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May 11, 1963

Hypofibrinogenemia and Presumptive Shwartzman Reaction in Septic Abortion

JAMA. 1963;184(6):502-504. doi:10.1001/jama.1963.73700190018021b

THE OCCURRENCE of hypofibrinogenemia in septic abortion is believed to be rare. Only seven cases17 have been reported in sufficient clinical detail for analysis; the outcome was fatal in all. In some of these cases death was attributable to gas gangrene of the uterus. In others, however, the predominant clinical feature was acute vascular collapse in association with coliform bacteremia. There is general agreement that such vascular collapse is caused by liberation of bacterial endotoxin into the blood stream. It has been postulated8 that the clinical and pathologic manifestations in pregnant patients dying from exposure to bacterial endotoxin are analogous to the reaction produced in laboratory animals by intravenous injections of endotoxin; ie, the generalized Shwartzman reaction.

One of the effects of experimental injections of bacterial endotoxin is a disturbance in the bloodclotting mechanism, evidently the result of intravascular coagulation. However, correlative observations of blood coagulation changes in