SEPTIC SHOCK IN PREGNANCY

Objective: To evaluate the etiology, management, and maternal and peri natal outcome in patients with septic shock during pregnancy. Methods: In 18 patients with septic shock during pregnancy, the criteria for t he diagnosis were sepsis-induced hypotension unresponsive to adequate fluid resuscitation and requirement for vasopressors. Results: Causes of shock were pyelonephritis (n = 6), chorioamnionitis (n = 3), postpa rtum endometritis (n = 2), toxic shock (n = 2), and one each of septic abortion, ruptured appendix, ruptured ovarian abscess, necrotizing fa sciitis, and bacterial endocarditis. Five women (28%) died. Comparing medians of the initial laboratory data for the 13 survivors with those of the five nonsurvivors revealed significant differences for hematoc rit (26 compared with 35%; Z = -2.267, P = .023), aspartate aminotrans ferase (30 compared with 287 U/L; Z = -2.068, P = .042), total bilirub in (1.6 compared with 5.8 mg/dL; Z = 2.046, P = .045), arterial carbon dioxide pressure (30 compared with 19 mmHg; Z = -2.384, P = .013), an d arterial oxygen pressure (62 compared with 104 mmHg; Z = -2.004, P = .048). Comparing medians of the hemodynamic data showed differences i n blood pressure (88 compared with 70 mmHg; Z = -2.439, P = .013), str oke volume (74 compared with 52 mt; Z = -2.041, P = .038), and left ve ntricular stroke work index (42 compared with 12 g.m.m(2); Z = -1.929, P = .052). Sixty-four percent of survivors and 80% of nonsurvivors ha d depressed left ventricular function (Fisher exact test, P > .99). Lo cating the source of infection was difficult and delayed in eight pati ents. Conclusion: In women with septic shock, progression to death can be dramatically rapid. Because vascular permeability is increased, it may be appropriate to administer vasopressors early during resuscitat ion. An initial low cardiac output is a poor prognostic sign. (C) 1997 by The American College of Obstetricians and Gynecologists.