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Shock inObstetric   s        1
ObjectivesDefine shock and its differentcategoriesDescribe management of shock
Definition of Shock  Inadequate perfusion    (blood flow) leading toinadequate oxygen delivery to            tissues      ...
What is needed to maintainperfusion? Pump Heart Pipes Blood Vessels Fluid Blood                             4
Types of Shock                 5
Hypovolemic ShockCardiogenic Shock Neurogenic and Anaphylactic ShockSeptic Shock                   6
In Obstetric cases shock is mostcommonly due to eitherhemorrhage or sepsis                                   7
Hypovolemic Shock                    8
Obstetric Causesof hpovolemicCauses of hypovolemicshock shock
Blood loss (obstetric haemorrhage)Bleeing in early pregnancyAntepartum hemorrhagePost partum hemorrhageFluid loss e.g Hype...
The most common form ofhypovolemic shock inobstetrics is hemorrhagicshock due to massiveobstetric hemorrhag               ...
Obstetrical HemorrhageBlood loss associated with pregnancy or parturition that  - causes maternal or perinatal death  - re...
Categorization of Acute Hemorrhage                 Class 1     Class 2   Class 3   Class 4Blood loss       15%         15%...
Stages of Shock*Compensated*Uncompensated*Irreversible
Compensated Shock#Defense mechanisms are successful in maintaining perfusion#Presentation    Tachycardia    Decreased skin...
Uncompenstated Shock#Defense mechanisms begin to fail#Presentation   Hypotension   Marked increase in heart rate   Rapid, ...
Irreversible Shock#Complete failure of compensatory mechanisms#Marked loss of tissue perfusion cause cell damage and death...
Shock: Signs and SymptomsHypotensionRapid weak pulsePallorSweatingCold clamy extremitiesOliguria or anureaconfusion       ...
Initial Treatment in           ShockSecure, maintain airwayApply high concentration oxygenAssist ventilations as neededPla...
Restoration of Circulation       Volume – Fluid Choices   Insert at least two large pore IV cathetersCrystalloids for init...
Blood•   Order at least 6 units of red cells. Do    not insist on cross matched blood if    transfusion is urgently needed...
Complications of      Hypovolemic shock 1) Acute renal failure. 2) Pituitary necrosis (Sheehan‟ssyndrome). 3) Disseminated...
Neurogenic Shock Abnormal vessel toneDue to truma and tissue  damage as in painful       conditions
Obstetric Causesof neurogenicCauses of hypovolemicshock shock
Disturbed ectopic pregnancyConcealed accidental hemorrhageManual removal of placenta withoutanathesiaDifficult forceps or ...
Neurogenic shock             Hemorrhagic                             shockPt is quiet &apatheic        Irritable ,anxious,...
Septic ShockResults from body’s response tobacteria in bloodstreamVessels dilate, become “leaky”                          ...
Obstetric Causesof Septic shockCauses of hypovolemic       shock
 Septic abortion (usually illegal). Acute pyelonephritis. Chorioamnionitis . Retained placental tissue. Puerperal sep...
Recognition of Septic      ShockEarly – warm shock – similarto neurogenic shockLate – Cold shock – similar tocardiogenic s...
Cardiogenic ShockPump failure/malfunction(decreased contractility)
Obstetric Causesof CardiogenicCauses of hypovolemicshock shock
Coronary spasmCardiomyopathyPulmonary embolisnAmniotic fluid embolismMendelson’s syndrome                          33
Cardiogenic Shock        SymptomsTachycardiaTachypneaRespiratory distressMental status changeCool extremitiesPoor perfusio...
Thank you            35
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Shock in obstetrics for undergraduate

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

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Shock in obstetrics for undergraduate

