Delays in the Management of Second-Trimester Pregnancy Loss, Associated Factors and Complications at an Urban Public Referral Center in Los Angeles, California [ID 850]

INTRODUCTION: As delays in the management of second-trimester pregnancy loss are thought to be linked to morbidity, we examined delays in care, potential factors, and associated outcomes at our institution. METHODS: We conducted a retrospective cohort study of patients undergoing dilation and evacuation (D&E) or induction termination for a second-trimester loss (13 0/7 to 28 0/7 weeks), from January 2019 to December 2024. Using bivariate analysis, we explored sociodemographic factors potentially linked to delays in care by size–date discrepancy (SDD, 4 weeks) and time from diagnosis to care (TDC, 1 week), as well as the association of these delays to complications (eg, hemorrhage, transfusion, intrauterine balloon use, reoperation, infection, retained products of conception, etc) both individually and in composite. RESULTS: Of 141 losses, 65% underwent D&E versus 35% induction termination. Two-thirds of patients received care within 1 week of diagnosis. The mean TDC was 5.6 days (SD 5.2), and the mean SDD was 20.6 days (SD 16.0), neither of which varied by maternal age, race/ethnicity, parity, insurance status, referral status, body mass index, or gestational age. Complications occurred among 15.7% of cases (eg, 11.4% additional procedures, 9.7% retained products, 3.2% transfused). However, neither delaying care for more than 1 week from diagnosis (33.3%) nor size-date discrepancies beyond 4 weeks (25.5%) or 5 weeks (17.0%) were linked to any complications. CONCLUSIONS/IMPLICATIONS: Although delays in the management of second-trimester pregnancy loss are thought to be linked to greater morbidity, this association may be historic, as the association was not supported by our data, potentially related to evolving management practices.