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
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
