Chapter 16, The Pregnant Trauma Patient

Question 1

Who should be considered pregnant?

Answer 1

Every woman of reproductive age until confirmed by pregnancy test or US.

Question 2

What is the most common injury resulting in fetal death?

Answer 2

Pelvic fractures

Question 3

What is the most common cause of maternal death due to trauma?

Answer 3

Hemorrhage

Question 4

What is the most common cause of fetal death?

Answer 4

Maternal death.

Question 5

Are pregnant women at risk to experience violent trauma?

Answer 5

Yes.
Twice as likely.

Question 6

What are some cardiovascular changes that occur during pregnancy?

Answer 6

Total blood volume increases
Resting HR increases 10-20 BPM
Increased estrogen & progesterone causing vasodilation
Supine hypotension syndrome (aortocaval compression)
ECG changes (ectopy, inverted T waves, ST Segment depression, left axis shift of QRS)
Increased blood flow to uterus and placenta (engorged pelvic vessels)

Question 7

What are some respiratory changes that occur in pregnancy?

Answer 7

Increased minute ventilation (d/t respiratory rate increase and tidal volume decrease)
Oxygen consumption increases
Respiratory alkalosis

Question 8

Why is the pregnant patient at higher risk for thromboembolism and DIC?

Answer 8

Increased fibrinogen levels and clotting factors.

Question 9

What is a normal fetal heart rate?

Answer 9

120-160 BPM

Question 10

What is the incidence of preterm labor in the pregnant trauma patient?

Answer 10

Occurs in 25% of patients.

Question 11

What should the nurse document regarding rupture of membranes?

Answer 11

Date and time of rupture.

Question 12

What is the triad of abruptio placentae?

Answer 12

Vaginal bleeding
Abdominal pain
Uterine irritability

Question 13

What fetal HR should increase suspicion of abruptio placentae?

Answer 13

Fetal HR < 110 or > 160 BPM.

Question 14

What are the priorities for pregnant women in cardiac arrest?

Answer 14

High quality CPR
Relief of aortocaval compression with lateral uterine displacement
ID and address the cause

Question 15

How should the caregiver manually displace the uterus during chest compressions when the pregnant patient is greater than 20 weeks gestation?

Answer 15

Displace uterus to the left and upward.

Question 16

Why is the pregnant patient at higher risk for upper airway edema?

Answer 16

Estrogen-mediated fluid retention.

Question 17

Is cricoid pressure recommended in the pregnant patient?

Answer 17

Yes.

Question 18

What should be done prior to intubation because of altered respiratory physiology?

Answer 18

Adequate preoxygenation.

Question 19

What is the recommended oxygen saturation to ensure adequate fetal oxygenation?

Answer 19

≥ 96%

Question 20

Where should chest tube placement occur on the pregnant patient?

Answer 20

1-2 intercostal spaces higher in the 3rd or 4th intercostal space and anterior to the midaxillary line.

Question 21

How should the pregnant patient be positioned to maximize circulation?

Answer 21

On the side.
Left lateral position is preferred.

Question 22

At what gestation should fetal heart rate and uterine contractions be monitored?

Answer 22

> 20 weeks gestation.

Question 23

In the event of altered level of consciousness or seizure, what should be evaluated in addition to maternal head injury?

Answer 23

Eclampsia.

Question 24

What can D also stand for in the pregnant patient?

Answer 24

Displacement.

Question 25

What vaginal fluid pH is suggestive of amniotic fluid?

Answer 25

PH of > 4.5

Question 26

When should RhoGAM be administered?

Answer 26

Within 72 hours in pregnant trauma patients who are Rh negative and at risk of fetal-maternal hemorrhage.

Question 27

How long should cardiotocographic monitoring be in place for women of greater than 20 weeks gestation who experience trauma?

Answer 27

A minimum of 6 hours.