Shock or its equivalent, by whatever name the era in question gave it, has been known since man came on the earth. Standard reference values for the shock index during pregnancy. Obstetric shock index may help in avoidance of underestimation of blood loss and the use of tranexamic acid, oxytocics and timely peripartum hysterectomy, if appropriate, will help save lives. Pocketbook obstetric emergencies neonatal resuscitation. Severe sepsis with acute organ dysfunction has a mortality rate of up to 40%, which increases to 60% if septic shock develops. Obstetric shock index may help in avoidance of underestimation of. Get a printable copy pdf file of the complete article 882k, or click on a page image below to browse page by page. An obstetric shock index osi 1 has been reported to be associated with increase in the likelihood of requiring a blood transfusion following pph. Postpartum shock index as a predictor of postpartum hemorrha. Dec 26, 2014 shock index compared favourably with conventional vital signs in predicting icu admission and other outcomes in pph, even after adjusting for confounding.
No other demographic or obstetric factors were associated with a change in shock index in this cohort. Values of the shock index are affected by labor, which may hinder its utility in identifying hemorrhage during this period. View the article pdf and any associated supplements and figures for a period of 48 hours. A new article in the british journal of obstetrics and gynecology bjog by ucsf safe motherhood program and kings college london finds shock index is a superior predictor of adverse outcomes in pph. The pathology of obstetric shock jama jama network. Jan 08, 2019 although septic shock remains one of the major causes of death in obstetric patients, the incidence of death in obstetric patients with septic shock is lower than that in nonobstetric patients with septic shock 03% in obstetric patients vs 1080% in nonobstetric patients.
Nov 01, 2012 shock is a critical condition and a life threatening medical emergency. Use of the shock index to predict maternal outcomes in women. Obstetric emergencies c21 general care principles c25 clinical use of blood, blood products and replacement fluids c37 antibiotic therapy c49 anaesthesia and analgesia c55 operative care principles c65 normal labour and childbirth c77 newborn care principles c111 provider and community linkages c115. Therefore, osi may be used as simple bedside clinical test to assess the degree of blood loss as visual estimation of blood loss is associated with significant inter and intraobserver errors. The identification of occult hemorrhagic shock in the injured obstetric patient represents a diagnostic challenge. Therefore, an abnormal postpartum shock index should not be attributed to an abnormal antepartum shock index due to mildmoderate anemia. Who recommendations for the prevention and treatment of. Isolated vital signs for example, heart rate or systolic blood pressure have been shown unreliable in the assessment of hypovolemic shock. To establish the normal range for the obstetric shock index osi after birth and to determine its usefulness as an aid to estimate blood loss in postpartum hemorrhage pph. University of texas medical branch galveston, texas 2. Any cause of obstetric shock can end by cardiac arrest, the commonest of which are. Please ensure your speakers are turned on and the volume up.
Shock is a clinical syndrome characterised by hypotension i. Sociodemographic and obstetric characteristics are described in table 1. Who recommendations for the prevention and treatment of postpartum haemorrhage 1 acknowledgements work on this guideline was initiated by a. Anesthetic considerations and management of obstetric. An evaluation of the shock index in predicting ruptured. Oct 18, 2010 obstetric hemorrhage is the leading cause of maternal mortality globally.
Part 6 audit of obstetrics and gynaecology 23 statistics of reproductive medicine, 297 answers to selfassessment questions, 306 index, 323 contents preface, vii acknowledgements, viii 1 basic science, 1 part 1 the woman 2 the woman as a patient, 19 part 2 the young woman 3 puberty and menstrual problems of young women, 29 4 subfertility, 38. Determination of normal ranges of shock index and other. Shock is a condition resulting from inability of the circulatory system to provide the tissues requirements from oxygen and nutrients and to remove metabolites. Shock index compared favourably with conventional vital signs in predicting icu admission and other outcomes in pph, even after adjusting for confounding. Metin gulmezoglu and joao paulo souza, of the who department of reproductive health and research, and by matthews mathai, of the who department of maternal, newborn, child and adolescent health. Articles were selected from pubmed using the following search terms. Postpartum haemorrhage is the commonest form of obstetric. Sepsis in obstetrics bja education oxford academic. The shock index indicates level of occult shock, especially in trauma or acute hemorrhage, based on heart rate and systolic blood pressure. Lee sy1, kim hy1, cho gj1, hong sc1, oh mj1, kim hj1.
