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Shock and Pregnancy

Background

The treatment of shock in a pregnant woman differs in two important respects from the treatment of shock in other adults.
First, normal physiologic changes occur in the most organ systems during pregnancy. Second, the mother and the fetus are both vulnerable during pregnancy. Therefore, obstetric critical care involves simultaneous assessment and management of the mother and fetus, who have differing physiologic profiles.

Shock is a state of compromised tissue perfusion that causes cellular hypoxia and is defined as a syndrome initiated by acute hypoperfusion, leading to tissue hypoxia and vital organ dysfunction (see the image below). It is a systemic disorder affecting multiple organ systems. Perfusion may be either decreased globally or distributed poorly, as in septic shock. During shock, perfusion is insufficient to meet the metabolic demands of the tissues; consequently, cellular hypoxia and end-organ damage ensue.

Determinants of cardiac function and oxygen delive

Determinants of cardiac function and oxygen delivery to tissues. Adapted from Strange GR. APLS: The Pediatric Emergency Medicine Course. 3rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1998:34.

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