Defibrination syndrome after intra-amniotic infusion of hypertonic saline

Abstract

Changes in the coagulation factors, fibrinogen survival, and plasma volume after intra-amniotic infusion of hypertonic saline are described. Highly significant decreases in platelets, fibrinogen, and factors VIII and V were observed. There was a significant decrease in fibrinogen survival in 4 of 5 patients, notably immediately preceding abortion, and a highly significant correlation between the degree of over-all change in fibrinogen survival and the time from intra-amniotic saline infusion. There was also a significant increase in the plasma volume, with a corresponding decrease in hematocrit, but the decreases in procoagulants were significantly greater than the decrease in hematocrit. Fibrinogen/fibrin degradation products, which were consistently negative prior to the infusion of saline, appeared in the serum. The euglobulin lysis time was not accelerated. It would appear that a generally mild and self-limited form of diffuse intravascular coagulation develops after the intra-amniotic infusion of hypertonic saline. In some patients, this defibrination process may result in a clinically significant bleeding diathesis.