OBSTETRIC SHOCK

DEFINITION
 Shock is defined as a state of circulatory
inadequacy with poor tissue perfusion
resulting in generalized cellular hypoxia. If
left untreated it will result in death.
CLASSIFICATION
1.Hypovolemic shock
It is due to the result of a reduction in
intravascular volume such as in severe
obstetric haemorrhage.

2.Cardiogenic shock
Impaired ability of the heart to pump blood.
It may be seen in pulmonary embolism or
women in cardiac defects.
3.Neurogenic Shock
It results from an insult to the nervous system
as in uterine inversion.

4.Septic or toxic shock

It occurs with a severe generalised infection.

5.Anaphylactic
It may occur as a result of a severe allergy or
drug reaction.

Among this hypolemic shock and septic

Shock develop as a consequence of child birth.
PATHOENESIS OF SEPTIC
SHOCK
Blood loss

Decreased intra vascular volume

Decreased venous return, decreased cardiac

output and lowered blood pressure.

Body compensating by increasing heart rate

to circulate the decreased volume faster,
vasoconstriction of peripheral vessels,
Increased respiratory rate.
Cold, Clammy skin ,decreased uterine
perfusion, in the face of continued blood loss-
the body shift fluid from interstitial spaces
into intravascular spaces. Blood pressure
continue to fall.

Reduced renal ,uterine , and brain perfusion

Renal failure

Maternal death
 PATHOGENESIS OF SEPTIC SHOCK
Infection

Gram(-ve) Gram (+)

Endotoxin Exotoxin

Neutrophils Monocytes Macrophages Endothelial cells

Systemic inflammatory response and release of

mediators.
Cytokines, platelet activating factor, endothelinI,
prostaglandins
(PGI2,PGE2,leukotriens,complements)

Myocardial infarction Vascular effects

* myocardial contraction vasoconstriction
* left ventricular ejection endothelial cell injury
* Left ventricular dilation hypotension
* Cardiac output tissue hypo perfusion

Irreversible phase
*Persistent hypotension * metabolic acidosis *severe
*
myocardial depression
MULTIPLE ORGAN FAILURE
CLINICL FEATURES
Hemorrhagic shock
 Mental confusion
 Paleness
 Increased pulse
 Decreased BP
 Tachycardia
 Diaphoresis
 Decreased cardiac output
 Decreased urinary output
 Cold extremities
ENDOTOXIC SHOCK
 Flushing of the face and the skin feels warm
 Temperature change
 Patient become pale, profuse sweating
 Heart rate >100 b/mt
 Respiratory rate >20 b/mt
 WBC >12000/ml
 Cold, clammy extremities
 Decreased urine output
 Grey cyanotic appearance
 Hypotension
 Hypo perfusion
 Multiple organ dysfunction syndrome.
MANAGEMENT
Haemorrhagic shock
 Immediate resuscitation by
 -Infusion and transfusion
 Crystalloids-normal saline initially followed
by colloids.
 Administration of oxygen to avoid metabolic
acidosis by oxygen face mask at a rate of 6-8
liters.
 Control haemorrhage by medical or surgical
measures.
ENDOTOXIC SHOCK
1.antibiotics
 Ampicillin-500 mg iv every 6 hrs
 Gentamycin 2 mg/kg IV loading dose
followed by 1.5 mg/kg IV every 8 hrs.and
 Metronidazole 500 mg IV every 8 hrs.

2.Intravenous fluids and electrolytes

 Correction of acidosis by sodium bicorbonate
solution 50-100 mEq
3.Maintenance of BP by
 vasodilator therapy
 Sodium nitropruside and nitroglycerine (1
mg,,2mg)
 Diuretic therapy-Frusemide-40 mg tabletatm

4.Treatment of intravascular coagulation

 Heparin 5000 IU/SC or IV 8 hry.
 Fresh frozen plasma, whole blood transfusion
 Treatment of myocarditis-digitalis
 Ranitidine (25 mg/ml) IV to prevent stress
induced bleeding and ulceration of the
gastric mucosa.
 Nutritional support oral or parenteral
nutrition to provide 20-30 kcal/kg/day with
fat and carbohydrate.
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