Obstetrics, Gynecology and Reproduction

Advanced search

Septic shock

Full Text:


The problem of sepsis and septic shock has recently become more and more actual. In obstetrics and gynaecology, the number of cases of sepsis has more than doubled over the past 10 years. The review examines the clinical forms of septic conditions, risk factors, pathogenesis of sepsis and septic shock, the main pathogens of septic conditions. Special attention is paid to neonatal sepsis. The relationship between septic shock and viral infections is considered in the context of the novel coronavirus infection caused by SARS-CoV-2 (COVID-19) pandemic. Hemostasis abnormalities have been demonstrated in patients with septic shock, including disseminated intravascular coagulation (DIC). The importance of determining the level of ADAMTS-13 to refine the forecast is discussed.

About the Authors

V. O. Bitsadze
Sechenov University
Russian Federation

Viktoria O. Bitsadze – MD, Dr Sci Med, Professor of RAS, Professor, Department of Obstetrics and Gynecology, N.F. Filatov Clinical Institute of Children’s Health
Scopus Author ID: 6506003478. Researcher ID: F-8409-2017.

62 Str. Zemlyanoi Val, Moscow 109004

T. A. Sukontseva
I.P. Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation
Russian Federation
6/8 Lev Tolstoy Str., Saint Petersburg 197022

S. V. Akinshina
Sechenov University
Russian Federation

Svetlana V. Akinshina – MD, PhD, Researcher, Department of Obstetrics and Gynecology, N.F. Filatov Clinical Institute of Children’s Health

62 Str. Zemlyanoi Val, Moscow 109004

Ya. Yu. Sulina
Sechenov University
Russian Federation

Yana Yu. Sulina – MD, Assistant, Department of Obstetrics and Gynecology, N.F. Filatov Clinical Institute of Children’s Health
Scopus Author ID: 57194140583. Researcher ID: S-9569-2018.

62 Str. Zemlyanoi Val, Moscow 109004

J. Kh. Khizroeva
Sechenov University
Russian Federation

Jamilya Kh. Khizroeva – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, N.F. Filatov Clinical Institute of Children’s Health.
Scopus Author ID: 57194547147. Researcher ID: F-8384-2017.

62 Str. Zemlyanoi Val, Moscow 109004

M. V. Tretyakova
«Medical Center» LLC
Russian Federation

Maria V. Tretyakova – MD, PhD, Obstetrician-Gynecologist, Department of Gynecology

15/1 Timura Frunze Str., Moscow 119021

Kh. G. Sultangadzhieva
Sechenov University
Russian Federation

Khadizhat G. Sultangadzhieva – Postgraduate Student, Department of Obstetrics and Gynecology, N.F. Filatov Clinical Institute of Children's Health

62 Str. Zemlyanoi Val, Moscow 109004

J. Yu. Ungiadze
Iris Borchashvili Health Center Medina

Jumber Yu. Ungiadze – MD, Dr Sci Med, Professor, Faculty of Medicine, Batumi Shota Rustaveli State University; Director of the Iris Borchashvili Health Center Medina

237 Fridon Khalvashi Avenue, Batumi6004, Georgia

N. V. Samburova
Sechenov University
Russian Federation

Natalia V. Samburova – PhD, Associate Professor, Department of Pathophysiology, Institute of Clinical Medicine

62 Str. Zemlyanoi Val, Moscow 109004

K. N. Grigoreva
Sechenov University
Russian Federation

Kristina N. Grigoreva – 6th year Student, Faculty of Pediatrics

62 Str. Zemlyanoi Val, Moscow 109004

V. I. Tsibizova
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Valentina I. Tsibizova – MD, Department of Functional and Ultrasound Diagnostics

2 Akkuratova Str., Saint Petersburg 197341

A. S. Shkoda
City Clinical Hospital № 67 named after L.A. Vorokhobov, Moscow Healthcare Department
Russian Federation

Andrey S. Shkoda – MD, Dr Sci Med, Professor, Chief Physician

2/44 Salyama Adilya Str., Moscow 123423

D. V. Blinov
Institute for Preventive and Social Medicine; Lapino Clinic Hospital, MD Medical Group; Moscow Haass Medical – Social Institute
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Head of Medical and Scientific Affairs; Neurologist; Faculty Member, Department of Neurology, Psychiatry and Narcology

4–10 Sadovaya-Triumfalnaya Str., Moscow 127006;
1st Uspenskoye Highway, 111, Moscow Region, Odintsovo District, Lapino 143081;
5, 1–1a 2nd Brestskaya Str., Moscow 123056, Russia


A. D. Makatsariya
Sechenov University
Russian Federation

Alexander D. Makatsariya – MD, Dr Sci Med, Professor, Academician of RAS, Head of the Department of Obstetrics and Gynecology, N.F. Filatov Clinical Institute of Children’s Health
Scopus Author ID: 6602363216. Researcher ID: M-5660-2016.

