Learn about obstetric shock

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Shock is a state of circulatory collapse due to various causes, reducing or stopping the supply of blood and oxygen to the organs, especially vital organs such as the heart, lungs, and brain. This is a dangerous condition that requires medical staff to have a timely and positive handling attitude to be able to save the patient's life.

1. Overview

The most common obstetric shock is hemorrhagic shock in obstetrics (postpartum haemorrhage, hemorrhagic miscarriage, ruptured ectopic pregnancy...) or due to infection (postpartum infection, septic abortion... ).
Common type of shock in obstetrics
1.1 Shock due to blood loss Ectopic pregnancy Uterine rupture Genitourinary tract and perineal tearing Placental defect Uterine stagnation Placenta placenta Placenta abruption 1.2 Septic shock In obstetrics and gynecology, shock Infections are often caused by:
Common in unsafe abortions. Postpartum vegetables. Pre-existing infection in the fallopian tubes and fallopian tubes, or the genital tract. Late uterine rupture. 1.3 Shock due to amniotic fluid embolism Embolism due to amniotic fluid is uncommon, can be encountered in normal delivery or requires surgical intervention with fork-ripple, or cesarean section. Clinically, there are often three prominent syndromes: dyspnea, cardiovascular collapse, coagulation disorders.

Clinical manifestations Small tachycardia (usually fast > 110 beats/min), sometimes irregular, peripheral pulse not captured.
Drop in blood pressure < 90/60 mmHg. Pale skin (around the lips, eyelids, and palms). Sweating. Cold hands and feet due to peripheral vasoconstriction. Rapid shallow breathing (respiratory rate is usually more than 30 breaths/minute). Drowsiness, restlessness, or coma. Oliguria or anuria. Depending on the cause of shock, there are different clinical manifestations. Initial management Before a case of shock, initial aggressive management is very important to save the patient from the crisis.
Calling people to help and give first aid to the sick. Check vital signs: pulse, breathing rate, temperature. Make sure the airway is clear by placing the patient in a supine position (or turning to one side if the patient is vomiting). Aspirate sputum if the patient produces a lot of sputum and give the patient oxygen through the nose at a rate of 6-8 liters / min. At the commune level, if there is no oxygen tank, it is possible for the patient to breathe oxygen through an oxygen bag, it is best to give oxygen through a water tank to ensure enough humidity. To compensate for volume by rapid intravenous infusion of isotonic solution (Ringer lactate), sugar solutions should not be used to restore volume. In case of emergency, it is necessary to set up multiple transmission lines at the same time. The rate of infusion can be up to 1 liter of fluid in 15-20 minutes, 2 liters of fluid must be infused in the first hour. Try to rehydrate at a rapid rate in the case of hemorrhagic shock, the volume of fluid needed to be replaced is 2-3 times the volume of blood lost. In case of haemorrhage, it is necessary to stop the bleeding immediately and consider a blood transfusion for the patient. The decision of blood transfusion or not is mainly based on clinical and hemoglobin test <50g/liter. Check vital signs every 15 minutes. Check blood count, liver and kidney function, coagulation factors... In case of septic shock, blood culture, fluid culture to find the cause of the disease, then immediately use broad-spectrum antibiotics and combination of antibiotics antibiotics, when the antibiogram is available, use the drug according to the antibiogram. Treatment according to the cause of shock After the patient has stabilized with initial treatment, the cause of shock should be determined.
Shock from blood loss Determine cause of bleeding and treat bleeding immediately: Bleeding can be caused by miscarriage, ectopic pregnancy or ruptured ectopic pregnancy. Bleeding may also occur in the last months of pregnancy or in labor such as placenta previa, placental abruption, uterine rupture, postpartum genital tract trauma, or uterine atony, causing haemorrhage. In these cases, it must be quickly either with medication or with a procedure or surgery to stop the bleeding. Transfusion of blood as soon as possible compensates for the lost circulating volume. Cardiovascular support: Intravenous Dopamine Anticoagulation disorders by using antifibrinolytic drugs and blood products. Septic shock and toxicity Intramuscular high-dose combination antibiotics (possibly ampicillin 1g and gentamycin 160 mg), initial intensive care and referral. Oxygen, intravenous fluids. Heart aid. High-dose antibiotics in combination and according to the antibiogram. Treat the cause of infection: Drain the pus, remove the infection (hysterectomy).

2. Prevention

Mothers must feel secure and worry less in the days leading up to birth and during labor. Women should not be allowed to work until the day they give birth. It is recommended to apply pain-relieving methods during labor such as painless labor training, local anesthesia of the pudendal nerve, anesthesia of the cauda equina, giving the mother oxygen when labor is long, labor difficult. If an emergency cesarean section is required, endotracheal anesthesia should be performed with at least 60% oxygen. Pay attention to the position of the pregnant woman, if you lie on your back and your blood pressure drops, you must switch to lying on your side immediately. Prevention of reflux for pregnant women who have just eaten full. Early detection and aggressive treatment of pregnancy toxicity or valvular heart disease must be initiated. Iron must be given to pregnant women during pregnancy, if the mother is severely anemic (red blood cells less than 3 million, hemoglobin less than 10g/100ml). Do not rely on hematocrit here, because it is not accurate. Blood transfusion is required, but it must be prepared in advance. New blood must be selected, and when taking blood from a fasting donor, without viral hepatitis, using blood from the same group (2 times cross-test). Diuretics (lasix x 20mg) must be given to pregnant women, a volume of water must be at least 500ml before the start of blood transfusion. For every 500ml of urine out, 250ml of blood is transfused. To avoid the risk of over-infusion, large volumes should not be infused at once. In extremely urgent situations, no more than 500ml of blood should be transfused (if the patient is not bleeding) and it is best to transfuse red blood cells (leave the plasma). It is not advisable to do too many vaginal antenatal visits when it is not necessary. Always wash your hands and wear sterile gloves during each examination. Early and timely detection of all signs of infection.

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