Undergraduate course lectures in OB&GYN ,Faculty of medicine ,Zagazig University Prepared by DR Manal Behery

1. Shock in
Obstetric
s
1

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
3

4. What is needed to maintain
perfusion?
Pump Heart
Pipes Blood Vessels
Fluid Blood
4

5. Types of Shock
5

6. Hypovolemic Shock
Cardiogenic Shock
Neurogenic and Anaphylactic
Shock
Septic Shock 6

7. In Obstetric cases shock is most
commonly due to either
hemorrhage or sepsis
7

8. Hypovolemic Shock
8

9. Obstetric Causes
of hpovolemic
Causes of hypovolemic
shock 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
10

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

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
12

13. Categorization of Acute Hemorrhage
Class 1 Class 2 Class 3 Class 4
Blood loss 15% 15%-30% 30%-40% >40%
(% blood volume)
Pulse rate <100 >100 >120 >140
Pulse pressure Normal Decreased Decreased Decreased
Blood pressure Normal or Decreased Decreased Decreased
increased

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
18

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
19

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 Ringer’s
solution while blood products are obtained
Colloids/PRBC’s 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.
•
21

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. Obstetric Causes
of neurogenic
Causes of hypovolemic
shock 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
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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
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27. Septic Shock
Results from body’s response to
bacteria in bloodstream
Vessels dilate, become “leaky”
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28. Obstetric Causes
of Septic shock
Causes of hypovolemic
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. Obstetric Causes
of Cardiogenic
Causes of hypovolemic
shock shock

33. Coronary spasm
Cardiomyopathy
Pulmonary embolisn
Amniotic fluid embolism
Mendelson’s syndrome
33

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

35. Thank you
35