title: Characteristics of presumptive idiopathic disseminated intravascular coagulation during second-trimester induced abortion.
abstract: BACKGROUND
  Disseminated intravascular coagulation (DIC) is a serious and relatively uncommon complication of induced or spontaneous abortion or delivery. Occasionally, it has been reported in the absence of predisposing conditions. Little information in the literature describing idiopathic DIC or the treatment of patients with DIC exists.
  
  
  METHODS
  From 2002 through 2008, 24 cases of presumptive idiopathic DIC occurred following dilation and evacuation (D&E) abortion between 13 5/7 and 23 6/7 weeks' estimated gestational age at a Midwestern ambulatory surgical center. The characteristics of each patient, their pregnancies and surgical experiences were examined and compared with a temporally matched control group of D&E patients. We explored whether the index cases had a predominance of any historical, clinical or reproductive characteristics compared with controls matched for demographic and reproductive landmarks.
  
  
  RESULTS
  Overall incidence of presumptive idiopathic DIC was 1.8 per 1000 D&E cases. Compared with matched controls, there was a greater likelihood of DIC with more advanced gestation (p=.009); no case of DIC was under 17 weeks' gestational age. Increased bleeding occurred at a mean time of 153 min after completion of surgery (range, 55-491 min; median, 131 min). Nineteen of 24 cases were successfully treated at the surgical center after receiving 6 to 8 units of fresh-frozen plasma (FFP); 5 cases were transferred to a hospital for further treatment.
  
  
  CONCLUSIONS
  The abnormal bleeding of presumptive DIC typically begins to appear within 2 h after uncomplicated D&E and is more likely to occur at 17 weeks' estimated gestational age and more. With rapid diagnosis and treatment, most patients were able to be treated in an outpatient setting with up to 6 to 8 units of FFP and rehydration.
authors: Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. sloane.york@gmail.com
authors: Sloane
authors: S
authors: York
authors: E Steve
authors: ES
authors: Lichtenberg
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D016913:Blood Component Transfusion; D016022:Case-Control Studies; D004107:Dilatation and Curettage / Q000009:adverse effects; D004211:Disseminated Intravascular Coagulation / Q000209:etiology* / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D015994:Incidence; D015146:Midwestern United States / Q000453:epidemiology; D010949:Plasma; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014592:Uterine Hemorrhage / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult