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PREGNANT PATIENT
U. Kaswiyan
Introduction
in
42% MVCs
34% falls
18% assaults
< 1% burns
Trauma
is often classified as
blunt vs penetrating
Blunt Trauma
Mechanism
- MVAs
- Falls
Injuries
Head injury
Hemorrhage
Obtetric complications (preterm labour or
abortion, premature rupture of membrane,
placental abruption, uterine rupture)
Penetrating Trauma
It
fetal injury:
Fetal mortality
Blunt trauma (in 3rd trimester)
Penetrating trauma (stabbing / gunshots)
Skull fracture and ICH
Indirect
fetal injury:
when maternal injury, inadequate
uteroplacental perfusion & fetal oxygenation
Blunt
Supine
Alterations in Anatomy
1st
trimester:
uterus is thick walled and intrapelvic
uterus rises out of pelvis after 12 weeks
2nd
trimester:
uterus contains large amount of amniotic fluid
3rd
trimester:
uterus is thin walled, large fetal head
engaging pelvis
at 36 weeks uterus reaches costal margin
HR , CO , blood plasma
SVR , CVP , BP
supine hypotensive syndrome
Hyperdynamic
&
Hypervolemic
may complicate:
- the evaluation of intravascular volume
- the assessment of blood loss
- the diagnosis of hypovolemic shock
Risk of
pulmonary aspiration
Priorities
Resuscitating
Catastrophic trauma
Minor trauma
Catastrophic trauma
Minor trauma
Trauma Surgeon
Obstetrician
Group 1 :
- Pregnancy unknown
- Need pregnancy test
Group 2 :
Group 3 :
Group 4 :
- Maternal perimortem
- Rescucitation SC perimortem (?)
Initial Management
Primary Survey
1. BLS, ATLS, ACLS
Begin as you would with any other trauma patient
2. Oxygenation, Airway management
Rapid sequence induction
3. Utero-plasental blood flow
position
4. Neurological deficit
GCS, ICP control, cardiotocographic monitoring
Secondary Survey
1. Anamnesis & Physical Examination :
Assess
tone
Secondary Survey
3. Laboratory screening :
Hb, Ht, Blood group, Urine analysis, Lactate,
BGA, Bicarbonate serum
Fetomaternal Blood Mixing
- Kleihaure-Betke test to check for fetal cells
- Important in Rh negative women who need
Rhogam (300 micrograms)
4. Radiographic Studies :
Obtain what the patient needs, dont hold back
Avoid repeated and unnecessary studies
0.05 to 0.1 rad safe to fetus
- Single Pelvis X-ray is < 0.01 rad
- Abd CT is 0.05 - 0.1 rad
Secondary Survey
5. Cardiotocographic Monitoring :
FHR
- Rate (120-160)
- Beat-to-beat variability
- Baseline variability
- Decelerations, esp. late
Uterine Activity
- If < 1 contraction / 10 min. for 4 hours, risk of
complications drops to baseline.
- If greater, then 20% risk of placental abruption
Excellent
5-10 minutes
Good
10-15 minutes
Fair
15-20 minutes
Poor
> 20 minutes
Unlikely
: 3 cases
: 2 cases
Craniotomy evacuation
(Neuroanesthesia technique)
Remember
... you will lose both mother
and infant if you cannot
restore blood flow to the
mothers heart
Summary
Anatomic
EARLY !!!