Desire for pregnancy remembrance among patients undergoing procedural uterine evacuation

To describe pregnancy remembrance preferences of patients undergoing procedural uterine evacuation.

We conducted a retrospective study of patients presenting at an academic referral center for procedural uterine evacuation for abortion or fetal demise from 2/1/2021-1/30/2022. Patients answered a questionnaire at their pre-procedure appointment regarding pregnancy remembrance preferences including viewing the ultrasound examination, receiving ultrasound pictures, information about multiple pregnancy or fetal sex, receiving fetal footprints, recitation of a blessing, and arranging private fetal disposition. We also asked if questioning induced emotional distress. We collected patient demographics, pregnancy gestational age, uterine evacuation indication, and questionnaire data from the electronic medical record. We categorized cases into maternal-fetal indications (fetal anomalies or demise, pregnancy or maternal health complications) and other indications. We tested for associations using chi-square, Fisher's exact, and Wilcoxon rank sum tests. We computed odds ratios using multivariate regression analysis adjusted for procedure indication, maternal age, gestational age, and parity.

The 368 evaluable questionnaires included 94(25.5%) for maternal-fetal and 274(74.5%) for other indications. Overall, 272(74.1%) desired pregnancy remembrance (maternal-fetal indications 77[81.9%]; other indications 195[71.4%], aOR1.96, 95%CI 1.09-3.70). Patients with maternal-fetal indications, as compared to other indications, less frequently requested multiple gestation (16[17.0%] vs 103[37.7%]) and sex information (32[34.0%] vs 137[50.2%]), and more frequently requested footprints (56[59.6%] vs 85[31.1%]), blessing (42[44.7%] vs 68[24.9%]), and private disposition (28[30.1%] vs 16[5.9%]), all p ≤ 0.01. Patients with maternal-fetal indications more frequently reported emotional distress (27/91[29.7%] vs 37/254[14.6%]; aOR 2.11, 95%CI 1.15-3.82), but many (50/64[78.1%]) still desired remembrance.

Most patients desired pregnancy remembrances regardless of indication, including those patients who reported emotional distress with being asked.

Patients who choose uterine evacuation for both maternal-fetal and other indications commonly want some type of information related to remembering the pregnancy, although those with maternal-fetal indications more frequently desire footprints, fetal blessing and private disposition. Clinics should consider universal inquiry of a desire for pregnancy remembrances.