Trauma and Pregnancy

Question 1

Differences in airway for pregnant women

Answer 1

• More difficult to intubate due to anatomy, patient positioning and different induction agents required:
  > Glottis oedema
  > Neck obesity
  > Larger breasts
  > increased O2 requirements
  > Relaxation of cardiac sphincter of stomach: increases likelihood of silent regurgitation and aspiration of stomach contents

Question 2

Differences in breathing for pregnant women

Answer 2

• Progesterone alteres sensitivity of respiratory centre increasing respiratory drive
• Commonly experience nasal congestion, mucosal oedema, and airway vascularisation
• Splinting of diaphragm from position of baby can make it harder to ventilate

Question 3

Differences in circulation for pregnant women

Answer 3

Hyperdynamic state from as early as 6-8 weeks

• Progesterone causes vasodilation
• DBP falls 6-15
• Oestrogen causes up to 40% increase in BV
• Cardiac output increases by 30-40%
• RBC increases by 25% to meet increased metabolic demand but plasma volume increases at greater rate causing anaemia
• Haemorrhage is not evident until approx. 1200mLs (15-20% circulating BV) is lost

Question 4

What measures should be taken to minimise compression of inferior vena cava in pregnant woman

Answer 4

• At 20/40 the uterus can compress the inferior vena cava

- Left lateral tilt (pillow under right hip) or manual displacement of uterus

Question 5

Is high BP a good or bad sign in pregnancy?

Answer 5

Bad - the higher the bp the more urgent the review

Question 6

What time frame is required for delivery of baby if cardiac arrest occurs

Answer 6

• Within 5 minutes