Nonhemorrhagic Primary Obstetric Shock

Abstract

Objective: Clinical evaluation of nonhemorrhagic primary obstetric shock (NHPOS). Methods: In a retrospective clinical study, data on 8 cases of NHPOS were analyzed. Data on patient age, parity, week of gestation, comorbidity, possible etiologic trigger, course of disease with clinical picture and laboratory findings of coagulopathy, and patient outcome including autopsy findings in two lethal outcomes were analyzed. Results: These 8 patients were treated in the intensive care unit. One patient died during delivery from cardiopulmonary arrest in the state of irreversible obstetric shock, verified by massive pulmonary thromboembolism at autopsy. Another patient died from stroke and cerebral coma caused by trophoblastic cerebrovascular embolism 5 days after artificial abortion, showing a clinical picture of shock and cardiopulmonary arrest. In 1 patient, severe septic shock developed several hours after premature stillbirth and abruptio placentae in the 26th week of pregnancy, associated with disseminated intravascular coagulopathy. Four patients developed intrapartum NHPOS, with a clinical picture of chest pain, dyspnea, tachycardia, hypotension, cyanosis, and disseminated intravascular coagulopathy, as demonstrated by laboratory findings. Based on clinical picture and laboratory findings, amniotic fluid embolism or trophoblastic embolism was suspected. All these patients survived. One patient developed NHPOS during the third labor stage after vacuum extraction because of a macrosomic child, followed by disseminated intravascular coagulopathy and secondary hemorrhage which necessitated B-Lynch procedures and total hysterectomy for massive bleeding. Hereditary thrombophilia was detected in subsequent patients. Conclusions: NHPOS can be caused by amniotic fluid embolism, trophoblastic embolism or thromboembolism, and sepsis. These conditions may frequently prove fatal due to their abrupt and unexpected course, mostly during pregnancy, delivery, or immediately thereafter.

Comparison of dyspareunia using female sexual index score in 3-month, 6-month, and 12-month postpartum after vaginal delivery and cesarean section: meta-analysis

“…Other studies have shown that cesarean delivery poseda higher risk of hysterectomy (OR = 1.30), obstetric shock (OR = 2.54), and anesthetic complications (OR = 2.18) [30]. Obstetric shock includes bleed-ing shock, pulmonary embolism, amniotic fluid embolism, and sepsis [31,32].…”

Fruchtwasserembolie

“…Somit ist eine definitive Diagnose der Fruchtwasserembolie trotz Autopsie im Einzelfall schwierig, wenn nicht unmöglich. Für diese Fälle ist der nichthämorrhagische, primäre geburtshilfliche Schock ("nonhemorrhagic primary obstetric shock", NHPOS) wohl eine treffendere Bezeichnung [16].…”

A case of full-term delivery after septic shock during second trimester of pregnancy

“…임신중 패혈성쇼크는 드물지만 모성사망의 주요 원인이며 태아에게 치명적인 경과를 초래할 수 있다 [1,2]. 원인은 감염성유산이 대표적이나 신우신염 등 비산과적인 원인으로 발생할 수도 있으며 실제로 원인을 밝힐 수 없는 경우도 많다.…”