OBJECTIVE:To evaluate the association between obesity (body mass index BMI 30 or higher) and dilation and evacuation (DE) complications.METHODS:We conducted a retrospective cohort study of women who underwent DE 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 DE 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 DEs (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 DE 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:We found no association between obesity and DE complications. Our findings are consistent with previous studies demonstrating that later gestational duration is associated with an increased risk of complications. Obesity may not warrant referral to a high-risk abortion center, particularly because referral-associated delay might increase the risk of complications.LEVEL OF EVIDENCE:II
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