Cervical shock: a complication of incomplete abortion

Abstract

A case of a 37-year-old female primagravida who attended the emergency department (ED) via ambulance in hypotensive shock. She was 10 weeks pregnant, but had an inevitable miscarriage confirmed in the local Early Pregnancy Unit 3 weeks previously. She was hypotension (90/60 mm Hg), bradycardic (45 bpm) and was peripherally shut down. A provisional diagnosis of haemorrhagic shock was made, but despite intravenous fluid challenges, she appeared to be deteriorating, so a major haemorrhage protocol was activated. On examination, there was some vaginal bleeding and a protruding sac noted. The gynaecology registrar was informed and performed an Evacuation of the Retained Products of Conception in the ED. This gave instant relief to the patient and her blood pressure and heart rate became normal over a few minutes. She went on to make a full recovery. This case provides useful learning points for doctors working in the ED and other urgent care settings.

Cardiovascular complications following medical termination of pregnancy: An updated review

“…Bradycardia was the most common arrhythmia observed in our review[ 35 - 37 , 47 ]. The common cause of bradycardia is vagal stimulation during the passage of the fetus or POC through the cervix, a phenomenon known as cervical vasovagal shock[ 39 , 40 ]. This is typically observed with retained POC, and management often involves dilatation and curettage to remove the POC.…”

Cervical vasovagal shock: A rare complication of incomplete abortion case report

“…Features that are highly suspicious for shock include hypotension, oliguria, abnormal mental status, tachypnoea, cool, clammy skin and metabolic acidosis (usually hyperlactatemia) [7] . Most clinical manifestations are neither sensitive nor specific for the aetiology of shock and are primarily used to narrow the differential diagnosis so that empirical therapy can be administered in a timely fashion [7] [8] .…”