Trauma In Pregnancy Flashcards
best predictors of fetal loss or other adverse outcomes are___________ and_____________.
crash severity and lack or improper use of seat belts
What is proper fit of seatbelt?
For proper fit, the lap belt should be worn under the gravid uterus (i.e., across both anterior superior iliac spines and the pubic symphysis) with the shoulder harness positioned snugly between the breasts and off to the side of the uterus.
proper body positioning (i.e., mother seated______ inches from the dash and steering column)
10
___________ is second only to maternal death as the most common cause of fetal death.
Placental abruption
Placental abruption may also lead to the introduction of placental products into the maternal circulation, stimulating disseminated intravascular coagulation or amniotic fluid embolism.
A fetus is considered viable at ______weeks of gestation or a weight of______ grams
22 to 24 weeks
500 grams
True or false
Fetal survival is dependent on maternal survival. Therefore, resuscitation of the mother always takes priority.
True
A pregnant woman may lose _________ % of her circulating blood volume before manifesting clinical signs of shock.
30% to 35%
Maternal blood volume expands at approximately week______ of gestation and peaks at week _______ with a 45% increase from baseline. Cardiac output increases by _______%
Week 10
Week 28
30 to 50%
The uterine fundus remains relatively protected in the pelvis until about week _____ of gestation when it reaches the level of the pubic symphysis.
Week 12 = pubic symphysis
By week_____, the uterus has reached the umbilicus and continues to grows approximately 1 cm beyond the umbilicus per each additional week of gestation.
Week 20 = umbilicus
Mothers at ___________weeks of gestation are at risk of __________in which venous return and cardiac output are decreased by compression of the maternal inferior vena cava by the gravid uterus while the mother is lying in the supine position. ‘
supine hypotension syndrome = ≥20 weeks of gestation
During pregnancy, the diaphragm elevates by as much as _____cm
4 cm
During pregnancy, the diaphragm elevates by as much as 4 cm, so adjust the anatomic landmarks for thoracostomy tube insertion by one to two ribs spaces cranially.
True or False
Never withhold critical maternal interventions or diagnostic procedures out of concern for potential adverse fetal consequences.
True
a known pregnant woman at_____ weeks of gestation should be triaged to a hospital with trauma, obstetric, and neonatal capabilities.
> 20 weeks
Administer supplemental oxygen to maintain a pulse oximetry > _______%
> 95%
True or false
Avoid placing IV lines in the femoral region or lower extremity because of uterine inferior vena cava compression and the possibility of injured pelvic veins.
True
Increase the crystalloid infusion volume by _____% to account for the patient’s additional plasma volume.
50%
True or False
Do not administer vasopressors until volume and blood are replaced to minimize risk of uteroplacental hypoperfusion.
True
Fluid in the vagina with a pH of _____is suggestive of amniotic fluid; a pH of 5 is consistent with vaginal secretions.
pH of 7 is suggestive of amniotic fluid
Evidence of __________ on microscopic evaluation of dried vaginal fluid suggests membrane rupture and an amniotic fluid leak
ferning
The classic clinical presentation for placental abruption includes__________.
abdominal pain
abdominal and uterine tenderness
painful vaginal bleeding
tetanic uterine contractions
The most sensitive clinical finding for placental abruption after trauma is_____________, which is defined as more than _______ uterine contractions per hour.
uterine irritability = >3 uterine contractions per hour
For pregnant women at ≥20 weeks of gestation, begin___________ and______ monitoring in the ED as soon as maternal resuscitation allows
cardiotocographic and fetal heart rate
For pregnant patients at >20 weeks of gestation, obtain an obstetric US to______________
assess fetal size and gestational age,
cardiac activity heart rate, and
fetal activity
The___________ provides a quantitative determination of the presence of fetal hemoglobin in maternal blood.
Kleihauer-Betke test
Acid elution is applied to an aliquot of maternal blood, and then both maternal and fetal red blood cells are counted under the microscope. The percentage of fetal red blood cells is used to determine the amount of fetal-maternal hemorrhage.
True or false
Administer Rho(D) immunoglobulin to all Rh-negative pregnant women with abdominal trauma.
True
Rho(D) immunoglobulin is given to the Rh-nega- tive pregnant mother to prevent antibody formation that could occur if her fetus is Rh positive.
Kleihauer-Betke analysis on pregnant women who are >_____ weeks of gestation.
> 12 weeks
True or false
IV iodinated contrast is safe both in pregnancy and breastfeeding; oral contrast material is safe as well.
IV gadolinium for MRI should not be given during pregnancy, but gadolinium is considered safe during breastfeeding
True
The Kleihauer-Betke test is used to determine if doses _____micrograms are indicated.
> 300
Emergent delivery of a viable fetus (>24 weeks of gestational age) by ED vertical cesarean section should be considered within _______ minutes of maternal cardiac arrest.
4 minutes
__________ hours of external cardiotocographic monitoring is indicated for all pregnant trauma patients >20 weeks of gestation, even if the mother has been deemed safe for discharge by the trauma service.
4 to 6 hours
If any signs of fetal distress develop, admission for a minimum of _______hours is warranted.
24 hours
