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Pathophysiology of shock in obstetrics

José Gerardo González-González, Omar David Borjas-Almaguer, Alejandro Salcido-Montenegro, René Rodríguez-Guajardo, Anasofia Elizondo-Plazas, Roberto Montes-de-Oca-Luna, René Rodríguez-Gutiérrez
Sheehan's syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed...
2018: International Journal of Endocrinology
Sheryl E Parfitt, Mary L Bogat, Sandra L Hering, Cheryl Roth
In spite of many medical breakthroughs, sepsis continues to be challenging to identify, treat, and successfully resolve, including among the obstetric population. Sepsis is the result of an overactive, complex inflammatory response that is not completely understood. Currently there are no nationally agreed-upon criteria for systemic inflammatory response syndrome or sepsis in pregnant or peripartum women, as the physiologic changes of pregnancy have not been taken into consideration.This article is the first in a series of three that discuss the importance of sepsis and septic shock in pregnancy...
July 2017: MCN. the American Journal of Maternal Child Nursing
Line Winther Gustafson, Jan Blaakær, Rikke Bek Helmig
Group A streptococci infection has re-emerged since the 1980s and onward, despite the awareness of the etiology and the use of penicillin. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of group A streptococci disease compared to non-pregnant women. This review focuses on the epidemiology, pathophysiology, clinical presentation, prevention and treatment of group A streptococcal infection in pregnancy. SEARCH STRATEGY: We searched the following electronic databases from 1980-March 2016: PubMed-Medline, Embase, SveMed+, Bibliotek...
August 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Marco Antonio Avila-Vergara, Alma Rita Peña-Ayón, Luis Enrique Guzmán-Gutiérrez, Jesús Everardo Valenzuela-Verduzco, Carmen Beatriz Caballero-Rodríguez, Felipe Vadillo-Ortega
BACKGROUND: Ovarian pregnancy (OP) is a low-frequency pathology but with devastating effects on women reproductive health. It is often difficult to distinguish from tubal or abdominal pregnancy. Diagnostic procedures and actual medical approaches to the treatment of OP are still a challenge. CLINICAL CASE: In this paper we present a 21 years old woman, seen at the Hospital as emergency abdominal pain and hypovolemic shock, with a pregnancy of 14 weeks of gestational age...
November 2015: Ginecología y Obstetricia de México
Waldemar Uszyński, Ewa Żekanowska, Mieczysław Uszyński, Przemysław Kieszkowski
BACKGROUND/AIM: It is believed that the amniotic fluid-derived TF, in the case of amniotic fluid embolism (AFE), contributes to acute disseminated intravascular coagulation (DIC) and obstetric shock in the mother. However, the role of amniotic fluid-derived contact phase coagulation factors that irrupt into the bloodstream simultaneously with TF is still unknown. Our study objective was to identify and measure the concentrations of CAS components and TF in amniotic fluid. MATERIAL AND METHODS: The study group consisted of 30 healthy parturients with uneventful pregnancy and birth...
April 2015: Thrombosis Research
J H W Veerbeek, M C Tissot Van Patot, G J Burton, H W Yung
Placental endoplasmic reticulum (ER) stress has been postulated in the pathophysiology of pre-eclampsia (PE) and intrauterine growth restriction (IUGR), but its activation remains elusive. Oxidative stress induced by ischaemia/hypoxia-reoxygenation activates ER stress in vitro. Here, we explored whether exposure to labour represents an in vivo model for the study of acute placental ER stress. ER stress markers, GRP78, P-eIF2α and XBP-1, were significantly higher in laboured placentas than in Caesarean-delivered controls localised mainly in the syncytiotrophoblast...
January 2015: Placenta
Richard P Dutton, Lorri A Lee, Linda S Stephens, Karen L Posner, Joanna M Davies, Karen B Domino
BACKGROUND: Hemorrhage is a potentially preventable cause of adverse outcomes in surgical and obstetric patients. New understanding of the pathophysiology of hemorrhagic shock, including development of coagulopathy, has led to evolution of recommendations for treatment. However, no recent study has examined the legal outcomes of these claims. The authors reviewed closed anesthesia malpractice claims related to hemorrhage, seeking common factors to guide future management strategies. METHODS: The authors analyzed 3,211 closed surgical or obstetric anesthesia malpractice claims from 1995 to 2011 in the Anesthesia Closed Claims Project...
