Obstetric Trauma

Question 1

Key anatomical differences with pregnancy

Answer 1

Changing size and thickness of uterus
Risk of amniotic fluid entering maternal intravascular space
Risk to foetus w maternal pelvic #
Risk of placental abruption due to lack of elasticity of placenta
Sensitivity of placental vasculature to a decrease in maternal intravascular volume

Question 2

Blood composition changes

Answer 2

Increased plasma volume, RCC volume, WCC and fibrinogen x2

Dereased Hct - dilutional
PTT, pCO2 is 3.3-40kPa

Question 3

Management differences

Answer 3

pCO2 4.0 above is respiratory failure. pregnant patients should be hypocapnoeic
Place chest tubes high
Foetus sensitive to hypoxia, be wary even when materal obs stable
NGT early

Question 4

Signs of eclampsia

Answer 4

Seizure with

Peripheral oedema
Hyperrelexia
Proteinuria
HTN

Question 5

First steps in primary survey of pregnant patient

Answer 5

Assess airway GCS <8 = definitive airway
NGT/OGT shortly after intubation due to increased risk of reflux
C spine protection
Chest drain insertion more cephalad
If hypo - tilt to L 15-30 degress (4-6 inch) off IVC

Question 6

Signs of placental abruption

Answer 6

PV bleeding
Abdo pain or cramping
Hypovolemia
Uterine tenderness
Frequent contractions
Uterine tetany - contraction>90s
Uterine irritability

Question 7

Signs of uterine rupture

Answer 7

Abdominal tenderness, guarding, rigidity
Rebound tenderness
Abnormal foetal lie
Easy palpation of parts
Inability to palpate fundus

Question 8

What does a normal fibrinogen level in late pregnancy indicate

Answer 8

Early disseminated intravascular coagulation