The safety of deep sedation for uterine dilation and evacuation in medically complex patients: a retrospective analysis at an urban center (2018–2024)

Background

Data on the safety of dilation and evacuation performed under deep sedation are limited for patients beyond 24 0/7 weeks’ gestational age, particularly in populations with comorbidities including obesity or substance use disorder. This study evaluated the incidence of anesthesia-related complications during dilation and evacuations under intravenous deep sedation in a medically complex patient cohort including pregnancy termination beyond 24 0/7 weeks’ gestation.

Methods

We conducted a single-center retrospective cohort analysis of elective dilation and evacuations performed under deep sedation between 12 0/7 to 27 6/7 weeks’ gestation. The primary outcome was the incidence of periprocedural anesthetic-related complications necessitating endotracheal intubation. Secondary outcomes included hypoxemic episodes requiring intervention by an anesthesiologist. A logistic regression analysis was used to determine the relationship between gestational age and all hypoxemic episodes.

Results

Of the 1,165 dilation and evacuations performed under deep sedation, 101 (8.7%) were conducted at greater than 24 0/7 weeks gestation, 397 (34.1%) were performed on patients with body mass indices above 30 kg/m², and 104 (8.9%) were performed in patients with substance use disorder. One case of emesis at 18 5/7 weeks’ gestation necessitated endotracheal intubation (0.09% [95% CI: 0.012 to 0.6]). Three cases of hypoxemic episodes required intervention (0.3% [95% CI: 0.08 to 0.8]).

Conclusion

Intravenous deep sedation for dilation and evacuation is associated with a low incidence of anesthetic-related complications in medically complex patients, including terminations beyond 24 0/7 weeks.