62 Str. Zemlyanoi Val, Moscow 109004


1. Макацария А.Д., Акиньшина С.В., Бицадзе В.О. и др. Септический шок в акушерстве: новый взгляд на патогенез. Практическая медицина. 2012;9(65):11–23.

2. Kumar G., Kumar N., Taneja A. et al. Nationwide trends of severe sepsis in the 21st century (2000–2007). Chest. 2011;140(5):1223–31.

3. Acosta C.D., Knight M., Lee H.C. et al. The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study. PloS One. 2013;8(7);e67175.

4. Nelson J.E., Angus D.C., Weissfeld L.A. et al; Critical Care Peer Workgroup of the Promoting Excellence in End-of-Life Care Project. End-of-life care for the critically ill: a national intensive care unit survey. Crit Care Med. 2006;34(10);2547–53.

5. Черешнев В.А., Гусев Е.Ю. Иммунологические и патофизиологические механизмы системного воспаления. Медицинская иммунология. 2012;14(1–2): 9–20.

6. Seymour C.W., Liu V.X., Iwashyna T.J. et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8);762–74.

7. Peigne V., Azoulay E., Coquet I. et al. The prognostic value of ADAMTS-13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) deficiency in septic shock patients involves interleukin-6 and is not dependent on disseminated intravascular coagulation. Crit Care. 2013;17:R273.

8. Shah B.A., Padbury J.F. Neonatal sepsis. An old problem with new insights. Virulence. 2014;5(1):170–8.

9. Al-Ostad G., Kezouh A., Spence A.R., Abenhaim H.A. Incidence and risk factors of sepsis mortality in labor, delivery and after birth: population-based study in the USA. J Obstet Gynaecol Res. 2015;41(8):1201–6.

10. Bauer M.E., Bateman B.T., Bauer S.T. et al. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. 2013;17(4):944–50.

11. Руднов В.А., Кулабухов В.В. Сепсис-3: Обновленные ключевые положения, потенциальные проблемы и дальнейшие практические шаги. Вестник анестезиологии и реаниматологии. 2016;13(4):4–11.

12. Casserly B., Phillips G.S., Schorr C. et al. Lactate measurements in sepsis – induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015;43(3):567–73.

13. Продеус А.П. Устинова М.В., Корсунский А.А., Гончаров А.Г., Новые аспекты патогенеза сепсиса и септического шока у детей. Система комплемента как мишень для эффективной терапии. Инфекция и иммунитет. 2018;8(1):19–24.

14. Plante L.A., Pacheco L.D., Louis J.M. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol. 2019;220(4):B2–B10.

15. Acosta C.D., Kurinczuk J.J., Lucas D.N. et al. Severe maternal sepsis in the UK, 2011-2012: a national case-control study. PLoS Med. 2014;11:e1001672.

16. Kramer H.M., Schutte J.M., Zwart J.J. et al. Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta Obstet Gynecol Scand. 2009;88:647–53.

17. Timezguid N., Das V., Hamdi A. et al. Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission. Int J Obstet Anesth. 2012;21:51–5.

18. Drew R.J., Fonseca-Kelly Z., Eogan M. A retrospective audit of clinically significant maternal bacteraemia in a specialist maternity hospital from 2001 to 2014. Infect Dis Obstet Gynecol. 2015;2015:518562. DOI: 10.1155/2015/518562.

19. Bauer M.E., Lorenz R.P., Bauer S.T. et al. Maternal deaths due to sepsis in the state of Michigan, 1999–2006. Obstet Gynecol. 2015;126:747–52.

20. Щеголев А.И., Мишнев О.Д., Туманова У.Н., Шувалова М.П.. Неонатальный сепсис как причина перинатальной смертности в Российской Федерации. Международный журнал прикладных и фундаментальных исследований. 2016;5–4:589–94.

21. Александрович Ю.С., Боронина И.В., Пшениснов К.В., Попова И.Н. Концентрация прокальцитонина как критерий отмены антибактериальной терапии при подозрении на ранний неонатальный сепсис у поздних недоношенных и доношенных новорожденных. Неонаталогия: новости, мнения, обучение. 2019;7(1):44–52.

