Pathophysiology of shock in obstetrics

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...

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...

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...

This article presents current understanding of the causes, pathophysiology, clinical, and laboratory diagnosis, and management of fulminant and low-grade DIC, as they apply to obstetric, pregnant, and gynecologic patients. General medical complications leading to DIC, which may often be seen in these patients, are also discussed. Considerable attention has been given to interrelationships within the hemostasis system. Only by clearly understanding these pathophysiologic interrelationships can the obstetrician/gynecologist appreciate the divergent and wide spectrum of often confusing clinical and laboratory findings in patients with DIC...

OBJECTIVE: To evaluate the pathophysiologic role of heat shock proteins and to examine the effect of danazol on these proteins in patients with endometriosis and adenomyosis. DESIGN: Immunohistochemical identification of human heat shock proteins 27, 60, and 70 in endometrial glandular cells identified using monoclonal antibodies. SETTING: Department of obstetrics and gynecology in a university hospital. PATIENT(S): Subjects were 119 women with documented endometriosis or adenomyosis...

OBJECTIVE: We analyzed the clinical course and investigated possible pathophysiologic mechanisms of amniotic fluid embolism. STUDY DESIGN: We carried out a retrospective review of medical records. Forty-six charts were analyzed for 121 separate clinical variables. RESULTS: Amniotic fluid embolism occurred during labor in 70% of the women, after vaginal delivery in 11%, and during cesarean section after delivery of the infant in 19%. No correlation was seen with prolonged labor or oxytocin use...

Septic shock remains an important cause of death and permanent disability in obstetric and gynecologic patients. Prompt recognition and diagnosis are critical to optimizing outcome. A thorough understanding of the pathophysiologic mechanisms operative in septic shock is important in treating these critically ill women. Immediate attention to oxygenation and hemodynamic stability is of paramount importance in effecting the best possible outcome. The use of sophisticated technology, including pulmonary artery monitoring and mechanical ventilation is frequently necessary, requiring intensive monitoring...

A 24 year old woman was delivered by caesarean section after an uncomplicated full-term pregnancy. Non-specific prodromes appeared 48 h later, with development of a severe shock. After confirmation of hypovolaemia, attention was focused on the abnormal haematological findings (a sharp drop in serum proteins with a rise in haematocrit) which suggested major leakage of plasma. Treatment based on infusions of plasma and albumin failed, and the patient died in a state of anasarca and pulmonary oedema with normal wedge pressure...

Although traditionally the exclusive domain of other medical specialties, pulmonary artery catheterization may be of tremendous benefit to a variety of obstetric and gynecologic patients. Our experience with such invasive hemodynamic monitoring in 72 patients in an obstetrics and gynecology service is presented. In 86% of cases, catheter placement and primary management were carried out by residents in obstetrics and gynecology. Although many of the indications for pulmonary artery catheterization encountered are common to other areas of medicine, certain conditions such as severe preeclampsia or rheumatic heart disease in pregnancy involve pathophysiologic conditions unique to our specialty...

An outline has been given of the major abnormalities of coagulation which can occur secondary to diseases in previously normal individuals. First, the disorders due to deficiency of the vitamin K-dependent clotting factors are described. Vitamin K deficiency can occur in the newborn, or at later stages in life when there is intestinal malabsorption. The malabsorption disorders, such as coeliac disease, together with major abdominal surgery or prolonged use of broad-spectrum antibiotics can give rise to vitamin K deficiency...

The syndrome of coagulation defects in obstetrics was detected as cause for obstetrical hemorrhage during the 50 years. Some of the etiologic factors like the dead fetus syndrome or the salting out syndrome have vanished. Amniotic fluid embolism is the only syndrome which is clearly associated with disseminated intravascular coagulation. This connection between premature separation is less clear. One concept assumes that the plasma fibrinogen concentration is low because it is consumed in the retroplacental hematoma...