Obstetric shock can be defined as any loss of circulating fluid volume that is not compensated for, as in haemorrhage but may also occur when there is severe vomiting during pregnancy, labour and after labour.
What are The Major Causes of Obstetric Shock
Haemorrhage;
This may be due to abruptio placenta, inevitable abortion, ectopic pregnancy, e.t.c. These may result in haemorrhage shock if a large amount of blood is lost. In this scenario, the amount of blood is not sufficient to supply nutrients to the vital organs hence, shock.
Sepsis;
This is a condition in which circulating micro-organism release endo-toxins causing high fever, rigors, endothelial damage resulting to vasodilation, hypotension and shock.
Severe Pain;
This is seen in acute inversion of thew uterus, crede’s removal of placenta or manual removal of placenta without anesthesia, forcible manual cervical dilatation. These could cause neurogenic shock.
Severe Dehydration;
This occurs when a large amount of fluid lost through hyperemesis gravidarum, prolonged labour, starvation and acidosis. This can lead to hypovolemic shock.
Embolism;
pulmonary embolism which occurs when dislodged blood thrombus from infected placenta sinus, pelvic veins or leg vein occlude the pulmonary vessels as well as amniotic fluid embolism can lead to embolic shock.
Anaesthetic Accident;
These include mendelson’s (inhalation pneumonia), prolonged or deep general anaesthesia or with spinal anaesthesia.
Anaphylaxis;
Mismatched blood transfusion or oxytocin injection especially if repeated may lead to coronary spasm if used with drugs such as antibiotics. These will result in anaphylactic shock.
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Nursing Management of a Post-partum Multi-para Shock
Call for Medical aid;
It is necessary that you call for assistance, in case the condition turns to become worse
- Encourage other midwives, students or relatives too actively participate in the care of the woman.
- Continue to care and handle the condition until the doctor arrives.
- If you are in a community setting, activate the transport system to transfer her to a well equipped hospital.
- Find out the cause to direct your action.
- Palpate the abdomen to detect the presence of uterine rupture.
- Check for uterine atony.
- Check for presence of blood clotting defect.
Resuscitate Mother;
This will help her to adjust or regain her lost fluid.
- Administer prescribe intravenous fluid.
- Set up blood transfusion if ordered.
- Place her in dorsal position with her head turned to one side.
- Lift her legs to enable blood drain from them to central circulation.
- Apply non-pneumatic antishock garment which helps to apply pressure, reduce blood loss and return most blood to the central part of the body thereby preventing shock.
- Administer oxygen.
Stop the bleeding;
- Rub up contractions.
- Put baby to breast.
- Empty the bladder by passing urinary catheter if she can’t empty herself.
- Empty the uterus through delivering the placenta if not yet delivered and removing any blood clots and remains of conception.
- Perform bi-manual compression of the uterus if bleeding continues after delivery of placenta.
- Suture any genital tract laceration.
- Give prescribed medication.
Record Keeping;
This is very essential especially when pneumatic anti shock is applied. It is essential to keep record the following;
- When oxygen was commenced and how long it was given.
- Intravenous fluids and other medications given.
- Relevant findings in history and physical examination.
Other care given;
- Ensure that the airway is open by using padded spatula if the woman is unconscious.
- Monitor vital signs and blood loss.
- Keep patient warm with blanket or extra linen.
- Place her on nil per oral until she recovers fully.
- Administer blood transfusion if prescribed.
- Assist the doctor in any other procedure carried on the patient. E.g surgery.
Complications That May Arise From Obstetric Shock
- Renal failure.
- Cardiac failure.
- Brain damage.
- Hysterectomy if due to post partum haemorrhage.
- Death
We hope this information was helpful. Feel free to ask your questions in the comment section below.