Presentation on theme: "Written and Illustrated by Bonnie U. Gruenberg, CNM, MSN, CRNP, EMT-P."— Presentation transcript:
Written and Illustrated by Bonnie U. Gruenberg, CNM, MSN, CRNP, EMT-P
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Trauma in Pregnancy Trauma is leading non-obstetric cause of death among pregnant women in the US Complicates 1 in 12 pregnancies Three most common mechanisms of trauma in pregnant women Motor vehicle accidents Domestic violence Falls
Accidents can happen quickly and have devastating consequences
Vulnerability to Trauma First trimester— Uterus well protected within pelvis Second trimester— Uterus rises into abdomen, more vulnerable
Vulnerability to Trauma Third trimester— Uterus larger and thinner walled Vulnerable to blunt trauma, penetration, or rupture. Bleeds copiously when injured. Fetus more vulnerable to direct trauma Maternal pelvic fractures can cause fetal head trauma.
Pregnancy changes and trauma assessment In second and third trimesters, cardiac output increases by almost half Blood volume increases by about 50%
Pregnancy Changes and Trauma Assessment Reduced oxygen reserve caused by diaphragm elevation. Increase in oxygen consumption. Increased aspiration risk due to slowed gastric emptying and pressure of uterus on digestive organs.
Pregnancy Changes and Trauma Assessment Mild tachycardia and hypotension common in pregnancy—may mimic shock. Vital signs may remain stable until blood loss is severe. Injured mother’s body protects itself at the expense of fetus. Fetus may be severely compromised even when mother is stable.
While serious injuries usually have more serious consequences, abruption can occur remote from trauma and follow even very minor injuries.
Stillbirth from abruption can occur even if trauma and maternal discomfort are mild, but risk is low if asymptomatic during first 4 hrs. Abruption can occur up to six days after the accident. Consequences of Trauma in Pregnancy
Managing the Pregnant Trauma Victim Activate EMS Perform a primary survey Airway—Open, protect and secure airway with cervical spine protection Breathing—Administer oxygen and assist ventilation as needed Circulation—Control bleeding, start large-bore IV, and administer a fluid bolus as indicated. CPR as indicated.
Managing the Pregnant Trauma Victim Perform a rapid primary survey of the fetus using the mnemonic “FETAL.” Fetal heart rate or presence of fetal movement Estimated gestational age and number of fetuses Trauma—observe for evidence of injury to uterus Abdominal palpation for tenderness and contractions Loss of amniotic fluid or vaginal bleeding
Managing the Pregnant Trauma Victim Perform maternal secondary survey as with any trauma victim For internal injuries or heavy bleeding, aggressive intravenous fluid resuscitation. Frequently assess for uterine tenderness, vaginal bleeding, contractions, fetal movement, fetal heartbeat.
EMS and the Pregnant Trauma Victim EMS will accommodate for pregnancy by: –Positioning in left lateral position whenever possible. –Tilting the backboard to a 15-30° if the woman needs to be immobilized supine. –Giving high-flow oxygen by mask. –Intubating if she cannot maintain her airway. –Cardiac monitoring when appropriate.
The Kleihauer-Betke (KB) test measures fetal red blood cells in maternal blood. A large fetomaternal hemorrhage in Rh neg mom may require multiple doses of RhoGAM. A fibrinogen <200 mg/dl or thrombocytopenia indicate possible disseminated intravascular coagulation (DIC), and may be a sign of abruption. Meaningful Changes in Lab Values
Assessing the Pregnant Trauma Victim Reassuring status after 4h monitoring includes Fewer than 6 contractions per hour No vaginal bleeding No abdominal pain Normal FHT tracing
Assessing the Pregnant Trauma Victim Non-reassuring status includes Frequent or painful contractions. Vaginal bleeding. Nonreassuring FHT. Tense uterus. Abdominal pain. Ultrasound scan suspicious for abruption. Low platelets or fibrinogen, positive KB, D-dimer >2,000-3,000.
The advice and strategies presented herein are not intended for use by nonprofessionals, may not be appropriate for every situation, and should not be used outside the applicable protocol or scope of practice. Neither the author nor the publisher shall have any liability to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information presented.