Trauma

Question 1

All pregnant trauma patients should undergo CEFM x4 hours at minimum. List five reasons why a pregnant woman should have 24 hours monitoring.

Answer 1

Uterine tenderness
Significant abdominal pain
Vaginal bleeding
Contractions q10 mins or more frequent
ROM
Atypical or abnormal FHR
High-risk mechanism of injury (motorcycle, pedestrian vs motor vehicle, high-speed crash of any kind)
Fibrinogen < 2

Question 2

How long after maternal cardiac arrest should perimortem cesarean be performed? What is the purpose of the perimortem cesarean?

Answer 2

4 minutes after arrest
Helps with maternal resuscitation as well as provides potential for fetal salvage

(for a potentially viable fetus only - pre-23 weeks the uterus is so small that cesarean is unlikely to have any positive effect on maternal venous return/resuscitation)

Question 3

What is the role of the obstetrician at a trauma (five points)?

Answer 3

Determine GA
Optimize uteroplacental perfusion
Assess fetal well-being
Provide information about radiation exposure, medications that may be used
Decide upon & perform cesarean where necessary

Question 4

What is the typical first sign of hypovolemia in a pregnant trauma patient?

Answer 4

Atypical or abnormal FHR - maternal vitals may be preserved at the expense of uteroplacental perfusion (therefore initiate fetal monitoring ASAP for maternal as well as fetal benefit)

Question 5

Which is the better test for assessment of fetal well-being in a trauma: BPP or CEFM?

Answer 5

CEFM (higher sensitivity for placental abruption & fetal hypoxic injury)

Question 6

List three mechanisms by which trauma precipitates preterm labour.

Answer 6

Abruption (blood at placental margin leads to decidual necrosis & prostaglandin production)
PPROM
Traumatic injury to uterus (trauma leads to destabilization of lysosomal enzymes & prostaglandin production)

Question 7

How would you advise a pregnant woman who is worried about injuries related to airbag deployment or seat belt use?

Answer 7

Use a seatbelt, do not disable the airbags

• Seatbelt use decreases maternal death rate (after abruption, maternal death is most common cause of fetal death from trauma), ejection from vehicle is higher risk for both mother & fetus
• Association between airbags & uterine rupture/abruption/fetal death is most likely due to force of collision (in the absence of other evidence prioritize maternal health over fetal health)