Shock In Obstetrics Flashcards
(31 cards)
What is the definition of shock?
A state of inadequate tissue perfusion and oxygenation resulting in cellular hypoxia and death.
What are the four main types of shock?
Hypovolaemic, distributive, cardiogenic, obstructive.
What are the key clinical features of shock?
Weak, rapid pulse; low BP; pallor; cold extremities; restlessness; shallow respiration; oliguria.
How is shock classified based on blood loss in pregnancy?
Class I–IV; Class IV involves >2500 mL blood loss in pregnancy and pulse >140 bpm.
Why does shock in pregnancy differ from that in non-pregnant adults?
Because pregnancy involves two patients (mother and foetus) and physiological adaptations.
Name three cardiovascular changes in pregnancy that affect shock.
↑ blood volume, ↑ cardiac output, ↓ systemic vascular resistance.
What haematological changes make pregnancy a hypercoagulable state?
↑ clotting factors, ↓ anticoagulants (Protein S), impaired fibrinolysis due to ↑ PAI.
What are the common causes of shock in obstetrics?
Haemorrhage, sepsis, uterine inversion, cardiogenic causes.
What are the initial steps in managing shock in obstetrics?
Call for help, position woman left lateral, ABC resuscitation, rapid IV fluids, anti-shock garment.
What are possible complications of obstetric shock?
Death, DIC, renal/hepatic failure, ARDS, MODS, Sheehan’s syndrome.
What is the global maternal mortality rate per year?
About 529,000 deaths/year.
What is postpartum haemorrhage (PPH)?
Excessive vaginal bleeding after delivery; >500 mL (vaginal), >1000 mL (C-section).
Differentiate between primary and secondary PPH.
Primary: within 24 hours postpartum; Secondary: from 24 hours to 6 weeks postpartum.
What is the estimated incidence of PPH?
Estimated at 2–11% of all deliveries.
What are the five main causes of primary PPH (4Ts + I)?
Tone (atony), Trauma, Tissue, Thrombin, Inversion.
What are major causes of uterine atony?
Uterine overdistension, prolonged/precipitate labour, infection, high parity, use of tocolytics.
List some causes of genital tract trauma in PPH.
Episiotomy, perineal/cervical laceration, ruptured uterus, pelvic hematoma.
What are causes of thrombin-related PPH?
DIC, HELLP, thrombocytopenia, vWD, amniotic fluid embolism.
What are the key principles of managing PPH?
Resuscitate, identify cause, specific treatment, prevent complications, long-term follow-up.
What drugs are used for medical management of atonic PPH?
Oxytocin, ergometrine, misoprostol, PGF2α, tranexamic acid.
Name some balloon tamponade devices used in uterine tamponade.
Sengstaken-Blakemore, Bakri, Rusch balloon, glove/finger balloons.
What surgical techniques are used to control PPH?
B-Lynch suture, uterine/iliac artery ligation, hysterectomy.
What is the HAEMOSTASIS algorithm in managing atonic PPH?
Help, Assess, Ecbolics, Massage, Oxytocin, Shock garment, Tamponade, Apply sutures, Systematic ligation, Interventional radiology, Subtotal/Total hysterectomy.
What are the stepwise stages in managing atonic PPH?
Step 1: Uterotonics → Step 2: Compression → Step 3: Surgery → Step 4: Hysterectomy.
