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.