OBSTETRICAL SHOCK

 Shock is defined as a state of circulatory

inadequacy with poor tissue perfusion
resulting in generalized cellular hypoxia.

 It
is a critical condition and a life threatening
medical emergency.
 Hypovolemic shock
 Cardinogenic shock
 Septic shock
 Anaphylactic shock
 Neurogenic shock
 Hypovolemic shock occurs due inadequate
volume or plasma volume.

 Circulating blood volume is inadequate

resulting from acute depletion.

 It
may be Hemorrhagic & Non-
Hemorrhagic.
HEMORRHAGIC SHOCK:
Associated with postpartum or postabortal
hemorrhage.
Ectopic pregnancy.
Placenta Previa.
Abruptio Placenta.
Rupture of the uterus.
Obstetric Surgery.
Shock associated with DIC.
IUD &Amniotic fluid embolism.
NON-HEMORRHAGIC SHOCK:
Fluid loss shock (Associated with excessive
vomitting,diarrrhea,diuresis or too rapid
removal of amniotic fluid.
Supine Hypotension Syndrome (Due to
compression of Inferior vena cava by the
pregnant uterus.
MI.
Vulvular regurgitation.
Acute myocarditis.
Cardiomyopathy.
Cardiac tamponade.
Pulmonary embolism.
Acute vulvular dysfunction.
Cardiac dysarythmia.
Rupture ventricular aneurysm.
Beta-blocker overdose.
Ca-channel blocker overdose.
EXTRA CARDIAC SHOCK:

Massive pulmonary embolism.

Amniotic fluid embolism.
Anaphylaxis.
Drug over dose.
 Also known as “ENDOTOXIC SHOCK”.

Associated with Septic Shock.

Chorioamnionitis.
Pyelonephritis.
Rarely Postpartum.
MENDELSON’S SYNDROME:

Associated with aspiration of GI contents

during GA.
Drug- Induced: Associated with S.A.
ENDOTOXIC
SHOCK
 PRINCIPLE:
To stop bleeding & replace the volume
which has been lost.

 RESTORE CIRCULATING VOLUME:

Blood transfusion.
Infusion of fluids.
 MAINTENANCE OF CARDIAC INSUFFICIENCY:
6 Liters of crystalloids may be needed for 1
liter of plasma volume loss.
 14 or 16G is inserted for volume
replacement.
Packed RBC combined with NS.
 O2 ADMINISTRATION:
Initial phase:
O2 by nasal cannula with 6-8 L per
minute.
Later phase:
Ventilation by ET intubation may be
necessary.
 PHARMACOLOGICAL AGENTS:
Inotropes.
Corticosteroids.
Vasopressors.
 MONITORING:
Temperature.
Visible peripheral veins (To assess the degree
of tissue perfusion).
Urine output (30ml/hr).
Critically ill patient (CVP, Pulse oximeter,
ABG).
 ADMINISTRATION OF ANTIBIOTICS:
 Broad spectrum antibiotics.
 Ampicillin (IV every 6 hrs).
 Gentamycin (2mg/kg/IV loading dose
followed by 1.5mg/kg/IV every 8 hrs).
 Metronidazole (400mg IV every 8 hrs).
 IV FLUIDS & ELECTROLYTES:
 Oliguria with high specific gravity (Liberal
fluid administration).
 Oliguria with low specific gravity (Fluid
Restriction).
 DIURETIC THERAPY:
 To reduce Fluid overload & pulmonary edema.
 E.g.: FRUSEMIDE.
NUTRITIONAL SUPPORT:
 TPN: Usually 20-30kcal/kg/day.
RECOMBINANT HUMAN-ACTIVATED PROTEIN C
THERAPY:
 It inhibits inflammation, Thrombosis & promotes
fibrinolysis.
 It decreases mortality in pt’s with severe sepsis.
 Ineffective tissue perfusion related to shock.
 Risk of fluid loss related to sweating.
 Risk of impaired gas exchange related to
hypotension.
 Fear / anxiety related to unknown prognosis
of the disease.