| Abstract: | To determine the role of changes in coagulation factors in hermorrhagic complications after intraamniotic infusion of hypertonic saline for therapeutic abortion, 21 women undergoing this operation, ranging 15-38 years in age with an average gestation of 18 weeks, were studied for coagulation factors, fibrinogen survival, and plasma volume. Blood tests were taken before, immediately after, and at 3-hour intervals after infusion of hypertonic saline. Significant changes were found in the following factors: Thrombin clotting time was consistently prolonged from the third hour after infusion. The platelet count dropped significantly from 310,000/cu. mm before infusion to 223,000/cu. mm 18 hours later. Fibrinogen levels dropped significantly from a mean preinfusion level of 393 mg/100 ml to 297 mg/100 ml at 18 hours. Factor VIII levels also fell significantly from 131% of normal at preinfusion to 85% of normal at 6 hours. Factor V levels declined significantly from a preinfusion mean of 104% of normal to 91% at 6 hours, though the rate of decrease varied widely among the patients. Fibrinogan/fibrin, degradation products, negative at preinfusion, appeared in all patients serums. Euglobulin lysis time was not accelerated. Fibrinogen survival studies were conducted in only 5 patients, 4 of whom showed a significant decrease, notably immediately preceding abortion, with a highly significant correlation to the time from infusion. Plasma volume increased significantly with a corresponding decrease in hematocrit. It is concluded that a mild form of diffuse intravascular coagulation develops after the intraamniotic infusion of hypertonic saline, but further research is necessary to pinpoint the cause of serious coagulopathy and hemorrhage. |
