×
Home Current Archive Editorial board
News Contact
Review paper

Obstetric shock and shock in obstetrics – steady obstetrical syndrome

By
Anis Cerovac Orcid logo ,
Anis Cerovac
Contact Anis Cerovac

Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina

University of Tuzla, School of Medicine, Tuzla, Bosnia and Herzegovina

Dubravko Habek ,
Dubravko Habek

Clinical Hospital, „Sveti Duh" , University Department of Gynaecology and Obstetrics, Zagreb, Croatia

School of Medicine, Croatian Catholic University Zagreb, Zagreb, Croatia

Elmedina Cerovac ,
Elmedina Cerovac

School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina

Department of Anaesthesiology, Reanimatology and Intensive Medicine, General Hospital Tešanj, Tesanj, Bosnia and Herzegovina

Jasna Čerkez Habek
Jasna Čerkez Habek

Clinical Hospital, „Sveti Duh" Zagreb, University Department of Gynaecology and Obstetrics , Zagreb, Croatia

School of Medicine, Croatian Catholic University Zagreb, Zagreb, Croatia

Abstract

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ,
abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones.

References

1.
Hayashi M, Maruyama O, Sato T. Classification of obstetric shock. Sanfujinka No Jissai. 1967. p. 212–5.
2.
Naik S, Kowsalya A, Padmasaritha R, Ramesh K, M. Obstetrics shock and its management. World J Pharm Pharm Scienc. 2017. p. 2045–52.
3.
Phillips M. Discussion on obstetric shock. Proc Royal Soc Medic. 1988. p. 43–8.
4.
Habek D. Forensic gynecology and perinatology. 2018. p. 325–34.
5.
Konar H. Shock in Obstetrics. DC Dutta’s Textbook of Obstetrics. Jaypee. 2015. p. 699–716.
6.
Ramirez B, E, Ahued A, R, Benitez G, C, et al. Shock in obstetrics. Institutional experience. Ginecol Obstet Mex. 1997. p. 137–40.
7.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014. p. 323–33.
8.
Chamberlain G. British maternal mortality in the 19th and early 20th centuries. J R Soc Med. 2006. p. 559–63.
9.
Habek D. Massive maternal dying during childbirth and confinement in Bjelovar and its surroundings in the 19th century. Manuscripts of the Institute for Scientific Research and Artistic Work in Bjelovar. 2019. p. 87–94.
10.
Cohen W. Hemorrhagic shock in obstetrics. J Perinat Med. 2006. p. 263–71.
11.
Thomson A, Greer I. Non-haemorrhagic obstetric shock. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000. p. 19–41.
12.
Verma R, Rao R, Sharma K. Sharma A. Labour Room Emergencies. Singapore. Springer; 2020. p. 537–43.
13.
Schneider C. Obstetric shock" and ’ ’shock in obstetrics. Postgrad Med. 1969. p. 185–91.
14.
Adams H, Baumann G, Gansslen A. Die Definitionen der Shockformes (The definitions of shock forms). Intensivmed. 2001. p. 541–53.
15.
Lapinsky S, Kruczynski K, Slutsky A. Critical care in the pregnant patient. Am J Respir Crit Care Med. 1995. p. 427–55.
16.
Greene R, Mckernan J, Manning E, Corcoran P, Byrne B, Cooley S, et al. Bhuinneain MN. Maternal Morbidity Advisory Group. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol. 2021. p. 114–20.
17.
Habek D, Habek Č, Jalšovec J, D. Anaphylactic shock in response to wasp sting in pregnancy. Zentralbl Gynakol. 2000. p. 393–4.
18.
Dane B, Dane C. Maternal death after uterine rupture in an unscarred uterus: a case report. J Emerg Med. 2009. p. 393–5.
19.
Davies S. Amniotic fluid embolus: a review of the literature. Can J Anaesth. 2001. p. 88–98.
20.
Deepti G, Sangeeta B, Swaraj B. Obstetric and Gynecological Emergencies. Jaypee; 2014.
21.
Habek D, Habek Č, J. Nonhaemorrhagic primary obstetric shock. Fetal Diagn Ther. 2008. p. 132–7.
22.
Kingston N, Baillie T, Chan Y, Reddy D, Stables S. Pulmonary embolization by chorionic villi causing maternal death after a car crash. Am J Forensic Med Pathol. 2003. p. 193–7.
23.
Habek D, Cerovac A, Habek Č, Begić J, Cerovac J, E. Sudden death of a pregnant woman because of massive aspiration-case report and review of literature. Wien Med Wochenschr. 2021.
24.
Tupek T, Gregorić A, Pavoković D, Cerovac A, Habek D, Severe. protracted anaphylaxis with hypovolemic shock after sublingual misoprostol administration. J Obstet Gynaecol. 2022. p. 169–70.
25.
Pavoković D, Cerovac A, Dž L, Habek D. Post-Cesarean peritonitis caused by hysterorrhaphy dehiscence with puerperal acute abdomen syndrome. Z Geburtshilfe Neonatol. 2020. p. 374–6.
26.
