Disseminated intravascular coagulation after second trimester procedural abortion: a review

Disseminated intravascular coagulation (DIC) after second trimester abortion is a rare but potentially catastrophic complication that is increasingly relevant as abortion care in the US becomes more restricted and concentrated in referral centers. This review summarizes current evidence about risk factors, diagnosis, and management of DIC in second trimester procedural abortion, including induced abortion and fetal demise, with particular attention to patients traveling for care.

Available literature identifies fetal demise as the strongest risk factor for DIC after dilation and evacuation; the risk of both hemorrhage and DIC is substantially higher in the setting of fetal demise than induced abortion. Increasing gestational duration is also associated with elevated risk. Hypofibrinogenemia is the most sensitive laboratory marker and correlates with severe hemorrhage. Preoperative coagulation studies are frequently normal and have limited predictive value. Prompt recognition, uterine evacuation, and replacement of clotting factors are central to effective management.

Although uncommon, DIC should be considered in patients with unexplained postabortion hemorrhage, especially in later gestations or prolonged fetal demise. As interstate travel for abortion increases, clinicians may more frequently encounter rare complications such as DIC, underscoring the need for risk stratification and institutional preparedness.