Haemorrhagic shock in obstetrics

1.

Haemorrhagic shock in
obstetrics
BY
VYAS KAVAN
163(2)

2.

DEFINITION
HAEMORHAGIC SHOCK IS THE CLINICAL
SYNDROME THAT RESULTS FROM
INADEQUATE TISSUE PERFUSION (POOR
BLOOD FLOW) WHICH LEADS TO HYPOXIA AND
ULTIMATELY CELLULAR DYSFUNCTION WHICH
MANIFESTS AS LACTIC ACIDOSIS.
ITS DIFFERENT FROM HYPOVOLAMIC SHOCK
BECAUSE , HYPOVOLAMIC SHOCK CAN OCCURE
THROUGH ANY KIND OF FLUID LOSS FROM
THE BODY , BUT HAEMORRHAGIC ISN’T.

3.

CONTINUE
SO FIRST OF ALL..
BLOOD LOSS HAS MAINLY 2 EFFECTS ON THE
BODY
1 – FIRST, THERE IS A LOSS OF VOLUME OF
BLOOD WITHIN VESSEL TO BE PUMPED
(HYPOVOLAMIC SHOCK)
2- REDUCED OXYGEN CARRYING CAPACITY OF
BLOOD BECAUSE OF LOSS OF RED BLOOD
CELLS(HAEMORRHAGIC SHOCK)

4.

CONTINUE
SO ACC. TO SUCH CRITERIA
HAEMORRHAGIC SHOCK IS SUBSET OF
HYPOVOLAMIC SHOCK ANS IT TYPICALLY
OCCURES WHEN THERE IS SIGNIFICANT
BLEEDING THAT ENSUES RELATIVELY QUICK.

5.

ETIOLOGY
BLOOD LOSS DUE TO
TRAUMA
2. RETROPERTONEAL BLEED
3. OBSTETRIC HAEMORRHAGE
(A) ANTEPARTUM HAEMORRHAGE
(b) POSTPARTUM HAEMORRHAGE
(C) ECTOPIC PREGNANCY
1.

6.

ETIOLOGY CONT.
ANTENATAL CASUE
- PLACENTA PREVIA
- PLACENTAL ABRUPTION
- UTERINE RUPTURE
POST PARTUM
- UTERINE ATONY
- LACERATION TO GENITAL TRACT
- CHORIOAMNIONNITIS
- COAGULOPATHIES

7.

DIAGNOSIS
THERE ARE NO SPECIFIC LABORATORY TESTS
FOR SHOCK
A HIGH INDEX OF SUSPICION AND PHYSICAL
SIGN OF INADEQUTE TISSUE PERFUSION AND
OXYGENATION ARE THE BSUSU FIOR
INITIATING PROMPT MANAGEMENT
INITIAL MANAGEMENT OF THE UNDERLYING
CAUSE.

8.

CLINICAL PICTURE
FETAL HEART RATE CHANGES – INCREASED ,
DECREASED, OR LESS FUNCTIONAL
RISING OR WEAK PULSE –TACHYCARDIA
RISIN RESPIRATORY RATE – TACHYPNEA
SHALLOW OR IRREGULAR RESPIRATIONS –
HUNGER FOR AIR
FALLING BLOOD PRESSURE- HYPOTENSION

9.

CLINICAL PICTURE CONTINUE
DECREASED OR ABSENT URINARY OUTPUT –
USUALLY LESS THAN 30 ML/HR
PALE SKIN OR MUCUS MEMBRANES
CLOD, CLAMMY SKIN
FAINTNESS
THIRST

10.

CONTINUE
PALLOR
SWEATING
CONFUSION
COLD CLAMMY EXTREMITIES

11.

STAGES OF HAEMORHHAGIC SHOCK
1- COMPENSATED
2 – UNCOMPENSATED
3- IRREVERSIBLE

12.

COMPENSATED
INTHIS STAGE , DEFENCE MECHANISM ARE
SUCCESSFULL IN MAINTAINING PERFUSION
PRESENTATION
1 – TACHYCARDIA
2- DECREASED SKIN PERFUSION
3- ALTERED MENTAL STATUS

13.

UNCOMPENSATD
DEFENCE MECHANISM BEGINS TO FAIL
PRESENTATION
- HYPOTENSION
- MARKED INCREASE IN HR
- RAPID AND THREADY PULSE
- AGITAION , RESTLESSNESS AND CONFUSION

14.

IRREVERSIBLE
COMPLETE FAILURE OF COMPENSATORY
MECHANISM
MARKED LOSS OF TISSUE PERFUSION CAUSE
CELLULAR DAMAGE AND DEATH EVEN IN THE
PRESENCE OF RESUSCITATION.

15.

INITIAL MANAGEMENT
OXYGENATE THE PERSON WITH AROUND 6-8
LITERS OF OXYGEN
SECURE AND MAINTAIN THE AIRWAY
APPLY ASSISTED VENTILATION IF NEEDED
RESTORE CIRCULATORY VOLUME
DRUG THERAPY
EVALUATE RESPONSE TO THE CURRENT
THERAPY
REMEDY THE UNDERLYNG CAUSE

16.

CONTINUE
INFUSION AND TRANSFUSION
- BLOOD
- CRYSTALOID – NORMAL SALINE
- COLLOIDS- HAEMACCEL , HUMAN ALBUMIN
SOLUTION 4.5%

17.

CONTINUE
PHARMACOLOGICAL AGENTS LIKE
1- VASOACTIVE DRUGS
2- INOTROPES
3- CORTICOSTEROIDS AND APART
ERYTHROPOETIN 40000U/WEEK WITH IRON
AND VIT-C IS GIVEN
ARE GIVEN

18.

CONTINUE
THE ABOVE MENTIONED MEASUREMENTS
WERE BASIC AND NOT TREAT SPECIFIC
SO LAPRATOMY FOR ECTOPIC PREGNANCY
SUCCTION EVACUATION FOR INCOMPLETE
ABORTION
MANAGEMENT OF UTERINE ATONY
- OPTIMISE UTERINE TONE
- SURGERY(BLYNCH SUTURES, BALLOON
CATHETER ETC.

19.

CONTINUE
REPAIR OF LACERATION
IN CASE OF UTERINE UPTURE
-- STOP OXYTOCIN INFUSIION IF RUNNING
-- CONTINUE MATERNAL AND FETAL
MONITORING
-- EMERGENCY LAPAROTOMY WITH RAPID
OPERATIVE DELIVERY
-- CESAREN HYSTERECTOMY MAY NEED TO
PERFORM IF HAEMORRHAGE IS NOT
CANCELLED

20.

MONITORING
THROUGHOUT ALL THE TREAMENT
MONITORING AS PER BELOW IS REQUIRED
MONITORING OF SKIN TEMPERATURE
URINE OUTPUT SHOUD BE GREATER THAN
30ML/HR
ARTERIAL BLLOD PRESSURE
CVP
PULSE EMYMETER AND ABG.

21.

THANK YOU
FOR
YOUR ATTENTION