Managing Complications in Pregnancy and Childbirth: - IAWG

S-4 ShockDETERMINING AND MANAGING THE CAUSE OF SHOCKDetermine the cause of shock after the woman is stabilized.• If heavy bleeding is suspected as the cause of shock:- Take steps simultaneously to stop bleeding (e.g. oxytocics,uterine massage, bimanual compression, aortic compression,preparations for surgical intervention);- Transfuse as soon as possible to replace blood loss (page C-23);- Determine the cause of bleeding and manage:- If bleeding occurs during first 22 weeks of pregnancy,suspect abortion, ectopic or molar pregnancy (page S-7);- If bleeding occurs after 22 weeks or during labour butbefore delivery, suspect placenta praevia, abruptioplacentae or ruptured uterus (page S-17);- If bleeding occurs after childbirth, suspect ruptureduterus, uterine atony, tears of genital tract, retainedplacenta or placental fragments (page S-25).- Reassess the woman’s condition for signs of improvement(page S-5).• If infection is suspected as the cause of shock:- Collect appropriate samples (blood, urine, pus) for microbialculture before starting antibiotics, if facilities are available;- Give the woman a combination of antibiotics to cover aerobicand anaerobic infections and continue until she is fever-freefor 48 hours (page C-35):- penicillin G 2 million units OR ampicillin 2 g IV every 6hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours.Do not give antibiotics by mouth to a woman in shock.- Reassess the woman’s condition for signs of improvement(page S-5).