Obstetric Shock

Obstetric Shock

Shock is collapse which is mostly due to circulatory failure. Shock in obstetric does not differ from surgical shock.

Causes:

In most cases shock in obstetrics are associated with

·              Hemorrhage (especially carried by Trauma)

·              Prolonged or severe anesthesia

·              Severe pains associated with manual removal of placenta.

Difficult labour, forceful dilatation of the cervix, difficultinstrumental delivery, internal version, Rupture of uterus. Inversion of uterus.Concealed accidental hemorrhage.Pulmonary embolism.

·              Amniotic fluid embolism – Intravascular coagulation .

·              Reaction to blood transfusion of incompatible blood.

·              Severe infection (clostridia or gm-ve enteric bacteria).

·              Very really – Air embolism.

·              It maybe purely neurogenic and due to fear.

·              Sudden reduction in intra-abdominal pressure following the delivery of twins.

In most cases shock is caused by more than one factor – hemorrhage and trauma and prolonged anesthesia.

Signs and symptoms

·              Rapid and thready pulse  - 90 beats & above

·              B/P of below 90 systolic call for alarm

·              Increased pallor of the skin ,Cold sweat ,cyanosis ,Subnormal temperature

·              Deep and sighing respiration. Restlessness, Patient may complain of thirst or faintness. May loose consciousness.

Management:

Call Doctor at the first sign of rising pulse rate.

Urgent resuscitative treatment

Principle of treatment.

·              The administration of fluids – collapse is due to circulatory failure so increase blood volume – usin g ABO group and Rhesus type. Plasma may be used. Saline or Dextrose may be set up temporarily.

·              Raise foot of bed – to maintain circulation to the vital organs.

·              Oxygen by mask at the rate of 1 –2 litres/minute

·              Rest – Morphine to relief pain.

·              Keep in a quiet and undisturbed as possible.

·              Cortisone or nor adrenaline are sometimes effect in adrenal failure but not in other cases as it may cause severe vasoconstriction and decrease venous return further.

·              Avoid warm – cold skin constrict the arterioles in the skin directing the little blood to the heart and brain. Warming the skin may contradict this compensatory mechanism.

·              Stimulantsuch as coramine (2mls) may be given intramuscularly.