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Septic shock in pregnancy

W C Mabie1, J R Barton, B Sibai

  • 1Department of Obstetrics and Gynecology, University of Tennessee-Memphis, Memphis, USA. cplunkett@utmeml.utmem.edu

Obstetrics and Gynecology
|November 5, 1997
PubMed
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Septic shock during pregnancy is rapidly fatal for some, with causes including pyelonephritis and chorioamnionitis. Early vasopressor use and monitoring cardiac output are crucial for improving outcomes in pregnant patients experiencing septic shock.

Area of Science:

  • Obstetrics and Gynecology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Septic shock in pregnancy presents a significant challenge with potentially rapid progression to mortality.
  • Understanding the diverse etiologies and outcomes is crucial for effective management.

Purpose of the Study:

  • To investigate the causes, treatment strategies, and maternal-fetal outcomes in pregnant patients diagnosed with septic shock.
  • To identify prognostic indicators for improved patient management.

Main Methods:

  • A retrospective analysis of 18 pregnant patients with septic shock, defined by sepsis-induced hypotension unresponsive to fluid resuscitation and requiring vasopressors.
  • Comparison of laboratory and hemodynamic data between survivors and non-survivors.

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Main Results:

  • Common causes included pyelonephritis, chorioamnionitis, and postpartum endometritis. Mortality was 28% (5/18 patients).
  • Non-survivors exhibited significantly different initial hematocrit, liver enzymes, bilirubin, and arterial blood gas levels compared to survivors.
  • Hemodynamic differences included lower blood pressure and stroke volume in non-survivors. Depressed left ventricular function was common in both groups.

Conclusions:

  • Septic shock in pregnancy can progress rapidly to death.
  • Early administration of vasopressors may be beneficial due to increased vascular permeability.
  • Initial low cardiac output is a significant negative prognostic indicator.