PREGO

Question 1

What are non-obstetric maternal deaths in trauma highly associated with?

Answer 1

• Head injuries and hypovolemic shock

Question 2

What amount of fluid are pregnant woman capable of losing before it becomes clinically apparent?

Answer 2

• 2 litre of fluid

Question 3

What week range do we allowed to deliver viable foetuses?

Answer 3

• > 24 weeks

Question 4

Why are foetal injuries less common in 1st trimester?

Answer 4

• Protected by pelvis

- Thicker walls of uterus and comparative more amniotic fluid

Question 5

Why are foetal injuries more common in 2nd and 3rd trimester?

Answer 5

• Compressive
• Deceleration
• Countercoup and sheering forces
• Increase vascularity results in major haemorrhage

Question 6

What are common causes of foetal injuries and death?

Answer 6

• MVA – High speed, side collisions, ejections, improper use of seatbelts
• Assault
• Falls – standing height is enough to shear

Question 7

What are indirect trauma and shearing forces likely to produce?

Answer 7

• Placental abruption

Question 8

Why can trauma to the uterus be catastrophic?

Answer 8

• Because blood supply to the region has increased 10 fold.

Question 9

Why is there an increase risk in the pelvic fracture Pt during pregnancy?

Answer 9

• Due to increased vascularity to the pelvis

- More space is occupied and will force more damage onto the pelvis

Question 10

What may direct trauma to the foetus cause?

Answer 10

• Skull #

Question 11

What is a placental abruption?

Answer 11

• Placenta separates from the uterus. It is the most common cause of foetal mortality in trauma.

Question 12

What does a placental abruption cause?

Answer 12

• Bleeding, shock and foetal demise,

Question 13

Signs and symptoms of Placental abruption

Answer 13

• Uterine tenderness
• Abdominal pain
• Uterine bleeding
• Expanding fundal height
• Uterine tetany
• Uterine contractions

Question 14

What is the management of a placental abruption?

Answer 14

• Pain relief – caution for opioids
• Fluid resuscitation
• Rapid transport to an appropriate facility
• Do not suppress labour

Question 15

Haemorrhage in pregnancy

Answer 15

• 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.

Question 16

What chest injuries are expected to be seen the pregnant Pt

Answer 16

• Respiratory compromise and hypoxia

- Uterus takes up lung capacity – this results in no respiratory reserve if there is chest trauma

Question 17

What occurs in uterine wall rupture?

Answer 17

• When uterine wall integrity is lost

Question 18

What is the blood supply to the uterus in the third trimester?

Answer 18

• 600mls/min

Question 19

What is a foetomaternal haemorrhage?

Answer 19

• Spread of foetal blood into the maternal circulation

- May lead to Rhesus sensitisation, neonatal anaemia, foetal cardiac arrhythmias, and foetal death

Question 20

During assessments what are key changes that a maternal patient will already have?

Answer 20

• 45% > blood volume
• Tachycardia
• Hypotensive
• May have ECG change
• May have reduced cardiac output

Question 21

What checks are vital for the pregnant patient?

Answer 21

• Foetal movement (from mother)
• Abo pain or injury
• Uterine tone
• Contractions
• PV loss
• When last emptied bladder

Question 22

Obstetric history

Answer 22

• P?G?
• Due date
• Complications
• Spotting
• Contractions
• Antenatal care

Question 23

Can we look in the vagina?

Answer 23

• No!

Question 24

What factors affect foetal outcome in trauma?

Answer 24

• Maternal hypotension
• Maternal hypoxia
• Maternal pelvis fracture
• High injury maternal score
• Young maternal age
• Acidosis
• Shock
• Uteroplacental foetal injury

Question 25

Pre-hospital treatment for the pregnant PT?

Answer 25

• 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

Question 26

If >20 weeks and trauma does mother need to be transported to Major trauma?

Answer 26

• Yes, even if there is no sign of foetus trauma or trauma to the mother.