  1. 1. Shock inObstetric s 1
  2. 2. ObjectivesDefine shock and its differentcategoriesDescribe management of shock
  3. 3. Definition of Shock Inadequate perfusion (blood flow) leading toinadequate oxygen delivery to tissues 3
  4. 4. What is needed to maintainperfusion? Pump Heart Pipes Blood Vessels Fluid Blood 4
  5. 5. Types of Shock 5
  6. 6. Hypovolemic ShockCardiogenic Shock Neurogenic and Anaphylactic ShockSeptic Shock 6
  7. 7. In Obstetric cases shock is mostcommonly due to eitherhemorrhage or sepsis 7
  8. 8. Hypovolemic Shock 8
  9. 9. Obstetric Causesof hpovolemicCauses of hypovolemicshock shock
  10. 10. Blood loss (obstetric haemorrhage)Bleeing in early pregnancyAntepartum hemorrhagePost partum hemorrhageFluid loss e.g Hyperemesisgravidarum,Diarrhea, keto-acidosis.Plasma loss e.g Severe burnsSupine hypotension syndrome.Splanchnic shock: sudden drop inintrauterine pressure eg Hydramnios 10
  11. 11. The most common form ofhypovolemic shock inobstetrics is hemorrhagicshock due to massiveobstetric hemorrhag 11
  12. 12. Obstetrical HemorrhageBlood loss associated with pregnancy or parturition that - causes maternal or perinatal death - requires blood transfusion - decreases Hct by 10 points - triggers emergency therapeuticresponse 12
  13. 13. Categorization of Acute Hemorrhage Class 1 Class 2 Class 3 Class 4Blood loss 15% 15%-30% 30%-40% >40%(% blood volume)Pulse rate <100 >100 >120 >140Pulse pressure Normal Decreased Decreased DecreasedBlood pressure Normal or Decreased Decreased Decreased increased
  14. 14. Stages of Shock*Compensated*Uncompensated*Irreversible
  15. 15. Compensated Shock#Defense mechanisms are successful in maintaining perfusion#Presentation Tachycardia Decreased skin perfusion Altered mental status
  16. 16. Uncompenstated Shock#Defense mechanisms begin to fail#Presentation Hypotension Marked increase in heart rate Rapid, thready pulse Agitation, restlessness, confusion
  17. 17. Irreversible Shock#Complete failure of compensatory mechanisms#Marked loss of tissue perfusion cause cell damage and death even in presence of resuscitation
  18. 18. Shock: Signs and SymptomsHypotensionRapid weak pulsePallorSweatingCold clamy extremitiesOliguria or anureaconfusion 18
  19. 19. Initial Treatment in ShockSecure, maintain airwayApply high concentration oxygenAssist ventilations as neededPlace patient in the TrendelenburgpositionControl obvious bleedingPrevent loss of body heat 19
  20. 20. Restoration of Circulation Volume – Fluid Choices Insert at least two large pore IV cathetersCrystalloids for initial resuscitationRapidly infuse 5% dextrose in lactated Ringer’ssolution while blood products are obtainedColloids/PRBC’s to replace blood loss
  21. 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. 22. Complications of Hypovolemic shock 1) Acute renal failure. 2) Pituitary necrosis (Sheehan‟ssyndrome). 3) Disseminated intravascular coagulation
  23. 23. Neurogenic Shock Abnormal vessel toneDue to truma and tissue damage as in painful conditions
  24. 24. Obstetric Causesof neurogenicCauses of hypovolemicshock shock
  25. 25. Disturbed ectopic pregnancyConcealed accidental hemorrhageManual removal of placenta withoutanathesiaDifficult forceps or breech extractionRapid evacuation of uterus polyhydramninous 25
  26. 26. Neurogenic shock Hemorrhagic shockPt is quiet &apatheic Irritable ,anxious,air hungerNo hemorrhage External or internal hemorrhageSuperficial veins are fill Periferal collapseHemoconcentration Hemodiluation 26
  27. 27. Septic ShockResults from body’s response tobacteria in bloodstreamVessels dilate, become “leaky” 27
  28. 28. Obstetric Causesof Septic shockCauses of hypovolemic shock
  29. 29.  Septic abortion (usually illegal). Acute pyelonephritis. Chorioamnionitis . Retained placental tissue. Puerperal sepsis. Postoperative infections.
  30. 30. Recognition of Septic ShockEarly – warm shock – similarto neurogenic shockLate – Cold shock – similar tocardiogenic shock
  31. 31. Cardiogenic ShockPump failure/malfunction(decreased contractility)
  32. 32. Obstetric Causesof CardiogenicCauses of hypovolemicshock shock
  33. 33. Coronary spasmCardiomyopathyPulmonary embolisnAmniotic fluid embolismMendelson’s syndrome 33
  34. 34. Cardiogenic Shock SymptomsTachycardiaTachypneaRespiratory distressMental status changeCool extremitiesPoor perfusionSigns of dehydration
  35. 35. Thank you 35

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