September 2014: Anesthesiology
Aimin Chang, Zhan Zhang, Liting Jia, Linlin Zhang, Yan Gao, Ling Zhang
OBJECTIVE: Heat shock protein 70 (Hsp70), a highly conserved cellular stress protein, is produced in every organism from bacteria to man. The purpose of this study was to determine the difference in Hsp70 concentrations between term and preterm deliveries. METHODS: In total, 30 healthy term delivery and 99 preterm delivery (PD) women were recruited, including 46 women with preterm labor and intact membranes (PTL) with or without an intra-amniotic infection (IAI) and 53 women with a preterm premature rupture of membranes (PPROMs) with or without IAI...
November 2013: Journal of Maternal-fetal & Neonatal Medicine
S Kadija, A Stefanović, K Jeremić, J Tavcar, R Argirović, S Pantović
INTRODUCTION AND OBJECTIVE: Postoperative infections are a great constituent of surgical complications. The most common one is surgical site infection (SSI), as well as vaginal and/or urinary tract infections, infections affecting distant organs and systems and systemic circulation leading to sepsis and septic shock. Our aim was to emphasize the effect of malignant disease on postoperative infection and to establish malignant disease as a risk factor for SSI, per se. MATERIAL AND METHOD: We designed a retrospective study in which 538 women who underwent surgery in the Gynecology and Obstetrics Clinical Center of Serbia during a six-month period in 2009 were analyzed...
2012: Clinical and Experimental Obstetrics & Gynecology
Pradeep K Singh, Deepti Shrivastva, Snigdha Paddalwar, Nagraj Shetty, Vipin Raut, Sarthak Patnaik, Abhishek Yadav
Trauma is the leading nonobstetric cause of maternal death. The worst complication can be fetal compromise that threatens premature labor or even fetal death. We are reporting a case of a 30-year-old primi, short stature woman who had fracture femur with hypovolaemic shock. Managing such trauma complicated by shock in a pregnant patient needs multidisciplinary approach. Clinician team evaluating and coordinating the care of pregnant trauma patient should understand the pathophysiological changes in pregnancy with trauma to manage hypovolaemic shock, related complications, treatment of fracture, and radiation exposure to the fetus...
January 2011: Journal of Surgical Technique and Case Report
Vivek Virmani, Ravi Kaza, Arifa Sadaf, Najla Fasih, Margaret Fraser-Hill
Ovarian vein thrombosis is an uncommon clinical entity, most familiar to radiologists as a source of postpartum sepsis, which, if unrecognized and left untreated, has the potential for septic shock, pulmonary thromboembolism, and death. Ovarian vein thrombosis also occurs with other common inflammatory and malignant conditions in the nonobstetrical patient. This article reviews the pathophysiology, predisposing conditions, clinical findings, imaging features on ultrasonography, computed tomography, and magnetic resonance imaging of acute and chronic ovarian vein thrombosis and its appropriate clinical management...
May 2012: Canadian Association of Radiologists Journal, Journal L'Association Canadienne des Radiologistes
Martina Montagnana, Massimo Franchi, Elisa Danese, Francesca Gotsch, Gian Cesare Guidi
Disseminated intravascular coagulation (DIC) is a syndrome characterized by a massive, widespread, and ongoing activation of the coagulation system, secondary to a variety of clinical conditions. Many obstetric complications, such as abruptio placentae, amniotic fluid embolism, endotoxin sepsis, retained dead fetus, post-hemorrhagic shock, hydatidiform mole, and gynecologic malignancies, might trigger DIC. In these gynecologic and obstetric settings, DIC is usually associated with high mortality and morbidity rates...
