Authors: Nguyen H et al.
International Journal of Obstetric Anesthesia, 2025 Volume 64
Summary
This single-center retrospective cohort study evaluated the safety of intravenous deep sedation for dilation and evacuation (D&E) procedures, specifically focusing on medically complex patients and pregnancies beyond 24 weeks’ gestational age. From 2018 to 2024, a total of 1,165 D&E procedures were performed under deep sedation between 12 and 27+6 weeks’ gestation.
The cohort was high-risk: 8.7% were beyond 24 weeks, 34.1% involved patients with BMI > 30 kg/m², and 8.9% involved patients with substance use disorder. Despite these risk factors, anesthetic complications were exceedingly rare. Only one patient (0.09%) required endotracheal intubation due to an emesis event at 18+5 weeks. Three cases (0.3%) involved hypoxemic episodes requiring anesthesiologist intervention, but none resulted in critical adverse outcomes. Logistic regression showed no significant relationship between gestational age and the occurrence of hypoxemic episodes.
Overall, the study suggests that deep sedation for D&E—even in medically complex patients and in later gestational ages—has a very low incidence of anesthesia-related complications. These results support the safety and feasibility of deep sedation as an anesthetic approach for high-risk D&E populations.
What You Should Know
• 1,165 D&E procedures under deep sedation analyzed from 2018–2024.
• High-risk cohort: >24 weeks gestation, obesity, and substance use disorder.
• Only one intubation event (0.09%) across all procedures.
• Three hypoxemia episodes required intervention (0.3%).
• No significant association between gestational age and hypoxemia risk.
• Deep sedation appears safe for D&E even in medically complex or late-gestation cases.
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