The Pregnant Trauma Patient

Placental Abruption Signs & Symptoms

- Vaginal bleeding • - Boggy uterus or Contractions • - Sudden abdominal pain • - Uterus too big for term of pregnancy • - Blood loss out of proportion to injury • - Decreased FHR variability/late decels

During maternal stress or injury......causes mother to release _________that cause uteroplacental ______and ________ perfusion = FETAL DISTRESS

catecholamines constriction decreased

Mark the height of the uterine fundus to identify changes that may be due to ________.

intrauterine bleeding

Avoid aorto-caval compression: use_______.

left uterine displacement (LUD)

Most common "minor" injury leading to fetal death is____.

placental abruption

Feto-maternal hemorrhage may be a cause of _____.

pre-term labor.

By term (40 weeks) Platelets _______.

stay the same or decrease slightly.

Trauma management in pregnancy Best way to take care of baby is to __________.

take care of mother

They may be ____ of blood loss, with delayed fall in ____.

tolerant BP

Uterine Rupture • Signs and symptoms:

• - Acute pain - decreases in couple hours • - Vaginal bleeding • - Absent fetal heart tones • - Fetal parts palpated outside the uterus in abdomen

Uterine Rupture • Causes:

• - Separation of scar of previous c/s • - Strong deceleration force - MVA • - Congenital uterine anomaly

Prolapsed Cord Management

• Hold presenting part off of umbilical cord • Position to relieve pressure - knee-chest position • Administer O2 • IV fluids • Monitor FHR • Usually emergency c-section delivery

Placental Abruption happens more in women with an _______ placenta.

Anterior

Nasal mucosa is engorged and susceptible to nose bleeds—take extra care with______.

NG tube insertion

Look for bleeding internally or externally—mom can lose ______ ml of blood without signs of shock

1500

________ are used to accelerate fetal lung maturity

Corticosteroids

Most common cause of fetal death is _____.

Maternal death

LUD (Left side position) is important for 3 reasons

Maternal hemodynamics Fetal oxygenation DVT prophylaxis

_______ levels rise in pregnancy , causing an increased tendency to clot and increased risk of ______.

Fibrinogen deep vein thrombosis or pulmonary emboli

FAST

Focused Abdominal Sonography for Trauma

Uterine Rupture Management might require ________.

Hysterectomy

One dose of _____ is routine in trauma to Rh- mother

RhoGam

Placental Abruption

Separation of the placenta from the uterine wall.

After first trimester, the _______ moves from the pelvic position to an intra-abdominal position—making it more vulnerable to injury

bladder

Prolapsed Cord

a loop of umbilical cord becomes caught between the presenting part of the fetus and the birth canal Vessels compressed Abnormal fetal heart rate (decels)

Fetal heart rate monitoring (for hypoxia) after trauma • Worry is________. • Usually combined with ______ monitoring. • ___ hours is routine.

abruption. contraction 4

Delayed gastric emptying can create possibility of _____.

aspiration

If chest tubes would be inserted in third trimester to avoid damaging the _______.

diaphragm

By term (40 weeks) white count and sedimentation rate have ____.

elevated

Fundus of uterus should feel relatively soft, if not, may be ________ or mother is contracting

filled with blood

Most maternal deaths are due to:

head trauma hemorrhagic shock.