Coagulopathy associated with dilation and evacuation for second-trimester abortion.

Objective: To characterize the clinical and laboratory features of coagulopathy following second-trimester surgical abortions. DESIGN. Retrospective study.

Setting: Gynecologic unit of a university-affiliated medical center.

Population: 1249 consecutive women underwent late second-trimester (16-24 weeks) surgical abortions between January 2002 and June 2010. Of those, 20 women (1.6%) were diagnosed with excessive bleeding accompanied by coagulopathy.

Methods: Women were divided into two groups based on whether the abortion was performed for fetal demise (n=14) or pregnancy termination (n=6).

Main Outcome Measures: Gestational age, indication for abortion, blood clotting tests, number of blood products and coagulation factors administered.

Results: Women who had pregnancy termination began to bleed significantly earlier than those with fetal demise (p<0.05). A significantly higher number of women with fetal demise had a gradual deterioration of the clotting test, compared with women who had pregnancy termination (p<0.05). In women with fetal demise, early bleeding was associated with a more severe clinical presentation.

Conclusions: Coagulopathy following surgical abortion manifests differentially in women who have fetal demise and those who have pregnancy termination, implying a different pathophysiology. Women with fetal demise suffering from excessive bleeding following surgical abortion accompanied with mild clotting test abnormalities should be carefully monitored to diagnose and treat an impending disseminated intravascular coagulation.