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Defibrination in Saline Abortion

From the Department of Obstetrics and Gynecology, New York Medical College and Metropolitan Hospital and the Department of Gynecology and Obstetrics, Albert Einstein College of Medicine and The Bronx Municipal Hospital Center, New York, NY.

Abstract

Defibrination has been reported in women who have undergone interruption of pregnancy by amniocentesis and instillation of hypertonic saline (saline abortion). In this investigation, clotting factors and fibrinolysis were studied in 14 women undergoing saline abortion. No significant changes were noted in platelets, thrombin time, hemoglobin or serum sodium and chloride concentrations. Factor V levels remained consistently elevated above the non-pregnant state. Factor VIII and plasma fibrinogen levels showed significant decreases within 24 hours of saline instillation. Plasma euglobulin lysis was accelerated at 6–24 hours after completion of abortion. Positive protamine paracoagulation tests (PPT) were found in 12 of 13 patients at 2 hours and in 3 of 10 patients at 24 hours after saline instillation. Fibrinogen-fibrin-related-antigen rose to highly significant levels at 2 hours after saline instillation, completion of abortion, and at 2 hours after completion of abortion. There was no correlation between the positive PPT and the increased FR-antigen, which suggests that the two tests are measuring two different substances or fibrin polymers. It is likely that the coagulation changes noted were independent of sodium, chloride or blood volume changes. The findings suggest that some degree of defibrination occurs in women undergoing saline abortion, similar to that of women during normal parturition but does not usually reach clinically significant levels.