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Shock in obstetrics for undergraduate

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Undergraduate course lectures in Obstetrics&Gynecology ,Faculty of medicine,Zagazig University prepared by DR Manal Behery – PowerPoint PPT presentation

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Title: Shock in obstetrics for undergraduate


1
Shock in Obstetrics
  • Dr Manal Behery
  • Assistant professor,Zagazig University
  • 2013

2
Objectives
  • Define shock and its different categories
  • Describe management of shock

3
Definition of Shock
  • Inadequate perfusion (blood flow) leading
    to inadequate oxygen delivery to tissues

4
What is needed to maintain perfusion?
  • Pump
  • Pipes
  • Fluid

Heart
Blood Vessels
Blood
5
Types of Shock
6
  • Hypovolemic Shock
  • Cardiogenic Shock
  • Neurogenic and Anaphylactic Shock
  • Septic Shock

7
In Obstetric cases shock is most commonly due
to either hemorrhage or sepsis
8
Hypovolemic Shock
9
Causes of hypovolemic shock
  • Obstetric Causes of hpovolemic shock

10
  • 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

11
The most common form of hypovolemic shock in
obstetrics is hemorrhagic shock due to massive
obstetric hemorrhag
12
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

13
Categorization of Acute Hemorrhage
Class 1 Class 2 Class 3 Class 4
Blood loss ( blood volume) 15 15-30 30-40 gt40
Pulse rate lt100 gt100 gt120 gt140
Pulse pressure Normal Decreased Decreased Decreased
Blood pressure Normal or increased Decreased Decreased Decreased
14
Stages of Shock
  • Compensated
  • Uncompensated
  • Irreversible

15
Compensated Shock
  • Defense mechanisms are successful in maintaining
    perfusion
  • Presentation
  • Tachycardia
  • Decreased skin perfusion
  • Altered mental status

16
Uncompenstated Shock
  • Defense mechanisms begin to fail
  • Presentation
  • Hypotension
  • Marked increase in heart rate
  • Rapid, thready pulse
  • Agitation, restlessness, confusion

17
Irreversible Shock
  • Complete failure of compensatory mechanisms
  • Marked loss of tissue perfusion cause cell
    damage and death even in presence of
    resuscitation

18
Shock Signs and Symptoms
  • Hypotension
  • Rapid weak pulse
  • Pallor
  • Sweating
  • Cold clamy extremities
  • Oliguria or anurea
  • confusion

19
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

20
Restoration of Circulation Volume Fluid Choices
  • Insert at least two large pore IV catheters
  • Crystalloids for initial resuscitation
  • Rapidly infuse 5 dextrose in lactated Ringers
    solution while blood products are obtained
  • Colloids/PRBCs to replace blood loss

21
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.

22
Complications of Hypovolemic shock
  • 1) Acute renal failure.
  • 2) Pituitary necrosis (Sheehan?s
  • syndrome).
  • 3) Disseminated intravascular coagulation

23
Neurogenic Shock
  • Abnormal vessel tone
  • Due to truma and tissue damage as in painful
    conditions

24
Causes of hypovolemic shock
  • Obstetric Causes of neurogenic shock

25
  • Disturbed ectopic pregnancy
  • Concealed accidental hemorrhage
  • Manual removal of placenta without anathesia
  • Difficult forceps or breech extraction
  • Rapid evacuation of uterus poly hydramninous

26
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
27
Septic Shock
  • Results from bodys response to bacteria in
    bloodstream
  • Vessels dilate, become leaky

28
Causes of hypovolemic shock
  • Obstetric Causes of Septic shock

29
  • ? Septic abortion (usually illegal)
  • .
  • ? Acute pyelonephritis.
  • ? Chorioamnionitis .
  • ? Retained placental tissue.
  • ? Puerperal sepsis.
  • ? Postoperative infections.

30
Recognition of Septic Shock
  • Early warm shock similar to neurogenic shock
  • Late Cold shock similar to cardiogenic shock

31
Cardiogenic Shock
  • Pump failure/malfunction
  • (decreased contractility)

32
Causes of hypovolemic shock
  • Obstetric Causes of Cardiogenic shock

33
  • Coronary spasm
  • Cardiomyopathy
  • Pulmonary embolisn
  • Amniotic fluid embolism
  • Mendelsons syndrome

34
Cardiogenic Shock Symptoms
  • Tachycardia
  • Tachypnea
  • Respiratory distress
  • Mental status change
  • Cool extremities
  • Poor perfusion
  • Signs of dehydration

35
Thank you
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