{
  "abstract": "Obstetric shock has traditionally been conceptualized within the framework of hemorrhage and macrocirculatory collapse. However, clinical deterioration may occur despite preserved blood pressure and cardiac output, indicating that disturbances in tissue perfusion and cellular metabolism can precede overt hemodynamic instability. This narrative review synthesizes current evidence examining the contributions of microcirculatory dysfunction, endothelial glycocalyx injury, mitochondrial impairment, immune–metabolic dysregulation, and placental signaling to the development and progression of obstetric shock beyond conventional hemodynamic paradigms. A literature review was conducted using PubMed/MEDLINE and PubMed Central, focusing on studies in obstetrics, critical care, endothelial biology, microcirculatory physiology, and mitochondrial function, with articles selected for their mechanistic, translational, and clinical relevance. Available evidence suggests that disruption of the microcirculation, endothelial injury, and impaired cellular energy metabolism may interact to produce tissue hypoperfusion despite preserved systemic hemodynamics, a phenomenon described as hemodynamic incoherence. These mechanisms may contribute to diverse clinical phenotypes, including normotensive hypoperfusion, endothelial dysfunction–associated shock, microthrombotic states, and impaired cellular oxygen utilization. Although much of the supporting evidence derives from studies of preeclampsia, sepsis, and non-obstetric critical illness rather than obstetric shock itself, these findings provide biologically plausible mechanistic insights that may improve understanding of unexplained maternal deterioration. Emerging physiologic monitoring techniques may facilitate earlier recognition of occult tissue hypoperfusion, although their validation and routine clinical application in obstetric practice remain limited. Overall, obstetric shock should be considered a heterogeneous syndrome that extends beyond hemorrhage alone, and an integrated framework incorporating microvascular, endothelial, metabolic, and placental processes may improve understanding of its pathophysiology while informing future diagnostic and therapeutic research. Further obstetric-specific studies are required to validate these concepts and define their clinical implications.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology and Intensive Care, Faculty of Medicine, Maranatha Christian University, Bandung, West Java 40164, Indonesia",
    "Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Maranatha Christian University, Bandung, West Java 40164, Indonesia",
    "Department of Anesthesiology and Intensive Care, Faculty of Medicine, Padjadjaran University, Bandung, West Java 45363, Indonesia",
    "Fertility Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Maranatha Christian University, Bandung, West Java 40164, Indonesia",
    "Department of Obstetrics and Gynecology, Faculty of Medicine, Maranatha Christian University, Bandung, West Java 40164, Indonesia"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Theresia Monica Rahardjo"
    },
    {
      "affs": [
        1
      ],
      "name": "Aloysius Suryawan"
    },
    {
      "affs": [
        1
      ],
      "name": "Wiku Andonotopo"
    },
    {
      "affs": [
        2
      ],
      "name": "Reza Widianto Sudjud"
    },
    {
      "affs": [
        1
      ],
      "name": "Ridwan Abdullah Putra"
    },
    {
      "affs": [
        3
      ],
      "name": "Arief Setiawan"
    },
    {
      "affs": [
        4
      ],
      "name": "Rizna Tyrani Rumanti"
    },
    {
      "affs": [
        4
      ],
      "name": "Roland Frederik Lengkey"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/45mst3p0cn7bf.bib",
  "cited_by": 0,
  "doi": "10.1097/fm9.0000000000000373",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706211/?tool=EBI",
  "id": "45mst3p0cn7bf",
  "issns": [
    "2096-6954",
    "2641-5895"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13706211",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RG1-991"
    ],
    [
      "openalex",
      "2729|Pregnancy and preeclampsia studies"
    ]
  ],
  "openalex": "W7171858379",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706211/pdf/?tool=EBI",
  "pmcid": "PMC13706211",
  "pmid": null,
  "published": "2026-07-29",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/45mst3p0cn7bf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:51Z",
      "native_id": "PMC:PMC13706211",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13706211"
    },
    {
      "first_seen": "2026-10-30T13:43:54Z",
      "native_id": "640a629f77da407fa050402c1cbdc5d5",
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      "url": "https://doi.org/10.1097/fm9.0000000000000373"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2729|Pregnancy and preeclampsia studies",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Obstetric Shock Beyond Hemorrhage: Microcirculatory Shunting, Endothelial Glycocalyx Injury, and Mitochondrial Failure in Pregnancy—A Narrative Review",
  "title_text": "Obstetric Shock Beyond Hemorrhage: Microcirculatory Shunting, Endothelial Glycocalyx Injury, and Mitochondrial Failure in Pregnancy—A Narrative Review",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:54Z",
  "url": "https://research.draconitic.com/paper/45mst3p0cn7bf",
  "venue": "Maternal-fetal medicine (Wolters Kluwer Health, Inc.)",
  "versions": []
}