Chapter 15 - Shock

Summary

Obstetricians most commonly encounter shock in the form of hemorrhage, but it is important to realize that shock can be classified in several types, and correction of the physiological derangement can correct the dysoxia at the tissue level before shock becomes irreversible. Etiologically shock is classified into the following types: hypovolemic shock (i.e. hemorrhage in coagulopathy), cardiogenic shock (myocardial dysfunction in the systemic inflammatory response syndrome and with toxins associated with septicemia), distributive shock (through activation of the systemic inflammatory response system), and obstructive shock (septic embolism). Therapy for cardiogenic shock requires restoration of adequate coronary perfusion in order to minimize further myocardial depression and necrosis. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. The goals of management of anaphylaxis are interrupting contact with the responsible drug, modulating the effects of the released mediators, and preventing further mediator production and release.