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Changes in the provision of hospital-based second-trimester uterine evacuation post-Dobbs in a consistently
Brittani Steinberg1, Bridget C Huysman2, Rachel Paul3
1Department of Obstetrics & Gynecology, Washington University in St. Louis, St. Louis, MO, United States.
Objective:
To examine changes in provision of hospital-based, second-trimester uterine evacuation before and after the Dobbs v Jackson Women's Health (Dobbs) decision.
Study Design:
We conducted a retrospective chart review of second-trimester uterine evacuations by dilation and evacuation (D&E) or induction of labor (IOL) at a single tertiary care center in an abortion-restrictive state from December 2020 to January 2024 and compared outcomes between pre- and post-Dobbs time periods. The primary outcome was method of uterine evacuation (D&E or IOL). Our secondary outcomes were indication for uterine evacuation (medical emergency vs. second-trimester pregnancy loss) and a complication composite. We compared outcomes using appropriate bivariate tests and logistic regression and stratified analyses by indication.
Results:
Three hundred fifty-five evacuations met inclusion criteria. Post-Dobbs, evacuations had 41% lower odds of being performed via D&E (59.5% post-Dobbs vs. 69.3% pre-Dobbs; aOR 0.59, 95%CI: 0.37-0.95). Pre-Dobbs, 73 (38%) evacuations were for medical emergencies compared to 45 (28%) post-Dobbs, and 119 (62%) were for second-trimester pregnancy loss pre-Dobbs compared to 118 (72%) post-Dobbs, representing 38% lower odds of an evacuation for medical emergency post-Dobbs (aOR 0.62, 95% CI 0.39-0.97). Among patients with medical emergencies, we observed 59% lower odds of D&E post-Dobbs (aOR 0.41, 95%CI: 0.18-0.97). Post-Dobbs, D&Es had 38% lower odds of being performed for medical emergencies (aOR 0.62, 95% CI: 0.39-0.97). We saw no changes in study outcomes for patients with second-trimester pregnancy loss.
Conclusion:
In an abortion-restrictive state after Dobbs, fewer second-trimester uterine evacuations were performed via D&E, and a smaller proportion of evacuations were for medical emergencies. Patients with medical emergencies had lower odds of undergoing a D&E.
Implications:
Post-Dobbs, patients requiring abortion had lower odds of undergoing dilation and evacuation compared to induction of labor. Practice changes post-Dobbs may be impacted by multiple factors, including interpersonal, institutional, and political influences. Post-Dobbs restrictions may influence patient and clinician decision-making about route of uterine evacuation, especially in medical emergencies.
