Maternal Collapse in Pregnancy and the Puerperium

Chu, Justin; Johnston, Tracey; Geoghegan, James; Gynaecologists,

doi:10.1111/1471-0528.15995

Cited by 38 publications

(51 citation statements)

References 100 publications

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“…Sepsis causes 11% of maternal deaths worldwide. The incidence is the highest in Southern Asia and Sub-Saharan Africa, although the burden is probably underestimated because of the lack of uniform definition for maternal sepsis [ 34 , 35 ]. It has been reported in humans that many pathological conditions in the mother can adversely impact neonatal life as well as later stages of development [ 36 – 39 ].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life

Granja

Alves

Leardini-Tristão

et al. 2021

J Neuroinflammation

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Background The term sepsis is used to designate a systemic condition of infection and inflammation associated with hemodynamic changes that result in organic dysfunction. Gestational sepsis can impair the development of the central nervous system and may promote permanent behavior alterations in the offspring. The aim of our work was to evaluate the effects of maternal sepsis on inflammatory cytokine levels and synaptic proteins in the hippocampus, neocortex, frontal cortex, and cerebellum of neonatal, young, and adult mice. Additionally, we analyzed the motor development, behavioral features, and cognitive impairments in neonatal, young and adult offspring. Methods Pregnant mice at the 14th embryonic day (E14) were intratracheally instilled with saline 0.9% solution (control group) or Klebsiella spp. (3 × 108 CFU) (sepsis group) and started on meropenem after 5 h. The offspring was sacrificed at postnatal day (P) 2, P8, P30, and P60 and samples of liver, lung, and brain were collected for TNF-α, IL-1β, and IL-6 measurements by ELISA. Synaptophysin, PSD95, and β-tubulin levels were analyzed by Western blot. Motor tests were performed at all analyzed ages and behavioral assessments were performed in offspring at P30 and P60. Results Gestational sepsis induces a systemic pro-inflammatory response in neonates at P2 and P8 characterized by an increase in cytokine levels. Maternal sepsis induced systemic downregulation of pro-inflammatory cytokines, while in the hippocampus, neocortex, frontal cortex, and cerebellum an inflammatory response was detected. These changes in the brain immunity were accompanied by a reduction of synaptophysin and PSD95 levels in the hippocampus, neocortex, frontal cortex, and cerebellum, in all ages. Behavioral tests demonstrated motor impairment in neonates, and depressive-like behavior, fear-conditioned memory, and learning impairments in animals at P30 and P60, while spatial memory abilities were affected only at P60, indicating that gestational sepsis not only induces an inflammatory response in neonatal mouse brains, but also affects neurodevelopment, and leads to a plethora of behavioral alterations and cognitive impairments in the offspring. Conclusion These data suggest that maternal sepsis may be causatively related to the development of depression, learning, and memory impairments in the litter.

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Section: Discussionmentioning

confidence: 99%

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life

Granja

Alves

Leardini-Tristão

et al. 2021

J Neuroinflammation

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“…Among cardiac causes, acute myocardial infarction, aortic dissection, and cardiomyopathy are the commonly mentioned etiologies. Symptoms and signs indicative of these three cardiac causes include central chest or interscapular pain, a wide pulse pressure, and new cardiac murmur [6].…”

Section: Discussionmentioning

confidence: 99%

Postpartum maternal collapse—a first-time presentation of severe mitral stenosis: a case report

Sium

Tafere

Abate³

2021

J Med Case Reports

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Background Among cardiac causes for postpartum maternal collapse, severe mitral stenosis is not listed as a potential cause in current literature. We report a rare case of severe mitral stenosis that presented with severe hypoxia and maternal decompensation in early postpartum period for the first time. Case summary A 30-year-old para 2, abortus 1, Ethiopian woman developed severe hypoxia and rapid deterioration on her sixth postoperative day after cesarean delivery for fetal bradycardia with a good fetal outcome. She was put on a mechanical ventilator when she developed respiratory failure. Initially, a diagnosis of pulmonary embolus was considered. After admission to the intensive care unit, severe mitral stenosis was diagnosed with the help of echocardiography. She was managed successfully for congestive heart failure and discharged from the intensive care unit with improvement. Conclusion The possibility of mitral stenosis, as a differential diagnosis, should be considered whenever a case of postpartum maternal collapse is encountered. We recommend a routine immediate echocardiography in any patient that experiences postpartum collapse, especially in the presence of a known trigger for heart failure such as long hours of labor, bleeding, anemia, hypotension, and infection.

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“…However, epilepsy should always be considered in cases of maternal collapse associated with seizure activity. 2 The acute onset of dyspnoea, signs of pulmonary congestion and severe coagulopathy were absent which rule out the amniotic fluid embolism, air embolism, stroke and pulmonary embolism. There was also no history or signs of trauma, fall or abuse.…”

Section: Investigationsmentioning

confidence: 99%

Resuscitative hysterotomy for maternal collapse in a triplet pregnancy

et al. 2020

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We encountered a 47-year-old woman, at 35 weeks of gestation, carrying triplets, who attended the hospital with severe pre-eclampsia and at admission had eclamptic fit followed by cardiac arrest. Cardiopulmonary resuscitation was started when she did not respond to initial measures; resuscitative hysterotomy was started on the site of collapse immediately, within 4 min postarrest, to deliver the triplets within 5 min postmaternal cardiac arrest. Timely decision of resuscitative hysterotomy done primarily to restore maternal cardiac output due to a grossly gravid uterus saved the mother and the triplets. With increasing maternal age and use of in vitro fertilisation resulting in multiple pregnancies, maternal comorbidities are more likely. These could result in maternal collapse in which case timely resorting to resuscitative hysterotomy can make survival of mother and feti more likely.

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Maternal Collapse in Pregnancy and the Puerperium

Cited by 38 publications

References 100 publications

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life

Postpartum maternal collapse—a first-time presentation of severe mitral stenosis: a case report

Resuscitative hysterotomy for maternal collapse in a triplet pregnancy

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