19) Shock in Obstetrics; DIC Syndrome

Question 1

What is the Definition of “Shock”?

Answer 1

• Condition characterised by general insufficiency of tissue perfusion
• With different etiology, but with similar pathophysiological mechanisms + reaction
• Leading to Imbalance of 02 supply + demand ; Hypoxia ; Multi-Organ Failure

Question 2

What are the Types of Shock

Answer 2

1) Hypovolemic (Hemorrhagic) - loss in circulatory vol {MOST COMMON!}

2) Septic {2nd MOST COMMON!}

3) Cardiogenic - poor pumping fx of heart

4) Distributive - poor vascular tone in Peripheral Circulation

5) Extracardiac Obstructive - physical impairment to circulatory flow

Question 3

What are the Reasons for Hemorrhage in Obstetrics?

Answer 3

• Placental Abruption
• Ruptured Uterus
• Placental Previa
• Hypo / Atony of the Uterus

NB! Also causes ANTEPARTAL Hemorrhage

Question 4

What are the 3 Forms of Hypovolemic Shock?

Answer 4

1) Light Form = Decreased Circulation**in the *Skin, muscles + Bones ; Presented with Ortho-HypoTN, Tachycardia, Wet + Pale Skin

2) Mild Form = Decreased Perfusion**of the *Kidneys, Liver + Intestines ; Presented with Tachycardia, Oligoanuria

3) Severe Form = Decreased Perfusion**of the *Heart + Brain ; Presented with Agitation, Confusion, Respiratory Distress + Tachycardia

Question 5

How is Hypovolemic Shock, treated?

Answer 5

1) Hemostasis

• Done Surgically
• Medications - Gluconium, Vitamin K

2) Oxygenation

3) Infusion Therapy - With Crystalloid or Colloid Infusions

4) Corticosteroids, Anticoagulants

Question 6

What are the Reasons for Septic Shock in Obstetrics?

Answer 6

Secondary Infection FROM:

• Septic Abortion
• Wound infection
• Pyelonephritis
• Endometritis
• Choreoamnionitis
• Genital Infections

Question 7

What are the Clinical Stages of Septic Shock?

Answer 7

1) Early HOT Shock

• HOT Skin, sweating
• Tachypnea, Dyspnea
• Hypotension and Decreased Cardiac Output (CO)

2) LateCOLD Shock

• COLD Skin, sweating, Cyanosis
• Oliguria
• Acute Respiratory Distress Syndrome ARDS

3) SECONDARY Shock

• Anuria
• Hypoglycemia
• Severe Heart Failure

Question 8

How is Septic Shock Treated?

Answer 8

• Resuscitation
• Oxygenation
• Broad-Spec Antibiotics
• Low-Mol Weight Heparin
• Surgical = Hysterectomy, in cases of Puerperal endometritiis

Question 9

What is Amniotic Embolism?

Answer 9

Acute Complex Disease that’s characterised by

• Pulmonary Embolism
• Shock
• DIC Syndrome

Due to amniotic fluid + Fetal Cells entering —> Maternal Circulation

Presented with Respiratory Distress, Cyanosis, Tonic-Clonic Seizures, Fetal Bradycardia and Uterine Hypotension

Question 10

What is DIC Syndrome?

Answer 10

• Acquired syndrome that’s characterised by systemic intravascular coagulation
• Most COMMON Maternal Complicaton

Question 11

What are the Reasons for DIC in Obstetrics?

Answer 11

• Placental Abruption
• Placental Previa
• Preeclampsia, Eclampsia
• Septic Abortion
• HELLP Syndrome
• Post-partum Hemorrhage

Question 12

What happens in DIC Syndrome?

Answer 12

1) Coagulation Cascade is activated!

2) Deposition of Fibrin —> causing micro-thrombosis –> Organ Failure (Death)

3) Depletion of Platelets / Coagulation Factors —> Bleeding / Hemorrhage (Death)

Question 13

How is DIC Syndrome Managed?

Answer 13

• Hysterectomy (removal of uterus)
• Erythrocyte Mass Transfusions
• Fresh-Frozen Plasma
• Low-Mol Weight Heparin