Subclinical coagulopathy following amnioinfusion with hypertonic saline

Abstract

Previously reported blood coagulation changes in unselected cases undergoing hypertonic saline amnioinfusion for second-trimester abortion were reviewed and compared with the authors' experience in 22 cases. The majority of cases studied developed laboratory evidence of coagulopathy within hours following infusion although no cases developed bleeding problems. Nearly all studies demonstrated an early postinfusion appearance of fibrin monomer complexes along with depression of platelet count, fibrinogen, and Factor VIII. Fibrin and fibrinogen degradation products also appeared early, and two studies demonstrated a significant drop in plasminogen. Only the author's work demonstrated a significant shortening of euglobulin clot lysis time indicating possible systemic activation of fibrinolysis. All factors exhibited a tendency to return toward normal by 24 to 48 hours after infusion, sometimes even before abortion was completed. Plasma fibrinogen and activated partial thromboplastin times are recommended in evaluating heavy uterine hemorrhage following saline amnioinfusion.