Trauma in Pregnancy Flashcards
A pregnant patient may lose up to what percent of her circulating blood volume before manifesting s/sx of shock?
35%
Uterine blood flow is directly proportional to what measured vital sign?
Mean arterial pressure
When in gestation does the uterus become an abdominal organ?
After week 12 of gestation, it outgrows and no longer receives full protection from the maternal pelvis
When in gestation does supine hypotension syndrome develop?
18-20 weeks
Why should you avoid placing a central line in the femoral vein in a pregnant patient?
Compression of the IVC may limit effectiveness
What precaution should be taken when placing a chest tube in a pregnant patient, due to their altered anatomy?
Chest tubes need to be placed higher since the diaphragm is elevated from baby
What is the most common organ to cause intraperitoneal hemorrhage in trauma patients? Does this change in pregnant patients?
spleen
No
At what week of gestation in the uterus above the level of the pubic symphysis? Umbilicus?
12
20
What is the rate of expansion per week of the uterine fundus?
1 cm beyond the umbilicus for each additional week
What are the abdominal exam findings of placental abruption?
Rigid abdomen with peritoneal signs
What gestational age is compatible with life?
24 weeks and over
True or false: direct fetal injury is uncommon in the first trimester
True
What is the presentation of uterine rupture?
Loss of palpable uterine contours, ease of fetal parts
What is the role of tocolytics in uterine irritability and preterm labor 2/2 uterine trauma?
Not generally recommended–call OB
What is the definition of uterine irritability?
more than 3 contractions / hour
What is the most sensitive sign of placental abruption?
Uterine irritability
What maternal risk can happen after placental abruption?
DIC or amniotic fluid embolism.
What is fetomaternal hemorrhage? What should be done if this occurs?
Entry of fetal RBCs into the maternal bloodstream (Check Rh and give Rhogam if indicated)
True or false: fetomaternal hemorrhage is assumed in cases of trauma in pregnancy, and Rhogam should be given, if indicated
True
How much more volume should be given to pregnant trauma patients compared to non-pregnant ones?
50% more
How should pregnant trauma patients be laid on the stretcher ? Why?
With a wedge under their right hip to take pressure off of the IVC
True or false: the sensitivity for detecting intraperitoneal fluid with US is similar in the pregnant patient compared to the non-pregnant patient
True
What is the dose (in Rad) that above which is a risk for fetal teratogenesis?
5 rad
Why should you never perform a pelvic exam prior to performing an US in a pregnant trauma patient?
To exclude placenta previa