22. Angus D.C., van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840–51.

23. Hornik C.P., Benjamin D.K. Becker K.C. et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31:799–802.

24. Connel T.G., Rele M., Cowley D. et al. How reliable as a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital. Pediatrics. 2007;119(5):891–6.

25. Ди Ренцо Д.К., Макацария А.Д., Цибизова В.И. и др. О принципах работы перинатального стационара в условиях пандемии коронавируса. Вестник РАМН. 2020;75(1):83–92.

26. Макацария А.Д., Григорьева К.Н., Мингалимов М.А. и др. Коронавирусная инфекция (COVID-19) и синдром диссеминированного внутрисосудистого свертывания. Акушерство, Гинекология и Репродукция. 2020;14(2):123–31.

27. Хизроева Д.Х., Макацария А.Д., Бицадзе В.О. и др. Лабораторный мониторинг COVID-19 и значение определения маркеров коагулопатии. Акушерство, Гинекология и Репродукция. 2020;14(2):132–147.

28. Бицадзе В.О., Хизроева Д.Х., Макацария А.Д. и др. COVID-19, септический шок и синдром диссеминированного внутрисосудистого свертывания крови. Часть 1. Вестник РАМН. [Принято к печати].

29. Бицадзе В.О., Хизроева Д.Х., Макацария А.Д. и др. COVID-19, септический шок и синдром диссеминированного внутрисосудистого свертывания крови. Часть 2. Вестник РАМН. [Принято к печати].

30. Рогальская Е.А. Климович Л.Г., Самсонова Н.Н. Диагностика нарушений системы гемостаза при системном воспалении, сепсисе и полиорганной недостаточности в кардиохирургии. Бюллетень НЦССХ имени А.Н. Бакулева РАМН. Сердечно-сосудистые заболевания. 2016;17(S3):96.

31. Semeraro N., Colucci M. Inflammation and thrombosis. In: Thrombosis fundamental and clinical aspects. Eds. J. Arnout, G. de Gaetano, M. Hoylaerts et al. Leuven: Leuven University Press, 2003. 433–59.

32. Мальцева Л.А., Базиленко Д.В. Патогенез тяжелого сепсиса и септического шока: анализ современных концепций. Медицина неотложных состояний. 2015;7(70):35–40.

33. Levi M., Schultz M., van der Poll T. Sepsis and thrombosis. Semin Thromb Haemost. 2013;39(5):559–66. DOI: 10.1055/s-0033-1343894.

34. Stief T.W., Ijagha O., Weiste B. et al. Analysis of hemostasis alterations in sepsis. Blood Coagul Fibrinolysis. 2007;18(2):179–86.

35. Asakura H., Ontachi Y., Mizutani T. et al. Depressed plasma activity of plasminogen or alpha2 plasmin inhibitor is not due to consumption coagulopathy in septic patients with disseminated intravascular coagulation. Blood Coagul Fibrinolysis. 2001;12(4):275–81.

36. Dempfle C.E. The TAFI system. The new role of fibrinolysis. Hamostaseologie. 2007;27(4):278–81.

37. Gando S. Role of fibrinolysis in sepsis. Semin Thromb Haemost. 2013;39(4):392–9.

38. Лопатин А.Ф. Редкин И.В., Самойленко В.В., Петровская Э.Л., Молчанов И.В. Роль антитромбина в диагностике и лечении сепсиса. Анестезиология и реаниматология. 2018;(3):19–24.

39. Воробьева Н.А. Роль антитромбина в диагностике и интенсивной терапии острого ДВС-синдрома. Атеротромбоз. 2017;(2):53–69.

40. Нехаев И.В., Приходченко А.О., Мазурина О.Г. и др. Полиорганная недостаточность, ССВР, ДВС-синдром и антитромбин III. Инфекции в хирургии. 2015;13(1):17–26.

41. Opal S.M., van der Poll T. Endothelial barrier dysfunction in septic shock. J Intern Med. 2014;277(3):277–93. DOI: 10.1111/joim.12331.

42. Вавилова Т.В. Лабораторные исследования в диагностике синдрома ДВС. Новости хирургии. 2010;18(5):166–74.

43. Акиньшина С.В., Бицадзе В.О., Гадаева З.К., Макацария А.Д. Значение тромботической микроангиопатии в патогенезе акушерских осложнений. Акушерство, гинекология и репродукция. 2015;9(1):62–71.

