Presentation on theme: "Birth Emergency Skills Training Trauma in Pregnancy"— Presentation transcript:
1Birth Emergency Skills Training Trauma in Pregnancy Written and Illustrated by Bonnie U. Gruenberg, CNM, MSN, CRNP, EMT-P
2All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or distributed in any form or by any means, electronic or mechanical (including photocopying, recording, and scanning), except as permitted under the 1976 United States Copyright Act, without the prior written permission of the publisher.
3Trauma in PregnancyTrauma is leading non-obstetric cause of death among pregnant women in the USComplicates 1 in 12 pregnanciesThree most common mechanisms of trauma in pregnant womenMotor vehicle accidentsDomestic violenceFalls
4Accidents can happen quickly and have devastating consequences
5Vulnerability to Trauma First trimester— Uterus well protected within pelvisSecond trimester— Uterus rises into abdomen, more vulnerable
6Vulnerability to Trauma Third trimester— Uterus larger and thinner walledVulnerable to blunt trauma, penetration, or rupture.Bleeds copiously when injured.Fetus more vulnerable to direct traumaMaternal pelvic fractures can cause fetal head trauma.
7Pregnancy changes and trauma assessment In second and third trimesters, cardiac output increases by almost halfBlood volume increases by about 50%
8Pregnancy 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.
9Pregnancy 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.Maternal shock carries fetal mortality as high as 85%
10While serious injuries usually have more serious consequences, abruption can occur remote from trauma and follow even very minor injuries.
11Consequences of Trauma in Pregnancy 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.
12Managing the Pregnant Trauma Victim Activate EMSPerform a primary surveyAirway—Open, protect and secure airway with cervical spine protectionBreathing—Administer oxygen and assist ventilation as neededCirculation—Control bleeding, start large-bore IV, and administer a fluid bolus as indicated. CPR as indicated.i. The fetus is best served by making care of the mother your priority
13Managing the Pregnant Trauma Victim Perform a rapid primary survey of the fetus using the mnemonic “FETAL.”Fetal heart rate or presence of fetal movementEstimated gestational age and number of fetusesTrauma—observe for evidence of injury to uterusAbdominal palpation for tenderness and contractionsLoss of amniotic fluid or vaginal bleedingi. Fetal injuries* maternal pelvic fracture can injure fetal head and brain* Penetrating trauma can puncture fetus* Blunt trauma may damage the uterus and placenta, causing fetal hypoxia
14Managing the Pregnant Trauma Victim Perform maternal secondary survey as with any trauma victimFor internal injuries or heavy bleeding, aggressive intravenous fluid resuscitation.Frequently assess for uterine tenderness, vaginal bleeding, contractions, fetal movement, fetal heartbeat.
16EMS 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.
17Meaningful Changes in Lab Values 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.
18Assessing the Pregnant Trauma Victim Reassuring status after 4h monitoring includesFewer than 6 contractions per hourNo vaginal bleedingNo abdominal painNormal FHT tracing
19Assessing the Pregnant Trauma Victim Non-reassuring status includesFrequent 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.
20The 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.