Chapter 14 – Acute Pelvic Pain and Other Gynaecological Emergencies

Cervical shock

Bradycardia and hypotension resulting from cervical stimulation or instrumentation is referred to as “cervical shock”. It may result from the presence of products of conception in the cervix during miscarriage, which should be removed if present. More commonly, in primary care settings, cervical shock can occur during insertion of an intrauterine device (IUD). It is thought to be due to stimulation of the vagal nerve. Whilst uncommon, it can rapidly cause a woman to become unwell with circulatory compromise.(19) The UK Faculty of Sexual and Reproductive Healthcare (FSRH) states that the availability of appropriate emergency medication, including atropine, during IUD insertion is essential, and this is a service standard for resuscitation in sexual health services in the UK.(20)

For a patient with symptomatic bradycardia secondary to cervical shock, cease manipulation of the cervix and remove all instruments. Call for help. Assess the patient with the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure).(20) Assess vital signs and provide oxygen, if required. Ensure the patient is supine and elevate the legs to improve venous return. If these are insufficient to improve the patient’s haemodynamic status, 500-600mcg IV atropine is recommended followed by a saline flush ... Buy now