44. Levi M., Scully M, Singer M. The role of ADAMTS-13 in the coagulopathy of sepsis. J Thromb Haemost. 2018;16:646–51.

45. Levi M., Opal S. Coagulation abnormalities in critically ill patients. Crit Care. 2006;10(4):222.

46. Schwameis M., Schorgenhofer C., Assinger A. et al. VWF excess and ADAMTS-13 deficiency: a unifying pathomechanism linking inflammation to thrombosis in DIC, malaria, and TTP. Thromb Haemost. 2015;113:708–18.

47. McGill S.N., Ahmed N.A., Christou N.V. Increased plasma von Willebrand factor in the systemic inflammatory response syndrome is derived from generalized endothelial cell activation, Crit Care Med. 1998;26(2):296–300.

48. Bockmeyer C.L., Claus R.A., Budde U. et al. Inflammationassociated ADAMTS-13 deficiency promotes formation of ultralarge von Willebrand factor. Haematologica. 2008;93:137–40.

49. Turner N.A., Moake J. Assembly and activation of alternative complement components on endothelial cell-anchored ultra-large von Willebrand factor links complement and hemostasis–thrombosis. PLoS ONE. 2013;8:e59372.

50. Ono T., Mimuro J., Madoiwa S. et al. Severe secondary deficiency of von Willebrand factor-cleaving protease (ADAMTS-13) in patients with sepsis-induced disseminated intravascular coagulation: its correlation with development of renal failure. Blood. 2006;107:528–34.

51. Habe K., Wada H., Ito-Habe N. et al. Plasma ADAMTS-13, von Willebrand factor (VWF) and VWF propeptide profiles in patients with DIC and related diseases. Thromb Res. 2012;129:598–602.

52. Sonneveld M., Franco O.H., Afran Ikram M. et al. Von Willebrand factor, ADAMTS-13, and the risk of mortality. Arterioscler Thromb Vasc Biol. 2016;36:2446–51.

53. Emmer B.T., Ginsburg D., Desch K.C. Von Willebrand factor and ADAMTS-13. Too much or too little of a good thing? Arterioscler Thromb Vasc Biol. 2016;36:2281–2.

54. George J., Nester C., McIntosh J. Syndromes of thrombotic microangiopathy associated with pregnancy. Hematology Am Soc Hematol Educ Program. 2015;2015:644–8. DOI: 10.1182/asheducation-2015.1.644.

55. Griffin P.T., Jaglal M. Metastatic prostate cancer mimicking thrombotic thrombocytopenic purpura. Blood. 2015;125:1349.

56. Bobbio-Pallavicini E., Gugliotta L., Centurioni R. et al. Antiplatelet agents in thrombotic thrombocytopenic purpura (TTP): results of a randomized multicenter trial by the Italian cooperative group for TTP. Hematologia. 1997;82:429–35.

57. Medina P.J., Sipols J.M., George J.N. Drug-associated thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Curr Opin Hematol. 2001;8(05):286–93.

58. Reese J.A., Bougie D.W., Curtis B.R. et al. Drug-induced thrombotic microangiopathy: Experience of the Oklahoma Registry and the Blood Center of Wisconsin. Am J Hematol. 2015;90(5):406–10.

59. Al-Nouri Z.L., Reese J.A., Terrell D.R. et al. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood. 2015;125(4):616–8.

60. Макацария А.Д., Бицадзе В.О., Хизроева Д.Х. Катастрофический антифосфолипидный синдром и тромботический «шторм». Сибирский медицинский журнал. 2010;25(4):118–23.

61. Asherson R.A. Multiorgan failure and antiphospholipid antibodies: the catastrophic antiphospholipid (Asherson's) syndrome. Immunobiology. 2005;10(6):727–33.

62. Bucciarelli S., Espinosa G., Cervera R. et al. Mortality in the catastrophic antiphospholipid syndrome: Causes of death and prognostic factors in a series of 250 patients. Arthritis Rheum. 2006;54(8):2568–76. DOI: 10.1002/art.22018.

63. Asherson R.A. The catastrophic antiphospholipid (Asherson's) syndrome. Autoimm Rev. 2006;6(2):65–7. DOI: 10.1016/j.autrev.2006.06.012.

For citation:

Bitsadze V.O., Sukontseva T.A., Akinshina S.V., Sulina Y.Yu., Khizroeva J.K., Tretyakova M.V., Sultangadzhieva K.G., Ungiadze J.Yu., Samburova N.V., Grigoreva K.N., Tsibizova V.I., Shkoda A.S., Blinov D.V., Makatsariya A.D. Septic shock. Obstetrics, Gynecology and Reproduction. 0;. (In Russ.)

Views: 183

ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)