Trauma in Pregnancy and Intimate Partner Violence

Question 1

What is the best initial treatment of the fetus in a pregnancy trauma?

Answer 1

Resuscitation of the mother

Question 2

Is the bowel more or less protected in pregnancy trauma? Why?

Answer 2

More. It is pushed cephalad by the growing uterus and is protected by it to a degree

Question 3

Where anatomically is the uterus located at:
12 weeks
20 weeks
34-36 weeks

Answer 3

12 weeks: intrapelvic
20 weeks: umbilicus
34-36 weeks: costal margin

Question 4

What are risks of release of amniotic fluid into maternal circulation during trauma?

Answer 4

Amniotic fluid embolism

DIC

Question 5

Reductions in maternal intravascular volume can have what effect on uterine vascular resistance?

Answer 5

Catecholamine release and dramatic increase in uterine vascular resistance which can reduce fetal oxygenation despite normal maternal vitals

Question 6

What is a normal Hct in the 3rd trimester?

Answer 6

31-35% (due to physiologic anemia)

Question 7

What happens to WBC during pregnancy?

Answer 7

It rise. Not unusual to see levels of 12,000 or even 25,000 during labor

Question 8

What happens to CO in supine pregnant patients and why? What happens to HR?

Answer 8

• Decreases by up to 30% because of vena cava compression

- HR rises by 10-15 beats/min by third trimester

Question 9

What is a common CO2 level in pregnancy? What level may indicate impending respiratory failure?

Answer 9

Hypocapnia (~30 mmHg)

Levels of 35-40 mmHg may signify impending respiratory failure

Question 10

What happens to position of spleen and liver in pregnancy?

Answer 10

Unchanged

Question 11

What happens to gastric emptying during pregnancy? What bearing does this have on mgmt of the pregnant trauma?

Answer 11

Delayed, so decompress stomach early to reduce aspiration risk

Question 12

What changes occur to GFR, RBF, creatinine, and urea nitrogen?

Answer 12

GBR and RBF increase

Creatinine and BUN decrease

Question 13

How should treatment of the mother and fetus generally be handled?

Answer 13

Focus on mother first and then fetus before conducting secondary survey

Question 14

When supine what maneuver should be done to the pregnant patient to increase cardiac output?

Answer 14

Manually displace uterus to left side to decompress vena cava

Question 15

What effect does the hypervolemia of pregnancy have on compensatory effects of intravascular volume loss?

Answer 15

The normal tachycardia and changes in BP may not be seen as early but this doesn’t mean the patient is ok

Question 16

Should vasopressors be used to maintain BP in pregnant patients?

Answer 16

It is an absolute last resort because of further risk of fetal hypoxia to the fetus

Question 17

What measures for fetal monitoring should be taken?

Answer 17

Fetal heart tones with Doppler Ultrasound. It can be completed after 10 weeks and should be continuous after 20-24 wks of gestation

Question 18

What should be provided to all Rh-negative patients with fetomaternal hemorrhage?

Answer 18

Rh immunoglobulin to reduce risk of Rh sensitization