PREGNANCY
The ABCDE priorities of trauma management in pregnant patients
is the same as those in non-pregnant patients.
Anatomical and physiological changes occur in pregnancy which
are extremely important in the assessment of the pregnant trauma
patient.
Anatomical changes
| :: |
The
size of the uterus gradually increases and becomes
more vulnerable
to damage both by blunt and penetrating injury
– At 12 weeks of gestation the fundus is at the symphysis pubis
– At 20 weeks it is at the umbilicus
– At 36 weeks it is at the xiphoid |
| :: |
The
fetus at first is well protected by the thick walled
uterus and large
amounts of amniotic fluid. |
Physiological changes
| :: |
Increased
tidal volume and respiratory alkalosis |
| :: |
Increased
heart rate |
| :: |
30%
increased cardiac output |
| :: |
Blood
pressure is usually 15 mmHg lower |
| :: |
Aortocaval
compression in the third trimester with hypotension. |
Special issues in the traumatized pregnant female
Blunt trauma may lead to:
| :: |
Uterine
irritability and premature labour |
| :: |
Partial
or complete rupture of the uterus |
| :: |
Partial
or complete placental separation (up to 48 hours after
trauma) |
| :: |
With
pelvic fracture, be aware of severe blood loss potential. |
Priorities
| :: |
Assessment
of the mother according to ABCDE |
| :: |
Resuscitate
in left lateral position to avoid aortocaval compression |
| :: |
Vaginal
examination (speculum) for vaginal bleeding and cervical dilatation |
| :: |
Mark
fundal height and tenderness and foetal heart rate, monitoringas
appropriate. |
Resuscitation of the mother may save the baby. There are times when the
mother’s
life is at risk and the fetus may need to be sacrificed in order to save the
mother.
Aortocaval compression must be prevented in resuscitation of the traumatized
pregnant woman. Remember left lateral tilt.
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