Shock in obstetrics for undergraduate
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Transcript of Shock in obstetrics for undergraduate
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Shock in Obstetrics
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Objectives
Define shock and its different categories
Describe management of shock
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Definition of Shock
Inadequate perfusion (blood flow) leading to inadequate oxygen delivery to tissues
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What is needed to maintain perfusion?
Pump Pipes Fluid
Heart
Blood VesselsBlood
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Types of Shock
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Hypovolemic Shock
Cardiogenic Shock
Neurogenic and Anaphylactic Shock Septic Shock
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In Obstetric cases shock is most commonly due to either hemorrhage or sepsis
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Hypovolemic Shock
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Causes of hypovolemic shock
Obstetric Causes of hpovolemic shock
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Blood loss (obstetric haemorrhage) Bleeing in early pregnancy Antepartum hemorrhage Post partum hemorrhage Fluid loss e.g Hyperemesis
gravidarum,Diarrhea, keto-acidosis. Plasma loss e.g Severe burns Supine hypotension syndrome. Splanchnic shock: sudden drop in intrauterine
pressure eg Hydramnios
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The most common form of hypovolemic shock in obstetrics is hemorrhagic shock due to massive obstetric hemorrhag
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Obstetrical Hemorrhage
Blood loss associated with pregnancy or parturition that
- causes maternal or perinatal death - requires blood transfusion
- decreases Hct by 10 points - triggers emergency therapeutic
response
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Categorization of Acute Hemorrhage
Class 1Class 1 Class 2Class 2 Class 3Class 3 Class 4Class 4
Blood loss Blood loss
(% blood volume)(% blood volume)15%15% 15%-30%15%-30% 30%-40%30%-40% >40%>40%
Pulse ratePulse rate <100<100 >100>100 >120>120 >140>140
Pulse pressurePulse pressure NormalNormal DecreasedDecreased DecreasedDecreased DecreasedDecreased
Blood pressureBlood pressure Normal or Normal or increasedincreased
DecreasedDecreased DecreasedDecreased DecreasedDecreased
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Stages of Shock
*Compensated*Uncompensated*Irreversible
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Compensated Shock
#Defense mechanisms are successful in maintaining perfusion
#Presentation Tachycardia Decreased skin perfusion Altered mental status
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Uncompenstated Shock
#Defense mechanisms begin to fail#Presentation
Hypotension Marked increase in heart rate Rapid, thready pulse Agitation, restlessness, confusion
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Irreversible Shock
#Complete failure of compensatory mechanisms
#Marked loss of tissue perfusion cause cell damage and death even in presence of resuscitation
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Shock: Signs and Symptoms
Hypotension Rapid weak pulse Pallor Sweating Cold clamy extremities Oliguria or anurea confusion
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Initial Treatment in Shock
Secure, maintain airway Apply high concentration oxygen Assist ventilations as needed Place patient in the Trendelenburg position Control obvious bleeding Prevent loss of body heat
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Restoration of CirculationVolume – Fluid Choices
Insert at least two large pore IV catheters
Crystalloids for initial resuscitation
Rapidly infuse 5% dextrose in lactated Ringer’s solution while blood products are obtained
Colloids/PRBC’s to replace blood loss
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Blood
• Order at least 6 units of red cells. Do not insist on cross matched blood if transfusion is urgently needed
• Apply compression cuff to infusion pack. Monitor central venous pressure (CVP) and arterial pressure.
•
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Complications of Hypovolemic shock
1) Acute renal failure.
2) Pituitary necrosis (Sheehan‟s syndrome).
3) Disseminated intravascular coagulation
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Neurogenic Shock
Abnormal vessel toneDue to truma and tissue
damage as in painful conditions
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Causes of hypovolemic shock
Obstetric Causes of neurogenic shock
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Disturbed ectopic pregnancy
Concealed accidental hemorrhage
Manual removal of placenta without anathesia
Difficult forceps or breech extraction Rapid evacuation of uterus poly
hydramninous 25
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Neurogenic shock Hemorrhagic shock
Pt is quiet &apatheic Irritable ,anxious,air hunger
No hemorrhage External or internal hemorrhage
Superficial veins are fill Periferal collapse
Hemoconcentration Hemodiluation
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Septic Shock
Results from body’s response to bacteria in bloodstream
Vessels dilate, become “leaky”
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Causes of hypovolemic shock
Obstetric Causes of Septic shock
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Septic abortion (usually illegal) . Acute pyelonephritis.
Chorioamnionitis . Retained placental tissue.
Puerperal sepsis. Postoperative infections.
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Recognition of Septic Shock
Early – warm shock – similar to neurogenic shock
Late – Cold shock – similar to cardiogenic shock
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Cardiogenic Shock
Pump failure/malfunction(decreased contractility)
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Causes of hypovolemic shock
Obstetric Causes of Cardiogenic shock
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Coronary spasm
Cardiomyopathy
Pulmonary embolisn
Amniotic fluid embolism
Mendelson’s syndrome
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Cardiogenic ShockSymptoms
Tachycardia Tachypnea Respiratory distress Mental status change Cool extremities Poor perfusion Signs of dehydration
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Thank you