Trauma in pregnancy and intimate partner violence

Question 1

Hypervolemia in a pregnant person is characterised by an increase of how much

Answer 1

1.0 to 1.5 L/min, after the 10th week of pregnancy

due to increased plasma volume and decreased vascular resistance

Question 2

The uterus grows to poke above the pelvic in which week of pregnancy

Answer 2

12th

Question 3

Signs of peritoneal irritation are more or less obvious in pregnant people

Answer 3

Less

Question 4

In pregnant person, decrease in maternal intravascular volume can cause what

Answer 4

reduction in foetal oxygen due to increased vascular resistance in the uterus

despite reasonably normal maternal vital signs

Question 5

Blood parts that increase in pregnancy

Answer 5

Plasma volume
RBC volume
WBC count
Serum fibrinogen and other clotting factors
CO2, O2

Question 6

Blood parts that decrease in pregnancy

Answer 6

Haematocrit
Prothrombin time
Bicarbonate

Question 7

Change to HR in pregnancy

Answer 7

Increases by approx 15 bpm in later stages

Question 8

BP changes in pregnancy

Answer 8

Decreased in second trimester
Near normal at term

Question 9

ECG changes in pregnancy

Answer 9

T wave changes in leads III and aVF
More ectopics

Question 10

Respiratory changes in pregnancy

Answer 10

Hypocapnia common in late pregnancy (increased tidal volume)
Fetus sensitive to maternal hypoxia
Aim 95%+

Question 11

GI changes in pregnancy

Answer 11

Gastric emptying delayed so consider early gastric tube decompressoin
Intestines shifted to upper part of the abdomen, may be shielded by uterus

Question 12

Urinary system physiological changes in pregnancy

Answer 12

GFR and renal blood flow increase
Creatinine and urea fall to approximately half of pre-pregnancy level

Question 13

MSK/vascular change in pregnancy

Answer 13

Large, engorged pelvis vessels around uterus
- could cause massive retroperitoneal bleeding after blunt trauma with associated pelvic fractures

Question 14

Signs of eclampsia

Answer 14

Seizures
Hypertension
Hyperreflexia
Proteinuria
Peripheral oedema

Question 15

Signs of placental abruption

Answer 15

Vaginal bleeding
Maternal abdo pain or cramping
Hypovolemia
Uterine tenderness
Frequent contractions
Uterine tetany
Uterine irritability

Question 16

Signs of uterine rupture

Answer 16

Abdo tenderness, guarding, rigidity or rebound tenderness
Abdominal fetal lie
Easy palpation of fetal parts
Inability to palpate fundus

Question 17

Administer Rh immunoglobulin therapy to pregnant trauma patient if

Answer 17

Rh negative mother

unless injury is very remote from the uterus