International statistical classification of diseases and related health problems 10th revision. World Health Organisation; 2016.
27.
Habek Č, Habek J, Horvatić D, Behin E, S. Fatal, spontaneuos, unknown aortal aneurysm dissection in a woman of 38 week’s gestation. Signa vitae. 2016. p. 214–21.
28.
Kallianidis A, Maraschini A, Danis J, Colmorn L, Deneux-Tharaux C, Donati S, et al. Vandenberghe G, Van Den Akker T, INOSS (the International Network of Obstetric Survey Systems). Epidemiological analysis of peripartum hysterectomy across nine European countries. Acta Obstet Gynecol Scand. 2020. p. 1364–73.
29.
Kainer F, Hasbargen U. Emergencies associated with pregnancy and delivery: peripartum hemorrhage. Dtsch Arztebl Int. 2008. p. 629–38.
30.
Li B, Miners A, Shakur H, Roberts I. WOMAN Trial Collaborators. Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: a cost-effectiveness analysis of data from the WOMAN trial. Lancet Glob Health. 2018. p. 222–8.
31.
Habek D, Bečarević R. Emergency peripartal hysterectomy in a tertiary obstetric center: 8-year evaluation. Fetal Diagn Ther. 2007. p. 139–42.
32.
Clark S, Yeh S, Phelan J, Bruce S, Paul R. Emergency hysterectomy for obstetric hemorrhage. Obstet Gynecol. 1984. p. 376–80.
33.
Schlembach D, Helmer H, Henrich W, Von Heymann C, Kainer F, Korte W, et al. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry. Geburtshilfe Frauenheilkd. p. 382–99.
34.
Escobar M, Nassar A, Theron G, Barnea E, Nicholson W, Ramasauskaite D, et al. FIGO safe motherhood and newborn health committee FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022. p. 3–50.
35.
Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt B, et al. Thomson AJ on behalfof the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG. 2016. p. e106-149.
36.
Bas L, Chandraharan A, Addei E, Arulkumaran A, S. Use of the “obstetric shock index” as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage. Int J Gynaecol Obstet. 2014. p. 253–5.
37.
Roeca C, Little S, Carusi D. Pathologically diagnosed placenta accreta and hemorrhagic morbidity in a subsequent pregnancy. Obstet Gynecol. 2017. p. 321–6.
38.
Colucci G, Helsing K, Biasiutti D, Raio F, Schmid L, Tsakiris P, et al. Standardized management protocol in severe postpartum hemorrhage: A single-center study. Clin Appl Thromb Hemost. 2018. p. 884–93.
39.
Pacheco L, Saade G, Hankins G. Medical management of postpartum hemorrhage: An update. Semin Perinatol. 2019. p. 22–6.
40.
Ekelund K, Hanke G, Stensballe J, Wikkelsøe A, Albrechtsen C, Afshari A. Hemostatic resuscitation in postpartum hemorrhage -a supplement to surgery. Acta Obstet Gynecol Scand. 2015. p. 680–92.
41.
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. Lancet. Woman Trial Collaborations; 2017. p. 2105–16.
42.
WOMAN: reducing maternal deaths with tranexamic acid. The Lancet. 2017. p. 31111.
43.
Habek D, Pavoković D. Primjena traneksamične kiseline u opstetričkim krvarenjima (Use of tranexamic acid in obstetric hemorrhage) [In Croatian]. Gynaecol Perinatol. 2019. p. 95–100.
44.
Habek D. Opstetričko krvarenje -preporuke i postupci (Obstetric hemorrhage -recommendations and procedures) [In Croatian]. Gynaecol Perinatol. 2015. p. 128–9.
45.
Alam A, Choi S. Prophylactic use of tranexamic acid for postpartum bleeding outcomes: a systematic review and meta-analysis of randomized controlled trials. Transfus Med Rev. 2015. p. 231–41.
46.
Habek D, Kulas T, Bobić-Vuković M, Selthofer R, Vujić B, Ugljarević M. Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review. Arch Gynecol Obstet. 2006. p. 307–9.
47.
Cerovac A, Hudić I, Softić D, Habek D. Perimortem Caesarean section because of a live fetus: case report and literature review. Wien Med Wochenschr. 2021.
48.
Woods M. Prehospital perimortem caesarean section-a survivor. Prehosp Emerg Care. 2020. p. 595–9.
49.
Habek D, Končar M, Ivičević-Bakulić T, Hodek B, Herman R, Gopčević S, et al. Cardiopulmonary arrest during delivery. Gynaecol Perinatol. 1998. p. 37–8.
50.
Lim P, Ng S, Shafiee M, Kampan N, Jamil M. Spontaneous rupture of uterine varicose veins: a rare cause for obstetric shock. J Obstet Gynaecol Res. 2014. p. 1791–4.
51.
James A, Federspiel J, Ahmadzia H. Disparities in obstetric hemorrhage outcomes. Res Pract Thromb Haemost. 2022. p. 12656.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.