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BMI as predictor of adverse outcomes with intravenous sedation during surgical abortion

Gillian Horwitz, BS, Harvard Medical School, 2015

Project abstract

In 2011, approximately 1.1 million abortions were performed in the United States, and 333,964 of these abortions were performed at Planned Parenthood Federation of America (PPFA) affiliates. PPFA instated new restrictions on intravenous sedation eligibility during surgical abortion. As of March 2015, affiliates can no longer offer sedation to women with a BMI ≥45 and women with a BMI between 40 and 45 can only be offered sedation after special consideration from medical leadership. Since there is limited published data on the safety of intravenous sedation among obese women undergoing surgical abortion, these restrictions were developed to provide guidance to Planned Parenthood affiliates looking to newly incorporate intravenous sedation into their scope of services. Affiliates that have been providing intravenous sedation to obese patients for many years must now restrict their practice.

This retrospective cohort study seeks to determine if BMI is a predictor of adverse outcomes with intravenous sedation during surgical abortion to elucidate if BMI restrictions place unnecessary barriers on access to abortion. We will describe the incidence of serious anesthesia-related complications in our population, and since these are exceedingly rare, we will also compare supplemental oxygen utilization, lowest documented intraoperative oxygen saturation level, lowest intraoperative consciousness level, and use of reversal agents among obese and non-obese women. Successfully demonstrating that with careful eligibility screening, as is the current standard of care at PPLM, intravenous sedation can be safely used in obese women would inform future clinical policies and help ensure safe, optimal access to abortion care.


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