An article on obstetrical shock
Shock is a condition where decreased tissue perfusion can be seen which leads to cellular hypoxia, which lead to irreversible tissue damage and it should be treated on time otherwise it can be collapse during the time of pregnancy.It is one of the most crucial and difficult problems faced by an obstetrician.The amount of morbidity in patient depends on the duration of shock.
Types and the causes of shock are as follows:
Hemorrhagic shock :
Hemorrhagic shock is a kind of shock which happens due to hypoglycemia ( it causes due to antepartum haemorrhage and postpartum haemorrhage )
Endotoxic Shock :
This kind of shock can happens due to the release of toxins which cause generalized vascular disturbance.
Cardiogenic shock :
This kind of shock can be happened due to inefficient pumping by heart which leads to circular collapse, rheumatoid heart disease, Eclampsia.
Neurogenic shock :
Anaphylactic shock : This kind of shock causes due to hypersensitivity reaction.
- Other causes are amniotic fluid air or thrombus .
- Due to uterine rupture.
- Trauma and operature
- Septic abortion
- Embolism,air embolism, amniotic fluid embolism.
Haemorrhagic shock:
This kinds of shock happens due to excessive blood loss.
Early pregnancy causes abortion, ectopic pregnancy, gestational trophoblastic disease.
Late pregnancy causes placenta previa,abruptio placenta Rupture uterus PPH
Clinical features:
pallor,cold and clammy extremities,rapid thready pulse,low blood pressure, air hunger, diminution of vision ,oliguria and anuria can be seen in haemorrhagic shock.
Classification: Depending on the amount of haemorrhagic shock,it is classified as following phases ;
Phase of compensation
Phase of decompensation
Phase of cellular damage — immediate resuscitative measures to be taken — establishment of airway and oxygen therapy, elevations of lower limbs to increase venous returns.
Drug therapy :
Analgesic can be given in this cases 10-15 mgs ,morphine I.V ,if there is pain , tissue damage or irritability.
Corticosteroid:
hydrocortisone 1 g or dexamethasone 20 days slow IV.
Vasopressor : Dopamin ,isoprenaline 1mg in 500 ml 5%glucose slow
Complications:
Acute renal failure
Pituitary necrosis
DIC
Endotoxic Shock ( Septic or bacteremia )
This kind of infection caused by gram positive or gram negative bacteria, viruses or fungi leads to septic shock during pregnancy.
Causative factor: Gram negative bacilli( E coli,proteus, klebsiella,pseudomonas and Bacteroides)
Causes : Septic abortion
Chorioamnionitis
Puerperal sepsis
Retained product of conception
Instrumentation of genito urinary tract
Severe acute pyelonephritis
Respiratory tract infection
Management:
Replacement of blood loss by colloids ,crystalliods,till blood is available.
Corticosteroid – hydrocortisone 1g IV 6 hours or dexamethasone 20 mg initially followed by 200 mg
Vasoactive drugs like isoprenaline can be given.
Maintain adequate tissue oxygenation.patient with severe hypoxemia need to be intubated and mechanically ventilated.
Bronchospasm can be treated with aminophylline.
Cardiogenic shock :
It is defined as circulatory collapse caused by sudden failure of the heart to pump the blood adequately.
Causes: The causes of cardiogenic shock in pregnancy is severe valvular disease.Any reason for obstetric shock can result in cardiac arrest. Septic shock is often related to myocardial dysfunction.
Management:
In case of cardiac arrest in pregnancy CPR is started with CAB instead of ABC.