What are the Phases of Haemorrhagic Shock as we commonly
come across in busy Medical Colleges, I mean Govt Medical colleges with annual
birth rate of 15-20,000 deliveries per annum??
The normal pregnant woman can withstand blood loss of 500 ml
and even up to 1000 ml during delivery without obvious danger due to
physiological cardiovascular and haematological adaptations during pregnancy.
Phase of compensation
Sympathetic stimulation: It is the initial response to blood
loss leading to peripheral vasoconstriction to maintain blood supply to the
vital organs.
Clinical picture: Pallor, tachycardia, tachypnoea.
Phase of decompensation
Blood loss exceeds 1000 ml in normal patient or less if
other adverse factors are operating.
Clinical picture: is the classic clinical picture of shock
(see before).
Adequate treatment at this phase improves the condition
rapidly without residual adverse effects.
Phase of cellular damage and danger of death
Inadequately treated haemorrhagic shock results in prolonged
tissue hypoxia and damage with the following effects:
Metabolic acidosis: due to anaerobic metabolism initiated
after lack of oxygen.
Arteriolar dilatation: caused by accumulation of metabolites
leading to pooling and stagnation of blood in the capillaries and leakage of
fluid into the tissues.
Disseminated intravascular coagulation: caused by release of
thromboplastin from the damaged tissues.
Cardiac failure: due to diminished coronary blood flow.
In this phase death is imminent, transfusion alone is
inadequate and if recovery from acute phase occurs residual tissue damage as
renal and/ or pituitary necrosis will occur.
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