Obstructive shock due to labor-related diaphragmatic hernia.

Abstract

To report diaphragmatic hernia as a cause of obstructive shock in the peripartum period. Case report. An adult, 12-bed medical/surgical intensive care unit of a general hospital. One patient who developed an obstructive shock following vaginal labor and was transferred under mechanical ventilation from a local hospital. Central venous pressure, blood pressure, blood gas analysis, electrocardiogram, and chest radiograph during and after obstructive shock. During shock, systolic blood pressure was 60 mm Hg, central venous pressure was +12 mm Hg, and the electrocardiogram showed a supraventricular tachycardia and an acute cor pulmonale pattern. Chest radiograph showed signs of left diaphragmatic hernia and right mediastinal shift. Chest ultrasound examination demonstrated loops of bowel in the left pleural space. After 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 PaO2 increased to 154 torr (20.5 kPa) while receiving mechanical ventilation with an FiO2 of 50%. The electrocardiogram showed disappearance of the acute cor pulmonale pattern. The chest radiograph showed a central venous catheter located in a persistent left superior vena cava without abnormalities of the diaphragm, the mediastinum, or the lung. Diaphragmatic hernia must be included in the differential diagnosis of obstructive shock in pregnant patients.