Trauma

Question 1

After 24 weeks gestation, how do you evaluate a pregnant patient following a minor motor vehicle crash or fail?

Answer 1

• brief fetal assessment
• no labs
• no radiologic imaging
• patient counseled on signs / symptoms of abruption

Question 2

How do you counsel the patient about risks to the pregnancy following a minor motor vehicle crash or fail?

Answer 2

• risk of shear force or tensile failure (contrecoup) causing placental abruption
• risk of maternal fetal hemorrhage

Question 3

What labs do you order on the patient following a minor trauma?

Answer 3

No labs, but if injury is greater than bruising/laceration then consider CBC, coagulation profile, type/screen & KB if Rh negative

Question 4

How long do you perform continuous fetal monitoring and contraction monitoring on a patient following minor trauma?

Answer 4

• fetal monitoring for four (4) hours
• contraction < six (6) / hour then discharge
• contraction > six (6) / hour consider admission

Question 5

What clinical and laboratory signs would make you suspect placental abruption?

Answer 5

Abdominal hemoglobin/hematocrit, coagulation panel, low fibrinogen

Question 6

What is the role of Kleihauer Betke screening in the management of a pregnant patient post trauma?

Answer 6

Assess role of RHOgam if maternal fetal hemorrhage is present

Question 7

How often does an abruption occur in a pregnant woman following minor trauma?

Answer 7

In minor cases (not more than bruising/laceration or contusion); 1/317 patients

In major trauma, 40%

Question 8

What is accuracy of ultrasound in detecting placental abruption?

Answer 8

Sensitivity is 24%

Question 9

Describe your initial assessment of a pregnancy woman following major trauma?

Answer 9

• (A) airway / cervical spine control
• (B) breathing
• (C) circulation
• (D) disability
• (E) exposure
• consult with trauma team
• consult with NICU
• displace uterus > 20 weeks

Question 10

If you called to the emergency department for a pregnant woman following a major trauma, what are your initial steps in her evaluation?

Answer 10

• consult trauma team
• consult with NICU
• > 20 weeks displace uterus
• intravenous access x 2
• labs (CGC, coagulation panel, type/screen,

Question 11

What fetal monitoring findings would make you suspect abruption in the patient following trauma, minor or major?

Answer 11

Greater than six (6) contractions in an hour

Question 12

Describe how a fibrinogen level can alert you to concealed abruption.

Answer 12

Fibrinogen is consumed to make fibrin clot in the setting of acute bleeding. In the event of preplacental bleed, the bleed may not be seen by ultrasound or vaginally but the fibrinogen would be low indicating an acute bleed that cannot be seen