Trauma in pregnancy and intimate partner violence

Question 1

Uterus position within abdo/pelvis through pregnancy

Answer 1

Intrapelvic until 12wks

Umbilicus 20 wks

Costal margin 34-36 wks

Question 2

What type of fracture could a maternal pelvic fracture lead to in fetus in vertex presentation

Answer 2

Skull fracture

Question 3

Normal ranges for the following in pregnant vs non pregnant

HCT
WBC

Answer 3

Question 4

What proportion of cardiac output does fetus receive in the third trimester?

Answer 4

20%

Question 5

Change in cardiac output in pregnancy

Answer 5

after 10 wks increases by 1-1.5 L/min due to increased plasma volume and reduced vascular resistance

Question 6

Changes to cardiac output in supine position in pregnancy

Answer 6

In the supine position, vena cava compression can decrease CO by 30% due to reduced venous return

Question 7

Musculoskeletal changes in pregnancy

Answer 7

Pubis symphysis widens to 4-8 mm and sacroiliac joint spaces increase by seventh month

Question 8

Spinal immobilisation in pregnancy

Answer 8

Do it tilted 15 to 30 degrees to the left to take pressure off vena cava

Question 9

What does a normal fibrinogen in pregnancy indicate

Answer 9

Normal range is higher, so a ‘normal fibrinogen’ means some fibrinogen has been used up, indicating DIC

Question 10

Placental abruption

Answer 10

Detachment of placenta from fetus

Question 11

Fetal heart rate monitoring

Answer 11

Doppler USS after 10 wks

a tocodynamometer after 20-24 wks

Question 12

Risk factors for fetal loss or placental abruption

Answer 12

Maternal HR>110

Injury severity score (ISS) >9

Evidence of placental abruption

Fetal HR >160 or <120

Ejection during RTC

Pedestrian or cyclist collision

Question 13

Indication for CT A/P in pregnancy

Answer 13

If significant concern over intra abdominal injury

Question 14

Dose of radiation dangerous for fetus

Answer 14

anything more than 50 mGy

CT/AP give fetus 25mGy

Question 15

Kleihaur Betke test

Answer 15

Looks for fetal RBC in mum’s blood

Sign of fetomaternal bleeding

Question 16

Effect of mixing 0.01 ml of Rhs positive fetal blood with maternal blood

Answer 16

It will sensitize 70% of the Rh neg maternal blood

Question 17

Mx of Rh-negative mothers post-trauma

Answer 17

Within 72 hours they need to get Rh immunoglobulins unless trauma far from the uterus (eg hands)