Trauma In Pregnancy Flashcards
For patients who are pregnant and are being treated as a trauma patient, is it the baby or mother who received the initial treatment priority?
The mother
At what week of gestation does the uterus no longer remain an intrapelvic organ?
12 weeks
At how many weeks gestation is the uterus at the umbilicus?
20 weeks
At how many weeks gestation does the uterus reach the costal margin?
34-36 weeks
What happens during the last 2 weeks of pregnancy?
The fundus frequently descends as the foetal head engages with the pelvis
What happens to the bowel as the uterus enlarges?
It is pushed upwards so that it lies in the upper abdomen
What can an abrupt decrease in maternal intravascular volume result in?
Profound increase in uterine resistance, reducing foetal oxygenation despite normal maternal vital signs
What is maximally dilated throughout gestation and is exceptionally sensitive to catecholamine stimulation?
The placental vasculature
At what week of gestation does the increasing plasma blood volume plateaus?
34 weeks
What does an increase of red blood cells cause?
Decreased haematocrit
In a healthy pregnant patient how much blood loss can she have prior to any symptoms of hypovolemia being exhibited?
1.2-1.5l blood loss
What clotting factors increase during pregnancy?
White blood cells count and serum fibrinogen
After what week of pregnancy does cardiac output increase by 1-1.5L/min because of the increase in plasma volume and decrease in vascular resistance of the uterus and placenta?
10 weeks
During which trimester of pregnancy dose the placenta receives 10% of cardiac output?
Third
During pregnancy systolic and diastolic pressures fall by how much during the second trimester
5 mmHg to 15 mmHg
Why does minute ventilation increase during pregnancy?
Increased tidal volume
What is common in late pregnancy?
Hypocapnia
Why is it important to maintain adequate arterial oxygenation during resuscitation for pregnant patients?
Oxygen consumption increases during pregnancy
What acts as a buffer to direct foetal injury from blunt trauma?
Abdominal wall, uterine myometrium and amniotic fluid
How does indirect injury to the foetus occur?
From rapid compression, deceleration, the contrecoup effect or a shearing force resulting in abruptio placentae
In early pregnancy, what can absorb a significant amount of energy from penetrating objects, decreasing their velocity and lowering the risk of injury to other viscera?
Dense uterine musculature
What can help slow a penetrating object in a pregnant patient?
Amniotic fluid and the foetus
What is the foetal outcome when there is penetrating trauma to the uterus?
Generally poor
What can you do to relieve uterine compression of the vena cava to stop reduced venous return to the heart, decreased cardiac output and aggravate shock?
Manually displace the uterus to the left side
Why can pregnant patients lose a significant volume of blood prior to signs of hypovolemia causing the foetus to become distressed and placenta deprived of oxygen?
Increased intravascular volume
What should be used as a last resort in restoring maternal blood pressure because they further reduce uterine blood flow which results in foetal hypoxia?
Vasopressors
Why is abdominal examination following trauma in pregnancy critically important?
To quickly identify serious maternal injuries as well as establishing foetal well being
What are the 2 leading causes of foetal death?
Maternal shock and death
Placenta abruption
When would should you suspect abruptio placentae in a pregnant trauma patient?
Vaginal bleeding
Uterine tenderness
Guarding
Rigidity or rebound tenderness
What is the most likely diagnosis in the presence of profound shock following blunt trauma in pregnancy?
Placental abruption
