Trauma In Pregnancy

Question 1

best predictors of fetal loss or other adverse outcomes are___________ and_____________.

Answer 1

crash severity and lack or improper use of seat belts

Question 2

What is proper fit of seatbelt?

Answer 2

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.

Question 3

proper body positioning (i.e., mother seated______ inches from the dash and steering column)

Answer 3

10

Question 4

___________ is second only to maternal death as the most common cause of fetal death.

Answer 4

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.

Question 5

A fetus is considered viable at ______weeks of gestation or a weight of______ grams

Answer 5

22 to 24 weeks

500 grams

Question 6

True or false

Fetal survival is dependent on maternal survival. Therefore, resuscitation of the mother always takes priority.

Answer 6

True

Question 7

A pregnant woman may lose _________ % of her circulating blood volume before manifesting clinical signs of shock.

Answer 7

30% to 35%

Question 8

Maternal blood volume expands at approximately week______ of gestation and peaks at week _______ with a 45% increase from baseline. Cardiac output increases by _______%

Answer 8

Week 10

Week 28

30 to 50%

Question 9

The uterine fundus remains relatively protected in the pelvis until about week _____ of gestation when it reaches the level of the pubic symphysis.

Answer 9

Week 12 = pubic symphysis

Question 10

By week_____, the uterus has reached the umbilicus and continues to grows approximately 1 cm beyond the umbilicus per each additional week of gestation.

Answer 10

Week 20 = umbilicus

Question 11

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. ‘

Answer 11

supine hypotension syndrome = ≥20 weeks of gestation

Question 12

During pregnancy, the diaphragm elevates by as much as _____cm

Answer 12

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.

Question 13

True or False

Never withhold critical maternal interventions or diagnostic procedures out of concern for potential adverse fetal consequences.

Answer 13

True

Question 14

a known pregnant woman at_____ weeks of gestation should be triaged to a hospital with trauma, obstetric, and neonatal capabilities.

Answer 14

> 20 weeks

Question 15

Administer supplemental oxygen to maintain a pulse oximetry > _______%

Answer 15

> 95%

Question 16

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.

Answer 16

True

Question 17

Increase the crystalloid infusion volume by _____% to account for the patient’s additional plasma volume.

Answer 17

50%

Question 18

True or False

Do not administer vasopressors until volume and blood are replaced to minimize risk of uteroplacental hypoperfusion.

Answer 18

True

Question 19

Fluid in the vagina with a pH of _____is suggestive of amniotic fluid; a pH of 5 is consistent with vaginal secretions.

Answer 19

pH of 7 is suggestive of amniotic fluid

Question 20

Evidence of __________ on microscopic evaluation of dried vaginal fluid suggests membrane rupture and an amniotic fluid leak

Answer 20

ferning

Question 21

The classic clinical presentation for placental abruption includes__________.

Answer 21

abdominal pain
abdominal and uterine tenderness
painful vaginal bleeding
tetanic uterine contractions

Question 22

The most sensitive clinical finding for placental abruption after trauma is_____________, which is defined as more than _______ uterine contractions per hour.

Answer 22

uterine irritability = >3 uterine contractions per hour

Question 23

For pregnant women at ≥20 weeks of gestation, begin___________ and______ monitoring in the ED as soon as maternal resuscitation allows

Answer 23

cardiotocographic and fetal heart rate

Question 24

For pregnant patients at >20 weeks of gestation, obtain an obstetric US to______________

Answer 24

assess fetal size and gestational age,
cardiac activity heart rate, and
fetal activity

Question 25

The___________ provides a quantitative determination of the presence of fetal hemoglobin in maternal blood.

Answer 25

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.

Question 26

True or false

Administer Rho(D) immunoglobulin to all Rh-negative pregnant women with abdominal trauma.

Answer 26

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.

Question 27

Kleihauer-Betke analysis on pregnant women who are >_____ weeks of gestation.

Answer 27

> 12 weeks

Question 28

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

Answer 28

True

Question 29

The Kleihauer-Betke test is used to determine if doses _____micrograms are indicated.

Answer 29

> 300

Question 30

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.

Answer 30

4 minutes

Question 31

__________ 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.

Answer 31

4 to 6 hours

Question 32

If any signs of fetal distress develop, admission for a minimum of _______hours is warranted.

Answer 32

24 hours