Disseminated intravascular coagulation resulting in severe hemorrhage, following the intraamniotic injection of hypertonic saline to induce abortion

Abstract

common ejaculatory ducts. \Ye bvere not able to tilld in the literature any similar case or any description of an attempt to correct surgically this kind of anomaly. In addition, since the patient had a normal libido, erection, and orgasm as I\-et1 as a happy Inaritnl lift, he refused to undergo aiiy operation. Another lvay \\-ould be to try and obtain sterile S~IIICII by treating the patient lvith antiI)iotic\, according to the sensitivity, followed by artificial insemination by the husband. 'I'\vo courses of neomycin, 6 Gm. per day, for 10 days \\.cre given to the patient, but repeated semen cultures were still positive for E. coli. The semen cultures remained positive even after the administration of repeated enemas with neomycin i;olution, 50 per cent. An attempt was made to steritiye the semen “in vitro” by mixing it with neomycin solution, 50 per cent. By this procedurc,, the semen cultures tvere sterile after 20 niinutes. Art’ificial insemination by the husband \\?th the senlr11 after being treated in the abovettlcntioncd \vay seemed to be another logical way of treatment in this case. But since there could be possible teratogenic influence of the neomycin on the semen, we did not choose this way. Th(a couple definitely refused artificial insemination by a donor. The single therapeutic possibility left \vas artificial insemination by the husband with the contaminated senlen. This lvay, of courw, \vould entail some danger of pelvic inflalilrrlatory disease to the ~vomm. Since intercourse is not considered to be a t~acteriologically sterile act, and since the female genital tract has natural defense mechanisnls against ascending infections (closed celvis, cer\.ical mucus, xraginal lactobacitli, etc.), \ve decided to insenkate the v~o1na11 lvith the contamiirated semen \\-hile covering her Ivith a broad\pectrurn antibiotic. The risk involved \c-as cnrefully explained to the couple. After establishing ovulation and patency of the tuber, the \voman leas given I’rnbritin (ampicillill), 2 Gm. per day, for 10 days and 3 artificial inseminations by the husband \cere performed, in the same cycle. The semen \cas oblained after a cleansing enenin. l’he Mife concci\,ed on her first cycle and had an uneventful, Ilorlnnl preglxmcy. AI $0 lvecks, she was adltlittcd I)ecaLIsc of hreectl presentation (high pre\Ixntitig part ) and pr(~tt~ature rupture of n1cmIxanes. A 101~ cemical cesarcan section Tras performed, and a Ilormal fenlale baby xc-eighing 3,500 grams \\-a~ delivered. The postoperative I)eriod \vas Ime~~entful; and the mother with the baby w’ere both discharged on the eighth postoperative day.