Though septic shock seemed the most likely scenario, her distended belly raised other possibilities. Cytokines are increase blood vessel permeability. The liquid part of blood--serum, can now leak out of vessels and cause swelling. Accumulation of this or similar fluid in the abdominal cavity is called ascites. So her distended abdomen can fit the septic shock scenario
But internal bleeding--perhaps from a ruptured uterus--coiuld also cause this distension. Now that's something we could/should address. So once the BP stabilized, an immediate laparoscopy (camera inserted through a half-inch umbilical incision) showed that the fluid was ascites not blood; a quart and a half were removed to take pressure off the lungs (more could have been removed, but we wanted the laparoscopy to be as quick and atraumatic as possible).
She was taken to the ICU, who found her condition so perilous that transfer by helicoptor to the local county hospital/medical school training site/multi-state trauma center was recommended.
There massive antibiotics were administered and a hysterectomy performed (to remove the most likely source of continuing infection. She improved slowly, discharged after three weeks. The mortality of septic shock can be as high as 50%. She did well.
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