(683) One year later: Comparison of care for nonviable second trimester pregnancies pre- and post-Dobbs decision

Objective: The Dobbs v. Jackson Women’s Health Organization (Dobbs) decision may affect the care provision of patients with second trimester nonviable pregnancies (STNPs). We sought to compare differences in type of, indications for, and access to care of STNPs in the year before and after the Dobbs decision.

Study Design: We conducted a retrospective cohort study of all patients who delivered following care for STNPs between 06/2021-07/2023 at a single, tertiary care center in a state where abortion became illegal, except in cases of medical emergency, immediately following Dobbs. We assigned patients to pre-Dobbs (June 2021-2022) or post-Dobbs (July 2022-2023) eras based on date of delivery. We compared differences in indication for care and procedure type pre- and post-Dobbs. We used multivariate logistic regression to determine the odds of obtaining a dilation and evacuation (D&E) pre- and post-Dobbs, adjusting for confounders.

Results: We included 318 patients in the analysis (n=195 pre-Dobbs, n=123 post-Dobbs). There was no difference in gestational age between the groups (19.5 vs. 19.0, p=0.27), and no difference in distance traveled (24 vs. 21 miles, p=0.42). There was a significant difference in indication for care, with 0 STNP deliveries for fetal anomalies post-Dobbs (p< 0.001). There was also a significant decrease in D&Es post-Dobbs (p=0.01, Table). Patients receiving care post-Dobbs had 53% lower odds of obtaining D&E (aOR 0.47, 95% CI 0.29-0.78). When stratified by indication, there was no difference in odds for obtaining D&E for intrauterine fetal demise (IUFD) (aOR 0.81, 95% CI 0.42-1.56), but patients with an indication of medical emergency had an 83% lower odds of obtaining D&E post-Dobbs (aOR 0.17, 95% CI 0.06-0.47).

Conclusion: Provision of care for STNPs in the one year since the Dobbs decision in an abortion-restrictive state has significantly changed for patients with fetal anomalies and medical emergencies, but remains similar to the pre-Dobbs era for patients with IUFDs. Continued surveillance is necessary to understand how the evolving legal landscape may affect patients.