ITLS Obsetrics Flashcards
What are the dual goals in managing the pregnant trauma patient?
Provide care to mother and provide care to fetus
This highlights the complexity of treating trauma in pregnant patients, as both maternal and fetal well-being must be considered.
What percentage of pregnancies experience some degree of trauma?
6–20%
This statistic indicates the prevalence of trauma among pregnant individuals.
What are the major causes of trauma in pregnancy?
- Motor vehicle collisions
- Falls
- Abuse and domestic violence
- Penetrating injuries
- Burns
- Suicide
- Homicide
These causes reflect both accidental and intentional injuries that can affect pregnant individuals.
List factors affecting fetal mortality and morbidity due to trauma.
- Hypoxia
- Infection
- Drug effects
- Pre-term delivery
These factors can exacerbate the impact of trauma on the fetus.
What influences the effects of trauma on pregnancy and the fetus?
- Gestational age of the fetus
- Type and severity of trauma
- Extent of disruption of normal uterine and fetal physiology
These factors determine how trauma impacts both the mother and the developing fetus.
What physiological changes occur in the respiratory system during pregnancy?
- Diaphragm elevated due to uterine size
- Decreased thoracic cavity volume
- Relative alkalosis due to increased respiratory rate
- Predisposed to hyperventilation
These changes affect how pregnant patients respond to trauma and stress.
What are normal vital signs in pregnancy?
- Normal pulse: 10–15 beats faster
- Blood pressure: 10–15 mmHg lower
It’s crucial to differentiate these normal changes from signs of shock during assessment.
What is the blood loss threshold before significant blood pressure change in pregnant patients?
30–35% blood loss (1500 cc)
This indicates the resilience of pregnant patients to blood loss and the importance of careful monitoring.
What are the signs of hypovolemia in pregnant patients?
- Vasoconstriction
- Tachycardia
- Reduction of uterine blood flow by 20–30%
- Decrease in fetal heart rate and blood flow
- Fetus becomes hypoxemic
Recognizing these signs is critical for timely intervention.
What is the maternal shock’s fetal mortality rate?
80%
This high percentage underscores the urgency of addressing maternal shock in trauma cases.
Describe the importance of high-flow 100% oxygen in pregnant trauma patients.
Essential for preventing fetal hypoxemia
Ensuring adequate oxygenation is critical for both maternal and fetal health during trauma.
What should be administered rapidly to a trauma patient in pregnancy?
High-flow 100% oxygen
Which occurs first in trauma cases: fetal hypoxia or maternal hypoxia?
Fetal hypoxia occurs before maternal hypoxia
What is the impact of supine position in pregnant trauma patients after 20 weeks?
Venous return decreases 30% due to inferior vena cava compression
What are some effects of supine hypotension in pregnant trauma patients?
- Acute maternal hypotension
- Syncope
- Fetal bradycardia
What technique is used for left uterine displacement?
Elevate right hip 4–6 inches and manually displace uterus to the left
What transport position is advised for pregnant trauma patients?
Better stabilized with vacuum backboard
What is a significant risk associated with relatively minor abdominal trauma in pregnancy?
Can cause fetal death
What is the most common cause of fetal death in trauma cases?
Maternal death
What types of trauma are commonly seen in pregnant patients?
- Motor-vehicle collisions
- Penetrating injuries
- Domestic violence
- Falls
- Burns
What percentage of pregnancy-related trauma in North America is due to motor-vehicle collisions?
65–75%
What is the effect of seatbelts on pregnancy-related trauma?
Significantly decrease mortality without increasing uterine injury
What is the most common head injury result of maternal trauma?
Fetal distress
What is the mortality rate for fetal injury due to penetrating injuries?
High fetal mortality rate: 40% via stabbing and 40-70% via gunshot wounds
What is the occurrence rate of domestic violence during pregnancy?
1 in 10 during 2nd and 3rd trimester
What physiological changes occur in pregnant patients during trauma?
- Decreased sensitivity
- Gradual stretching
- Hormonal changes
- Uterus very vascular
What is the risk associated with burns in pregnant patients?
Fetal mortality increases with >20% BSA
What does FAST stand for in trauma assessment?
Focused Assessment with Sonography in Trauma
What is the primary purpose of the FAST exam?
Rapid assessment for free fluid/blood in various spaces
What is a key component of trauma prevention in pregnancy?
Proper seatbelt use
ITLS -During pregnancy blood volume increases by about how much?
45%
ITLS - During pregnancy blood volume increases. Dilution resulting from disproprotiationate increase in plasma volume over the red cell mass. This is referred to as?
Anemia of pregnancy
ITLS - How does cardiac output change during pregnancy?
Increases by 20-30%