June 2010: Seminars in Thrombosis and Hemostasis
P G Pryde, B Gonik
Septic shock is a life-threatening clinical syndrome that, despite its rare occurrence in obstetrics, remains a leading cause of maternal mortality. Its pathophysiology is explained by a profound systemic response to a complex variety of host cellular and humoral mediators elaborated after exposure to microbial toxins. Early recognition, prompt diagnostic workup, and immediate initiation of therapy improve outcomes. Therefore, recent publications have popularized the concept of the "sepsis syndrome," a preshock list of clinical criteria associated with progressive sepsis...
1994: Infectious Diseases in Obstetrics and Gynecology
Julie Reid
Subgaleal hemorrhages, although infrequent in the past, are becoming more common with the increased use of vacuum extraction. Bleeding into the large subgaleal space can quickly lead to hypovolemic shock, which can be fatal. Understanding of anatomy, pathophysiology, risk factors, differential diagnosis, and management will assist in early recognition and care of the infant with a subgaleal hemorrhage.
July 2007: Neonatal Network: NN
Dushyant Maharaj
UNLABELLED: Puerperal pyrexia and sepsis are among the leading causes of preventable maternal morbidity and mortality not only in developing countries but in developed countries as well. Most postpartum infections take place after hospital discharge, which is usually 24 hours after delivery. In the absence of postnatal follow-up, as is the case in many developing countries, many cases of puerperal infections can go undiagnosed and unreported. Besides endometritis (endomyometritis or endomyoparametritis), wound infection, mastitis, urinary tract infection, and septic thrombophlebitis are the chief causes of puerperal infections...
June 2007: Obstetrical & Gynecological Survey
Wayne R Cohen
Acute postpartum hemorrhage is the leading worldwide cause of maternal mortality, such deaths being usually related to the development of hemorrhagic shock and its consequences, especially the multiple organ dysfunction syndrome. Obstetricians should be aware of the clinical manifestations and principles of management of hemorrhagic shock. Initial assessment of the bleeding patient requires monitoring blood pressure, pulse, capillary refill, mental status and urinary output. This allows estimation of the amount and the rate of blood loss and helps direct treatment...
2006: Journal of Perinatal Medicine
Barry K Ray, Manuel C Vallejo, Mitchell D Creinin, Kelly T Shannon, Gordon L Mandell, Bupesh Kaul, Sivam Ramanathan
PURPOSE: Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination. CLINICAL FEATURES: A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care...
February 2004: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Debra A Gilmore, Judith Wakim, Janet Secrest, Richard Rawson
This article is a review of information on the subject of anaphylactoid syndrome of pregnancy or amniotic fluid embolism, as it is more commonly known. Information was found through a computer search of English articles published from 1958 to 2001. Anaphylactoid syndrome of pregnancy has an 80% to 90% mortality rate. It is difficult to diagnose, and once symptoms occur, there is a rapid deterioration in the patient's condition. It has severe manifestations such as shock and coagulopathy. Identification of the exact mechanism and pathophysiology that trigger the syndrome continue to be investigated...
April 2003: AANA Journal
Jakob Schneider, Mulu Muleta
Septic shock remains an important cause of death and serious morbidity in medical, surgical and obstetric illness. Many patients with septic shock succumb despite aggressive therapy. Any microorganism can initiate septic shock; the pathophysiology of the disease is not clear; the clinical manifestation is not specific; and there is no reliable laboratory result to diagnose septic shock before it is late. Moreover, despite increasingly complex modes of mechanical ventilation, sophisticated respiratory and hemodynamic monitoring, and a continually expanding array of potent antibiotics, the overall mortality from septic shock remained constant...
January 2003: Ethiopian Medical Journal
C Rørbye, I S Petersen, L Nilas
Clostridium bacteria are anaerobic Gram positive spore-form-ing bacilli, known to cause distinct clinical syndromes such as botulism, tetanus, pseudomembranous colitis and myonecrosis. The natural habitats of Clostridium species are soil, water and the gastrointestinal tract of animals and humans. In 5-10% of all women, Clostridium species are also found to be normal inhabitants in the microbial flora of the female genital tract. In case of a non-sexually transmitted genital tract infection, Clostridium species are isolated in 4-20%, and clostridium welchii seems to be the most common isolate...
December 2000: Acta Obstetricia et Gynecologica Scandinavica
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