[Shock in obstetrics. Institutional experience]

Shock is one of the most difficult problems an obstetrician can face. Hemorrhage is the main reason of shock. A descriptive and retrospective research was conducted at Instituto Nacional de Perinatología, from January 1992 to May 1996, including all patients admitted to the intensive care unit with diagnosis of shock. There were found 90 cases with diagnosis of shock, 82 were hipovolemic, and 8 cases had the septic kind of shock. The average of age was 32.2 years, with a gestational age between 6.2 to 41.4 weeks . There were 71 healthy patients, hypertension was associated to pregnancy in 9 cases, infertility in two, myomatosis in 2, and diabetes in 2 more patients. Other 5 cases reported different pathologies. The most frequent cause for hipovolemic shock resulted to be placenta acreta (40 cases), followed by uterine tone alterations in 37 patients, ectopic pregnancy in 7, uterine rupture or perforation in 4, and vaginal or cervical lacerations in 2. The estimated blood loss varied from 2200 cc to 6500 cc, and the minimal arterial pressure registered during shock was between 40/20 mmHg to 90/60 mmHg. Medical initial assistance consisted in volume reposition with crystalloids, globular packages, and plasma expansors in 73 patients (81.1%). The rest of the patients received in addition coloids, platelets and cryoprecipitates. A total of 76 patients required surgical intervention consisting in total abdominal hysterectomy. In 5 cases the previous surgical procedure was done and ligation of hypogastric vessels was needed. Salpingectomy was performed in 5 patients, and rupture or perforation repair in 3. The average surgery time was 2 hours and 33 minutes. The observed complications were 7 cases with abscess of the cupula, consumption coagulopathy in 2, 1 vesical quirurgical injury, 1 intestinal occlusion, and 11 vesico-vaginal fistula. The average days of hospitalization resulted to be 5. The most frequent kind of shock seen by obstetricians is the hipovolemic type, followed by septic shock, Volume reposition and restoration of adequate tissue oxygenation is the main goal in treatment, and so the rapid and opportune decision for surgery shall prevent the patients decriment and maternal mortality.