Shock Hipovolemico Refractario Secundario a Hemorragia Postparto

Abstract

Postpartum hemorrhage is defined as blood loss exceeding 500 mL in a vaginal delivery and 1000 mL exceeding a cesarean delivery. For clinical purposes, any loss of ability to produce blood with hemodynamic instability should be considered a postpartum hemorrhage. 6,18 Primary postpartum hemorrhage is one that occurs within the first 24 hours after delivery. Mostly they occur due to uterine atony which is the inability of the uterus to contract properly after delivery of the product. 6, 18 Secondary Postpartum hemorrhage occurs between 24 hours and six weeks postpartum. Most cases are due to retained products of conception, infection or both. 6, 18 The aim of this case report is to know the clinical characteristics, proper management based on Protocol Postpartum Hemorrhage care and a relevant diagnosis. This case corresponds to a pregnant patient, female 19 years old, without personal pathological or family history, which goes presenting abdominal pain type contraction located in hipogastrio that radiated lumbar region of great intensity, accompanied by expulsion of mucus plug, with vital signs within normal parameters, pregnant uterus, uterine activity present. Get driving with oxytocin and childbirth single vaginal céfalo uncomplicated after it occurs genital bleeding of 1000 cc, with altered vital signs were observed, reviewing cavity extracted corioplacentarios remains is done, begins Protocol Postpartum Hemorrhage, which is achieved control uterine bleeding. After it has again hemodynamic instability, the same as entering Cardiopulmonary Resuscitation, performing cardiopulmonary resuscitation. It handles with vasopressors and crystalloid remains with endotracheal intubation assisted with invasive mechanical ventilation. Although vasopressors continues persistent hypotension, signs of poor distal perfusion refractory measures introduced so dies shock.