S21C253 - Trauma in Pregnancy

Question 1

Risks of trauma in pregnancy:

Answer 1

Increased risk of:

• preterm labor
• abruptio placentae (occurs 50% of time in major trauma)
• fetomaternal hemorrhage
• pregnancy loss

Question 2

Maternal physiologic changes

Answer 2

• maternal blood volume expands at week 10 gestation and peaks at week 28 when it reaches 45% increase from baseline, creates a physiologic anemia
• CO increases from 1L/min to 1.5L/min at week 10
• incr heart rate by 10-20 bpm in 2nd trimester
• drop in bp
• can lose 35% of blood volume before becoming hypotensive
• at 18w the uterus can compress large vessels
• delayed gastric emptying
• decreased FRC

Question 3

Maternal positioning

Answer 3

-placed wedge under right hip or manually push uterus to left side

Question 4

Maternal trauma considerations:

Answer 4

• ABCs for mom and babe
• left lateral decubitus if possible
• blod type and Rh status
• determine fetal age
• do imaging as always
• initiate fetal monitoring and continue for 4-6h after
• low threshold for admitting
• screen for IPV
• do kleihauer betke or Apt test
• fundus at umbilicus = 20 weeks
• do not do a blind bimanual exam, do spec exam if bleeding, ROM, injury suspected

Question 5

Fetomaternal hemorrhage

Answer 5

• uterine tenderness, uterine contractions, vaginal bleeding, abdominal trauma
• give Rhogam unless pt has received it in that past 72h or known baby with Rh -

Question 6

Imaging and exposure to fetus

Answer 6

-risks: childhood neoplasia, leukemia, fetal loss, congenital malformation, mental retardation, microcephaly

• greatest risk to fetal viability is in the first 2w after conception
• greatest risk of malformation is 2-8w after conception
• greatest risk of neuro teratogenicity is 10-17w

-negligible risk for

Question 7

Rads

Answer 7

C-spine

Question 8

Fetus assessment

Answer 8

• HR 120-160

- most common cause of brady is hypoxia