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symptoms of obstetric shock, early symptoms and signs of obstetric shock

symptoms of obstetric shock, early symptoms and signs of obstetric shock

Obstetric shock symptoms

Typical symptoms: pale complexion, nervous irritability and nausea, accelerated heart rate, small pulse compression, slow response, cyanosis of lips and extremities, cold sweat, fine pulse, etc.

Related symptoms: hepatocyte necrosis, nausea, slow response, toxemia and high fever

I. Symptoms

The severity of shock is different according to the cause of shock and the tolerance of individual constitution, but its manifestations are common according to the stages of microcirculation pathological changes.

1. The compensatory period of shock is also called pre-shock. If the symptoms in this period are not carefully observed, they are often ignored, because in hemorrhagic shock, the blood loss has not exceeded 20% of the body's blood volume [7% ~ 8% of body weight (kg)], and the compensatory effect of the patient's hemodynamics and nervous system keeps the blood pressure normal or slightly higher. Increased excitability of central and sympathetic nervous systems, manifested as pale complexion, mental tension, irritability and nausea, accelerated heart rate and small pulse compression. Urine volume is normal or decreased, such as opening vein to supplement crystal fluid in this period; Shock can be corrected quickly. If vasoconstrictors are not treated or given improperly, the disease will develop and enter the inhibition period.

2. In shock inhibition period, patients have indifferent expression, slow response, cyanosis of lips and extremities, cold sweat, fine pulse speed and lower pulse pressure difference. In severe cases, unconsciousness or coma, obvious hypoxia and cyanosis of skin and mucous membrane of the whole body, cold extremities, weak pulse or even untouchable, blood pressure drop or even zero, oliguria or anuria, and CO2 binding force decrease acidosis. Bleeding spots on skin and mucous membrane or gastrointestinal bleeding indicate that the disease has developed to the stage of disseminated intravascular coagulation. If there is no progress in active treatment, dyspnea can be secondary. If arterial blood pressure drops below 8kPa (60mmHg), although the symptoms of pressurized oxygen supply cannot be improved, the oxygen partial pressure cannot be increased, indicating that dyspnea syndrome and other organ injuries will enter the failure stage.

The course of obstetrical shock is similar to that of various departments, but it has its particularity. Shock caused by any reason is easy to induce DIC, because it has the following special factors: ① The uterus in late pregnancy compresses the inferior vena cava, the return blood volume decreases, the inferior vena cava is congested, and the blood flow rate is slow, which is easy to induce thrombosis. ② Amniotic fluid embolism and air embolism are easy to occur when uterine venous system is dilated and blood sinus is open. ③ During pregnancy, uterus compresses ureter, ureter dilates and urinary retention, which is prone to urinary system infection. After postpartum or abortion, placental stripping surface is prone to endometritis and intrauterine infection because blood is the best culture medium for bacteria. Fetus and its appendages, due to pathological conditions, necrosis and degeneration, can produce exogenous thromboplastin and activate coagulation system. ⑤ In order to meet the needs of bleeding and physiology during childbirth, coagulation factors I, VII, VIII, IX and X increased and hypercoagulation occurred in normal pregnant women.

Second, diagnosis

Hemorrhagic shock and septic shock are not difficult to diagnose and have a history of bleeding and infection. Early diagnosis is important. In the past, the diagnosis of shock was mainly based on the index of blood pressure reduction, and the actual blood pressure was reduced, which lost a good treatment opportunity. Shock was a manifestation of decompensation and entered an inhibition period. Because blood pressure = cardiac output * total peripheral resistance, After blood loss and hyperthermia and dehydration, although the early cardiac output decreased, the contraction of arterioles strengthened, the total peripheral resistance increased, and the blood pressure did not decrease. Therefore, the decrease of blood perfusion preceded the decrease of blood pressure. Therefore, the possibility of shock should be considered when a large amount of blood loss, fluid loss, trauma and persistent hyperthermia are seen in clinic in a short period of time.

1. Early diagnosis of vital indicators blood pressure and pulse observation is important, but comprehensive clinical observation of insufficient tissue perfusion is helpful for early diagnosis of shock compensatory period.

2. During the shock inhibition period, the blood pressure drops below 90mmHg (12kPa), the pulse is weak, the mouth is thirsty, the mind is indifferent, the response is slow, the cold sweat occurs, the limbs and extremities are cold, and the urine is less than 30ml per hour. It should be realized that the shock has changed from the compensatory period mentioned above to the decompensated period.

3. Hypovolemia, hemorrhagic shock and septic shock, which are common in obstetrics during shock failure, have not been properly and timely treated, and there are systemic damage factors: when the effective circulation volume is too low, the systemic tissues and organs can be ischemic and hypoxic. Decreased cardiac output, coronary artery ischemia, decreased blood pressure and acute heart failure. Renal ischemia can lead to decreased glomerular filtration rate and even renal tubular necrosis. Serum creatinine is 178.6 μ mol/L and urine volume is 24h in acute renal failure<400ml或尿量多。肝脏缺血,可使肝脏的代谢功能降低,甚至引起急性肝功能衰竭,血胆红素>34.2 μ mol/L (2mg/dL) for 5 days, the GOT was 2 times higher than the normal value, resulting in hepatocyte necrosis. Gastrointestinal ischemia, intestinal mucosal injury, gastrointestinal bleeding, perforation, hematochezia and stress ulcer. All kinds of sepsis infections, such as bacterial toxins, immune complexes, inflammatory mediators, etc., flow all over the body with blood, damage tissues and organs, damage vascular endothelium, increase vascular permeability, rough endothelium, and form microthrombus by platelet adhesion. If they occur in the lungs, dyspnea syndrome may occur, and even develop into disseminated intravascular coagulation. Central nervous systemIschemia and hypoxia are damaged, showing insensitivity or even unconsciousness and coma. Therefore, shock can not only fail one organ, but also affect the dysfunction of other organs, forming a chain reaction with each other, and organ disorders can occur sequentially. However, there are differences in the severity before and after the occurrence of clinical organ failure. Hypovolemic hemorrhagic shock often occurs first with renal dysfunction. Infection causes sepsis. When sepsis occurs, heart, lung and brain dysfunction often appears first. Generally, when an organ is dysfunctional, At first, it is mild, such as renal dysfunction, First of all, it is characterized by oliguria, blood biochemical examination may not be obviously abnormal, treatment is neglected without attention, and function continues to decline and deteriorate. If acute tubular necrosis occurs, blood urea nitrogen and creatinine levels will increase, water, electrolyte and acid-base imbalance will affect the dysfunction of heart, lung, brain, liver and other organs, and then multiple system organ failure (MSOF) will occur. The concept of MSOF was put forward in 1970s. Mainly refers to various organ dysfunction in acute and severe cases, Emphasize the sequential nature of onset, Strive to actively stop its development and deterioration to save patients' lives, But when the disease becomes extremely serious, Many organs can fail at the same time, and some patients develop into acute MSOF rapidly before knowing which organ fails first, which leads to irreversible shock. According to literature reports, the mortality rate of patients with three organ failures is 80%, while those with four organ failures hardly survive.

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