Hemorrhagic shock in obstetrics and gynecology

If the body loses more than one liter of blooda person develops a hemorrhagic shock. If the bleeding is not stopped in time and continues on, then with the loss of about thirty percent of the volume of circulating blood, this condition poses a threat to life.

The blood loss can be either visible orinvisible. With open trauma to the eye, doctors can determine the amount of blood lost and the severity of the situation. After a significant loss of it, a hemorrhagic shock develops in a person. This is a special response state of the body to a threatening situation. For example, hemorrhagic shock in obstetrics and gynecology is one of the most dangerous, since concealed bleeding occurs, and if the patient fails to provide medical assistance on time, she may die. Most often this leads to apoplexy of the ovary, trauma to the genital organs, frozen pregnancy, submucous uterine myoma, perforation of the uterus body, bladder skeleton, consequences of abortion.

The main threat in such situations isdisproportion of the capacity of the vascular bed and blood, which circulates there, or rather, its remainder. This leads to a violation of macrocirculation - blood circulation along arteries, veins and in the heart. The next stage - the violation of microcirculation - on arterioles, venules and capillaries.

If you lose about half a liter of blood, then the bodycan compensate for this by an increase in venous tone. At the same time, the arterial tone does not suffer, the frequency of heart contraction does not change, there is no failure in the supply of tissues.

Significant hypovolemia leads to a seriousstressful state. In order to maintain life, the body includes powerful compensatory mechanisms. Increases the tone of the nervous system, increases the release of hormones. Under their action, the heart rate increases, the elimination of fluid from the body is reduced, there is a spasm of the vessels along the periphery. However, such changes in the body only temporarily support his life. Later, if the condition worsens, such mechanisms fail, and oxygen starvation of organs and tissues begins.

Hemorrhagic shock can be of three stages,classification of which is based on the volume of lost blood and violations in the work of organs due to this loss. At the first stage - compensated, the affected pale, the veins on the hands are sunken, slightly pulsating, tachycardia appears. The volume of lost blood is up to one liter. In case the bleeding is stopped, the symptomatology may still persist for a while. If the bleeding continues, the symptomatology is aggravated - this condition is called decompensated reversible. That is, the body itself can not cope with such violations, but the medical care provided on time saves the woman. In the second stage, the heart, lungs, brain, liver and kidneys suffer, severe hypoxia develops. The last stage is an irreversible hemorrhagic shock. The loss of blood is about half the total volume that circulates in the body. In this case, even the reanimation measures may not help.

Hemorrhagic shock is diagnosed on the basis ofsuch indicators as temperature and skin color (special attention is paid to the limbs), blood pressure, shock index, hematocrit, hourly diuresis.

Emergency care for hemorrhagic shock,rendered in time - the key to success in removing from this state. In the field of gynecology, the first measures should be aimed at accessing the place where bleeding occurs. Here urgent surgical intervention is required. Simultaneously with the surgeon-gynecologist, an anesthesiologist is also working. When the bleeding stops, it is necessary to remove the patient as soon as possible from the condition of hemorrhagic shock.