ATLS MODULE 12 TRAUMA IN PREGNANCY &
INTIMATE PARTNER VIOLENCE
• how does the respiratory system change during pregnancy?
Answer: minute ventilation increases primarily due to increase in tidal volume... so
hypocapnia (PaCO2 of 30) is common in late pregnancy
• what might a PaCO2 of 35-40 mmHg indicate during pregnancy?
Answer: impending respiratory failure during pregnancy
*bc hypocapnia is normal during pregnancy
• why is it so important to maintain and ensure adequate arterial oxygenation
when resuscitating injured pregnant patients?
Answer: oxygen consumption increases during pregnancy
• how is the GI system affected during pregnancy?
Answer: gastric emptying is slowed
*thus, early gastric tube decompression may be particularly important
*& intestines are pushed up to upper abdomen
• how is the urinary system affected during pregnancy?
Answer: GFR and renal blood flow increase
but serum creatinine and urea nitrogen fall
*glycosuria is common
• what is a common complication of late pregnancy that can mimic head injury?
Answer: eclampsia
• how should clinicians proceed through assessment/resuscitation of opti- mize
outcomes for mother and fetus?
Answer: assess and resuscitate the mother first and then assess the fetus before
conducting secondary survey
• uterine compression of vena cava may reduce venous return to heart, thus
decreasing cardiac output and aggravating shock state ..................................... how
do you prevent this?
Answer: manually displace uterus to the left side to relieve pressure on inferior vena
cava (RED text)
*if pt requires spinal motion restriction, log roll her to left 15-30 degrees & support
with a bolstering device
• what should be a last resord in restoring maternal blood pressure bc the agents
, further reduce uterine blood flow, resulting in fetal hypoxia?
Answer: vasopressors
• what do you expect of the fibrinogen level during pregnancy?
Answer: fibrinogen may double late in pregnancy.... a normal fibrinogen may
indicate DIC
• what is x-ray evidence of uterine rupture?
Answer: extended fetal extremities, abnormal fetal position, free intraperitoneal air
• initial fetal heart tones can be auscultated with doppler US by 10 weeks ... how
do you perform continuous fetal monitoring beyond 20-24 weeks?
Answer: toco- dynamometer
• what are the risk factors for placental abruption?
Answer:
-maternal HR >110
-injury severity score >9
-evidence of abruption
-fetal heart rate >160 or <120
-ejection during MVC
-motorcycle/pedestrian collision
• what is normal fetal heart rate
Answer: 120-160 beats/min
• what are signs of impending maternal and/or fetal decompensation?
Answer: ab- normal fetal HR, repetitive decelerations, absence of accelerations or
beat to beat variability, frequent uterine activity
• what does the presence of amnioitic fluid in vagina (pH >4.5) suggest?
Answer: -ruptured chorioamniotic membrane
• clinicians who treat pregnant trauma patients must remember......they are treating
2 patients
Answer: mother and fetus
*the best initial tx for fetus is to provide optimal resuscitation of the mother (RED text)
• what should you consider in every female of reproductive age with significant
injuries?
Answer: they are considered pregnant until proven otherwise with pregnancy test of
pelvic US
INTIMATE PARTNER VIOLENCE
• how does the respiratory system change during pregnancy?
Answer: minute ventilation increases primarily due to increase in tidal volume... so
hypocapnia (PaCO2 of 30) is common in late pregnancy
• what might a PaCO2 of 35-40 mmHg indicate during pregnancy?
Answer: impending respiratory failure during pregnancy
*bc hypocapnia is normal during pregnancy
• why is it so important to maintain and ensure adequate arterial oxygenation
when resuscitating injured pregnant patients?
Answer: oxygen consumption increases during pregnancy
• how is the GI system affected during pregnancy?
Answer: gastric emptying is slowed
*thus, early gastric tube decompression may be particularly important
*& intestines are pushed up to upper abdomen
• how is the urinary system affected during pregnancy?
Answer: GFR and renal blood flow increase
but serum creatinine and urea nitrogen fall
*glycosuria is common
• what is a common complication of late pregnancy that can mimic head injury?
Answer: eclampsia
• how should clinicians proceed through assessment/resuscitation of opti- mize
outcomes for mother and fetus?
Answer: assess and resuscitate the mother first and then assess the fetus before
conducting secondary survey
• uterine compression of vena cava may reduce venous return to heart, thus
decreasing cardiac output and aggravating shock state ..................................... how
do you prevent this?
Answer: manually displace uterus to the left side to relieve pressure on inferior vena
cava (RED text)
*if pt requires spinal motion restriction, log roll her to left 15-30 degrees & support
with a bolstering device
• what should be a last resord in restoring maternal blood pressure bc the agents
, further reduce uterine blood flow, resulting in fetal hypoxia?
Answer: vasopressors
• what do you expect of the fibrinogen level during pregnancy?
Answer: fibrinogen may double late in pregnancy.... a normal fibrinogen may
indicate DIC
• what is x-ray evidence of uterine rupture?
Answer: extended fetal extremities, abnormal fetal position, free intraperitoneal air
• initial fetal heart tones can be auscultated with doppler US by 10 weeks ... how
do you perform continuous fetal monitoring beyond 20-24 weeks?
Answer: toco- dynamometer
• what are the risk factors for placental abruption?
Answer:
-maternal HR >110
-injury severity score >9
-evidence of abruption
-fetal heart rate >160 or <120
-ejection during MVC
-motorcycle/pedestrian collision
• what is normal fetal heart rate
Answer: 120-160 beats/min
• what are signs of impending maternal and/or fetal decompensation?
Answer: ab- normal fetal HR, repetitive decelerations, absence of accelerations or
beat to beat variability, frequent uterine activity
• what does the presence of amnioitic fluid in vagina (pH >4.5) suggest?
Answer: -ruptured chorioamniotic membrane
• clinicians who treat pregnant trauma patients must remember......they are treating
2 patients
Answer: mother and fetus
*the best initial tx for fetus is to provide optimal resuscitation of the mother (RED text)
• what should you consider in every female of reproductive age with significant
injuries?
Answer: they are considered pregnant until proven otherwise with pregnancy test of
pelvic US