Shock index as initial marker of hypovolemic shock in obstetric hemorrhage of the. The hemostatic management of major obstetric hemorrhage is a major challenge for both anesthesiologist and obstetricians. Although the term obstetric shock may be variously interpreted, it seems to be without exact definition. An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery.
Postpartum shock index as a predictor of postpartum. Full text full text is available as a scanned copy of the original print version. Improving compliance with early recognition and management of perinatal sepsis. Definition shock is a critical condition an da life threatening medical emergency. An update on the risk factors for and management of obstetric. We sought to explore the utility of this clinical sign in obstetrics by. Fluid management and obstetric shock shock circulatory. Obstetrics is unique in that there are two patients to consider and care for.
Obstetric emergencies american association of physician. Adherence to these guidelines when assigning icd10cm diagnosis codes is required under the health insurance portability and accountability act hipaa. Shock index and heart rate standard reference values in the. The detailed history, meticulous physical examination, and high index of suspicion, particularly in a highrisk group of obstetric patients, are essential for early recognition of sepsis. Shock results from acute, generalised, inadequate perfusion of tissues. Author links open overlay panel abigail le bas a edwin chandraharan a anthony addei b sabaratnam arulkumaran c. It is the dedication of healthcare workers that will lead us through this crisis. In lowresource settings, delays in identifying hemorrhage, delays in transport to facilities from a home birth or from primary care centers, and delays in receiving definitive therapies upon arrival at tertiary facilities contribute to high rates of maternal mortality and morbidity secondary to hypovolemic shock. Clinically the concept of pure obstetric shock excludes all cases in which the etiologic factor is known. Use of the obstetric shock index as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage.
Shock is a critical condition and a life threatening medical emergency. Heavy blood loss leads to hypovolemic shock, insufficient perfusion of vital organs and death if not rapidly treated. This paper discusses basic emergency care, obstetric and fetal assessment, preterm labor, premature rupture of membranes, severe preeclampsia, eclamp. Haemorrhagic shock excessive blood loss may be due to. In the normal nonpregnant population, the normal shock index range is 0. Multiinstitutional studies are needed to validate our findings, and larger study cohorts may be able to detect an effect of trimester on clinical signs of hemorrhagic shock. The impact of maternal anemia and labor on the obstetric. Anesthetic considerations and management of obstetric hemorrhage. Ruptured ectopic pregnancy miscarriage antepartum haemorrhage.
Shock results from acute, generalized, inadequate perfusion of below the tissues needed to deliver the oxygen and nutrient for normal. The contemporary evaluation of severe obstetric morbidity in the united states is challenged by the. Fluid management and obstetric shock free ebook download as powerpoint presentation. Hippocrates undoubtedly gave admonitions about the. Pathologically the essential requirement is that the patient shall have died of shock. An effective predictor of outcome in postpartum haemorrhage. It has been studied in trauma and nontrauma patients and is used in clinical practice to assess hypovolemic shock or the severity of nonhypovolemic shock and to aid acute management in this setting. Ob shock lecture organization definitionclassification of shock pathophysiology of shock hemorrhagic shock sepsis sirs resuscitation special circumstances 3. Prompt recognition and management can improve maternal and fetal outcome in obstetrical shock. Summaryin order to evaluate the shock index in predicting a ruptured ectopic pregnancy in a nigerian obstetric population, a prospective observational study of consecutive pregnant women presenting to the emergency room of the university of nigeria teaching hospital, enugu with complaints of abdominal pain andor vaginal bleeding in the first trimester of pregnancy over a 23month period 1. In cases of retained placenta, manual removal should be attempted under anaesthesia.
Aug 12, 20 isolated vital signs for example, heart rate or systolic blood pressure have been shown unreliable in the assessment of hypovolemic shock. Although maternity hospitals have introduced a modified early obstetric warning scoring system, there is not yet a nationally agreed system in the uk. Objective to establish the normal range for the obstetric shock index osi after birth and to determine its usefulness as an aid to estimate blood loss in postpartum hemorrhage pph. However, the values were not altered by maternal anaemia. Primitive men and women, in their struggle for existence, survived or died of shock from injury, trauma, hemorrhage and sickness. Abstract objective to establish the normal range for the obstetric shock index osi after birth and to determine its usefulness as an aid to estimate blood loss in postpartum hemorrhage pph. Free, official information about 2012 and also 202015 icd9cm diagnosis code 669.
590 1008 1202 119 490 477 1271 863 713 1303 192 237 1570 1441 184 1255 941 1223 1333 213 1455 1416 487 1146 295 1311 599 1342 210 753 751