Shock in obstetrics
Shock is failure of tissue perfusion. Pregnant women compensate well (large blood volume), so tachycardia and hypotension appear late, after losing 30–40% of the blood volume.
Management
- Call for help; left lateral tilt (relieves caval compression); airway, high-flow oxygen.
- Two large IV lines, warmed crystalloid, then blood early (O-negative if needed), FFP, platelets and fibrinogen in a massive transfusion protocol.
- Find and stop the cause (surgery, uterotonics, antibiotics); catheter and hourly urine output; ICU.
- Shock index (heart rate ÷ systolic BP) > 0.9–1 suggests serious blood loss.
Amniotic fluid embolism
A rare (≈ 2–6 per 100,000) but often fatal reaction when amniotic fluid and fetal cells enter the maternal circulation, usually in labour or just after birth. It is an anaphylactoid reaction, not simply a mechanical block.
- Sudden breathlessness, hypoxia, hypotension and collapse, seizures, cardiac arrest, followed by DIC with massive bleeding.
- A clinical diagnosis after excluding PE, sepsis, anaphylaxis and haemorrhage.
- Treatment is supportive: resuscitation, ventilation, inotropes, perimortem caesarean within 4–5 minutes of arrest if undelivered (also helps the mother), correct coagulopathy.