After delivery, a pregnant woman develops features of shock. What can be the cause?

NHM MP Staff Nurse-2019

Obstetrics & Gynaecology

Medium

Appeared in: NHM MP Staff Nurse-2019

Explanation

Both Postpartum Hemorrhage (PPH) and Uterine Inversion are critical emergencies that can cause shock immediately following delivery.
PPH is the most common cause, leading to hypovolemic shock from significant blood loss, typically due to uterine atony.
Uterine inversion is a rare but life-threatening complication that causes a profound state of shock, which is often a combination of severe hemorrhage and a strong vasovagal (neurogenic) reaction.
Because both are valid and immediate causes, the option that encompasses both is the most accurate and comprehensive answer.

Option A: This option is incomplete. While PPH is a major cause of immediate postpartum shock, it is not the only one. Uterine inversion is another critical possibility that must be considered in the differential diagnosis.
Option B: This option is incomplete. Uterine inversion is a valid cause of immediate postpartum shock, but PPH from other causes (like atony) is far more common and must be considered.
Option C: The timing is incorrect. Septic shock is a systemic response to infection (puerperal sepsis). It typically develops over hours to days postpartum, not immediately after delivery.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of immediate postpartum shock as background academic context rather than a clinical decision trigger.
Rapidly differentiating the cause of postpartum shock is critical for survival. While initial resuscitation (ABCs, IV access, fluids) is similar for all shock states, definitive treatment varies.
For PPH due to atony, the nurse's first actions are fundal massage and administering uterotonic medications (e.g., Oxytocin, Methergine).
For uterine inversion, uterotonics must be stopped, and immediate manual replacement of the uterus is the priority before administering uterotonics to contract the replaced uterus.

How to Approach the Question

First, identify the critical time frame given in the question: 'After delivery' implies an immediate or early postpartum event.
Next, evaluate each option based on its typical onset time in the postpartum period.
Recall that Postpartum Hemorrhage (PPH) is the most common cause of immediate postpartum shock, primarily due to uterine atony.
Remember that Uterine Inversion is a rare but severe emergency that also occurs immediately after birth and causes profound shock.
Consider Septic Shock. This is caused by infection and its onset is delayed, typically taking hours to days to manifest.
Conclude that since both PPH and Uterine Inversion are valid and immediate causes, the option that includes both (Both a and b) is the most comprehensive and correct answer.

Concept Tested & Keywords

Concept Tested: Causes of immediate postpartum shock
Stem keywords: after delivery, pregnant woman, features of shock
Lead-in keywords: cause
Clinical cues: The timing 'After delivery' is a critical cue, pointing to immediate complications rather than delayed ones.

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E6 Obstetrics Williams p. 48-69

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 65-80