Assessing and managing hypovolemic shock in puerperal women

Publication date: Available online 27 May 2019Source: Best Practice & Research Clinical Obstetrics & GynaecologyAuthor(s): Rodolfo de Carvalho Pacagnella, Anderson Borovac-PinheiroAbstractThe major cause of maternal death worldwide is postpartum hemorrhage. Early identification is the basis of adequate treatment. In addition to the visual estimation of blood loss, clinical signs could offer a more reliable representation of the cardiovascular system of the bleeding woman. However, in postpartum women, recognition of hypovolemic shock through vital signs is impaired due to physiological cardiovascular changes in pregnancy. The Shock Index [SI] is one composite vital sign that may help the identification of the hypovolemic women. Values of SI ≥1 in the first hour postpartum indicate cardiac decompensation and treatment should be implemented immediately. From the diagnosis of PPH, first line measures should ensure coordinated care actions including the availability of blood derivatives, the establishment of conditions for volume replacement, oxygen therapy, and identification and timely treatment causes of bleeding. Individualized fluid resuscitation should start with warmed crystalloids and be limited to 3.5 liters.
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research