Medical expert of the article
New publications
Hemorrhagic shock
Last reviewed: 05.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Hemorrhagic shock is usually caused by hemorrhages exceeding 1000 ml, i.e. loss of more than 20% of the BCC or 15 ml of blood per 1 kg of body weight. Continuous bleeding, in which blood loss exceeds 1500 ml (more than 30% of the BCC), is considered massive and poses an immediate threat to the woman's life. The volume of circulating blood in women is not the same, depending on the constitution it is: in normal-walled women - 6.5% of body weight, in asthenics - 6.0%, in pyknics - 5.5%, in muscular women of athletic build - 7%, therefore the absolute figures of the BCC may change, which must be taken into account in clinical practice.
[ Causes and pathogenesis of hemorrhagic shock
The causes of bleeding leading to shock in gynecological patients may be: ruptured ectopic pregnancy, ovarian rupture, spontaneous and artificial abortion, missed abortion, hydatidiform mole, dysfunctional uterine bleeding, submucous uterine fibroids, and genital trauma.
Whatever the cause of massive bleeding, the leading link in the pathogenesis of hemorrhagic shock is the disproportion between the reduced BCC and the capacity of the vascular bed, which first manifests itself as a disruption of macrocirculation, i.e. systemic circulation, then microcirculatory disorders appear and, as a consequence of them, progressive disorganization of metabolism, enzymatic shifts and proteolysis develop.
The macrocirculation system is formed by arteries, veins and the heart. The microcirculation system includes arterioles, venules, capillaries and arteriovenous anastomoses. As is known, about 70% of the total circulating blood volume is in the veins, 15% in the arteries, 12% in the capillaries, and 3% in the heart chambers.
When blood loss does not exceed 500-700 ml, i.e. about 10% of the BCC, compensation occurs due to an increase in the tone of the venous vessels, the receptors of which are most sensitive to hypovolemia. In this case, there is no significant change in arterial tone, heart rate, and tissue perfusion does not change.
Symptoms of hemorrhagic shock
Symptoms of hemorrhagic shock have the following stages:
- Stage I - compensated shock;
- Stage II - decompensated reversible shock;
- Stage III - irreversible shock.
The stages of shock are determined based on an assessment of the complex of clinical manifestations of blood loss corresponding to pathophysiological changes in organs and tissues.
Stage 1 hemorrhagic shock (low output syndrome, or compensated shock) usually develops with blood loss approximately corresponding to 20% of the BCC (from 15% to 25%). At this stage, compensation for the loss of BCC is carried out due to hyperproduction of catecholamines. The clinical picture is dominated by symptoms indicating a change in cardiovascular activity of a functional nature: pale skin, desolation of the subcutaneous veins in the arms, moderate tachycardia up to 100 beats/min, moderate oliguria and venous hypotension. Arterial hypotension is absent or weakly expressed.
If the bleeding has stopped, the compensated stage of shock can continue for quite a long time. If the bleeding is not stopped, further deepening of circulatory disorders occurs, and the next stage of shock occurs.
Who to contact?
Treatment of hemorrhagic shock
Treatment of hemorrhagic shock is an extremely important task, for the solution of which a gynecologist must combine efforts with an anesthesiologist-resuscitator, and, if necessary, involve a hematologist-coagulologist.
To ensure the success of therapy, it is necessary to follow the following rule: treatment should begin as early as possible, be comprehensive, and be carried out taking into account the cause of the bleeding and the patient’s health condition preceding it.
The complex of treatment measures includes the following:
- Gynecological operations to stop bleeding.
- Provision of anesthetic assistance.
- Directly bringing the patient out of a state of shock.
All of the above activities must be carried out in parallel, clearly and quickly.
Drugs