ABSTRACT
Shock is a pathological state in which the body’s blood pressure is lowered to such a degree that tissue perfusion is limited. If this condition proceeds unaltered, cellular hypoxia and eventually death will occur. There are different types of shock: cardiogenic shock, related to pump failure; hemorrhagic or hypovolemic shock, related to acute blood loss, and neurogenic shock, related to loss of sympathetic control of vessel resistance. Septic shock has an infectious focus as its inciting event. This type of shock can have components of all the other types of shock, especially cardiogenic and hypovolemic. It occurs in the presence of severe sepsis, when the mechanisms of a systemic inflammatory response to a microbial invasion go astray. In the case of severe septic shock, the release of numerous pro-inflammatory cytokines contributes to multiple organ dysfunctions, and sometimes to death. In the United States, the incidence of septic shock is increasing with a greater proportion of cases due to Gram-positive aerobic organisms. This is probably related to the increasing age of our population, an ever-increasing number of HIV positive patients, and increasing numbers of invasive therapies (organ transplant, bone marrow transplant) that utilize immunosuppressive treatments. In contrast to this overall trend, the number of cases of septic shock in Obstetrics-Gynecology is probably less than in the 1960s. Improved antibiotic treatments targeting Gram-negative anaerobes have contributed by lessening the numbers of patients with a ruptured tubo-ovarian abscess. Social changes have been the bigger contributor to lessening numbers of patients with septic shock. Legal terminations of unwanted pregnancies have nearly eliminated the desperate ‘back alley’ attempts to eliminate pregnancies of the 1950s and 60s. In those days, women with pregnancies beyond twelve weeks would be subjected to the insertion or injection of tissue damaging substances in often-unclean circumstances. Hopefully, those dark days will not be revisited in the United States.
