morphine and Shock

Topics: Cesarean Section; Combined Modality Therapy; Embolism, Amniotic Fluid; Enterobacteriaceae Infections; Epilepsy, Generalized; Female; Hemoperitoneum; Hemostasis, Surgical; Humans; Hysterectomy; Meconium; Morganella morganii; Multiple Organ Failure; Postoperative Complications; Postoperative Hemorrhage; Postpartum Hemorrhage; Pregnancy; Shock; Shock, Septic; Splenectomy; Young Adult

The amniotic fluid embolism (AFE) syndrome is a catastrophic complication of pregnancy frequently associated with maternal death. The causes and mechanisms of disease responsible for this syndrome remain elusive.. We report two cases of maternal deaths attributed to AFE: (1) one woman presented with spontaneous labor at term, developed intrapartum fever, and after delivery had sudden cardiovascular collapse and disseminated intravascular coagulation (DIC), leading to death; (2) another woman presented with preterm labor and foul-smelling amniotic fluid, underwent a Cesarean section for fetal distress, and also had postpartum cardiovascular collapse and DIC, leading to death.. Of major importance is that in both cases, the maternal plasma concentration of tumor necrosis factor-alpha at the time of admission to the hospital and when patients had no clinical evidence of infection was in the lethal range (a lethal range is considered to be above 0.1 ng/mL).. We propose that subclinical intraamniotic infection may be a cause of postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some patients with the clinical diagnosis of AFE may have infection/systemic inflammation as a mechanism of disease. These observations have implications for the understanding of the mechanisms of disease of patients who develop cardiovascular collapse and DIC, frequently attributed to AFE. It may be possible to identify a subset of patients who have biochemical and immunological evidence of systemic inflammation at the time of admission, and before a catastrophic event occurs.

Topics: Adult; Chorioamnionitis; Diagnosis, Differential; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Fatal Outcome; Female; Humans; Meconium; Postpartum Period; Pregnancy; Sepsis; Shock; Shock, Septic; Tumor Necrosis Factor-alpha

Sodium nitroprusside was administered to 58 neonates, including 11 with severe respiratory distress syndrome, 15 with persistent pulmonary hypertension of the newborn, 28 with clinical shock, three with systemic hypertension, and two with pulmonary hypoplasia, all refractory to conventional intensive therapy. Nitroprusside was infused at 0.2 to 6.0 micrograms/kg/min for periods of 10 minutes to 126 hours. Infants with severe respiratory distress syndrome had increased PaO2 and decreased PaCO2 or peak inspiratory pressure, and nearly all (82%) survived. Infants with persistent pulmonary hypertension of the newborn had variable responses; improvement did not correlate with survival, but survival (47%) was identical to that in an earlier series of infants given tolazoline. Infants in shock had improved perfusion, urine output, and serum bicarbonate levels, and these responses were significantly related to survival. Hypertension was controlled in all three hypertensive infants. Adverse effects were very uncommon. Toxic effects were not observed. Sodium nitroprusside is effective and can be used safely in circulatory disorders in the neonate.

Topics: Bicarbonates; Carbon Dioxide; Drug Evaluation; Ferricyanides; Hemodynamics; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Inhalation; Lung; Lung Diseases; Meconium; Nitroprusside; Oxygen; Persistent Fetal Circulation Syndrome; Respiratory Distress Syndrome, Newborn; Shock

Topics: Apgar Score; Body Temperature Regulation; Cardiovascular Physiological Phenomena; Drug Therapy; Fetus; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pneumonia, Aspiration; Respiratory Physiological Phenomena; Resuscitation; Shock

The clinical course and follow-up of 14 neonates who developed acute renal failure are reported. Renal failure in these patients was secondary to major perinatal disorders, e.g., hyaline membrane disease, pneumonia, hemorrhage, or sepsis. Thirteen patients had hypoxia and nine were in shock when renal failure developed. Five patients died during the acute stage of renal failure. Of nine survivors, five patients sustained residual renal damage.

Topics: Acute Kidney Injury; Anuria; Follow-Up Studies; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pneumonia; Shock

Topics: Blood Coagulation; Blood Coagulation Disorders; Embolism; Female; Fibrin; Hemorrhagic Disorders; Heparin; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy; Shock