PREGO Flashcards
What are non-obstetric maternal deaths in trauma highly associated with?
- Head injuries and hypovolemic shock
What amount of fluid are pregnant woman capable of losing before it becomes clinically apparent?
- 2 litre of fluid
What week range do we allowed to deliver viable foetuses?
- > 24 weeks
Why are foetal injuries less common in 1st trimester?
- Protected by pelvis
- Thicker walls of uterus and comparative more amniotic fluid
Why are foetal injuries more common in 2nd and 3rd trimester?
- Compressive
- Deceleration
- Countercoup and sheering forces
- Increase vascularity results in major haemorrhage
What are common causes of foetal injuries and death?
- MVA – High speed, side collisions, ejections, improper use of seatbelts
- Assault
- Falls – standing height is enough to shear
What are indirect trauma and shearing forces likely to produce?
- Placental abruption
Why can trauma to the uterus be catastrophic?
- Because blood supply to the region has increased 10 fold.
Why is there an increase risk in the pelvic fracture Pt during pregnancy?
- Due to increased vascularity to the pelvis
- More space is occupied and will force more damage onto the pelvis
What may direct trauma to the foetus cause?
- Skull #
What is a placental abruption?
- Placenta separates from the uterus. It is the most common cause of foetal mortality in trauma.
What does a placental abruption cause?
- Bleeding, shock and foetal demise,
Signs and symptoms of Placental abruption
- Uterine tenderness
- Abdominal pain
- Uterine bleeding
- Expanding fundal height
- Uterine tetany
- Uterine contractions
What is the management of a placental abruption?
- Pain relief – caution for opioids
- Fluid resuscitation
- Rapid transport to an appropriate facility
- Do not suppress labour
Haemorrhage in pregnancy
- No matter the haemorrhage the Pt will have increased CO, HR and blood volume can mask the VSS expected in shock
- Tachycardia may be the only indication until 30-40% of blood loss occurs.
What chest injuries are expected to be seen the pregnant Pt
- Respiratory compromise and hypoxia
- Uterus takes up lung capacity – this results in no respiratory reserve if there is chest trauma
What occurs in uterine wall rupture?
- When uterine wall integrity is lost
What is the blood supply to the uterus in the third trimester?
- 600mls/min
What is a foetomaternal haemorrhage?
- Spread of foetal blood into the maternal circulation
- May lead to Rhesus sensitisation, neonatal anaemia, foetal cardiac arrhythmias, and foetal death
During assessments what are key changes that a maternal patient will already have?
- 45% > blood volume
- Tachycardia
- Hypotensive
- May have ECG change
- May have reduced cardiac output
What checks are vital for the pregnant patient?
- Foetal movement (from mother)
- Abo pain or injury
- Uterine tone
- Contractions
- PV loss
- When last emptied bladder
Obstetric history
- P?G?
- Due date
- Complications
- Spotting
- Contractions
- Antenatal care
Can we look in the vagina?
- No!
What factors affect foetal outcome in trauma?
- Maternal hypotension
- Maternal hypoxia
- Maternal pelvis fracture
- High injury maternal score
- Young maternal age
- Acidosis
- Shock
- Uteroplacental foetal injury
Pre-hospital treatment for the pregnant PT?
- Choose the right hospital?
- Treat the mother first – But consider the foetus
- Fluid admin should be early and aggressive, Do not wait for signs of compromise
- Still consider your modifying fluid factors
If >20 weeks and trauma does mother need to be transported to Major trauma?
- Yes, even if there is no sign of foetus trauma or trauma to the mother.
