spontaneous abortion or fetal or neonatal death.

CONCLUSION: Continuation of pregnancy after placement and removal of osmotic dilators may increase the risk of adverse pregnancy outcomes.

IMPLICATIONS: Of the women who had outcome data available, 50% who had cervical dilators removed experienced spontaneous abortion or fetal or neonatal death. Conservatively assuming that all women lost to follow up had healthy pregnancies, 30% of women experienced fetal or neonatal death and 40% had an adverse pregnancy outcome.