Shock in obstetrics for undergraduate
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Transcript of Shock in obstetrics for undergraduate
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Shock in Obstetrics
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
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
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
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
Stages of Shock
*Compensated*Uncompensated*Irreversible
Compensated Shock
#Defense mechanisms are successful in maintaining perfusion
#Presentation Tachycardia Decreased skin perfusion Altered mental status
Uncompenstated Shock
#Defense mechanisms begin to fail#Presentation
Hypotension Marked increase in heart rate Rapid, thready pulse Agitation, restlessness, confusion
Irreversible Shock
#Complete failure of compensatory mechanisms
#Marked loss of tissue perfusion cause cell damage and death even in presence of resuscitation
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
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
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
Neurogenic Shock
Abnormal vessel toneDue to truma and tissue
damage as in painful conditions
Causes of hypovolemic shock
Obstetric Causes of neurogenic shock
Disturbed ectopic pregnancy
Concealed accidental hemorrhage
Manual removal of placenta without anathesia
Difficult forceps or breech extraction Rapid evacuation of uterus poly
hydramninous 25
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”
Causes of hypovolemic shock
Obstetric Causes of Septic shock
Septic abortion (usually illegal) . Acute pyelonephritis.
Chorioamnionitis . Retained placental tissue.
Puerperal sepsis. Postoperative infections.
Recognition of Septic Shock
Early – warm shock – similar to neurogenic shock
Late – Cold shock – similar to cardiogenic shock
Cardiogenic Shock
Pump failure/malfunction(decreased contractility)
Causes of hypovolemic shock
Obstetric Causes of Cardiogenic shock
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