Endotoxin shock and the generalized Shwartzman reaction in pregnancy

Abstract

The clinical and pathologic findings in 7 pregnant patients with endotoxin shock have been presented. Escherichia coli was the most common infective organism. The syndrome occurred in 2 clinical situations; namely, (1) infected abortion, and (2) premature rupture of the membranes with chorioamnionitis and placentitis. The presence of bilateral renal cortical necrosis due to disseminated intravascular coagulation in 3 of these patients demonstrates that the human being is subject to the generalized Shwartzman phenomenon. A comparison between the response of the patient and that of the experimental animal to intravenous bacterial endotoxin has been made. Both showed marked alterations in the blood coagulation mechanism associated with disseminated intravascular coagulation and both exhibited profound, sometimes irreversible, shock. Animal experiments suggest that the shock is caused by a decreased venous return to the right side of the heart because of obstruction of the portal circulation by the liver. The obstruction may be due to vasospasm and thrombosis of the central veins of the liver. Acute cor pulmonale may also contribute to the decreased cardiac output and hence to the systemic hypotension. A general discussion of the current armamentarium in the management of these cases has been presented.