OBSTRUCTIVE SHOCK DUE TO LABOR-RELATED DIAPHRAGMATIC-HERNIA

Objective: To report diaphragmatic hernia as a cause of obstrucive sho ck in the peripartum period. Design: Case report. Setting: An adult, 1 2-bed medical/surgical intensive care unit of a general hospital. Pati ents: One patient who developed an obstructive shock following vaginal labor and was transferred under mechanical ventilation from a local h ospital. Interventions: Central venous pressure, blood pressure, blood gas analysis, electrocardiogram, and chest radiograph during and afte r obstructive shock. Measurements and Main Results: During shock, syst olic blood pressure was 60 mm Hg, central venous pressure was + 12 mm Hg, and the electrocardiogram showed a supraventricular tachycardia an d an acute cor pulmonale pattern. Chest radiograph showed signs of lef t diaphragmatic hernia and right mediastinal shift, Chest ultrasound e xamination demonstrated loops of bowel in the left pleural space. Afte r surgical resolution of the left diaphragmatic hernia, the patient's blood pressure increased to 120/80 mm Hg, the central venous pressure decreased to + 1 mm Hg, and the pao(2) increased to 154 torr (20.5 kPa ) while receiving mechanical ventilation with an Fio(2) of 50%. The el ectrocardiogram showed disappearance of the acute cor pulmonale patter n. The chest radiograph showed a central venous catheter located in a persistent left superior vena cava without abnormalities of the diaphr agm, the mediastinum, or the lung. Conclusion: Diaphragmatic hernia mu st be included in the differential diagnosis of obstructive shock in p regnant patients.