Vous êtes sur la page 1sur 22

TRAUMA IN

PREGNANCY
1
TRAUMA IN
PREGNANCY
TRAUMA IN
PREGNANCY
2
OVERVIEW
Anatomy and physiology
Pathophysiology
Evaluation and management
TRAUMA IN
PREGNANCY
3
THE PREGNANT
TRAUMA PATIENT
Two patients with separate needs
Mother
Fetus
Twin goals of management
Support mother
Identify needs of the fetus
TRAUMA IN
PREGNANCY
4
PHYSIOLOGIC CHANGES
OF PREGNANCY
Changes related to gestational
age
Major shift of circulatory system
to provide blood flow to uterus
Mother at more risk
Increased risk of injury
Less able to compensate for shock
TRAUMA IN
PREGNANCY
5
CARDIOPULMONARY
CHANGES
Increased cardiac output by
20-30%
Pulse increases by 10-15
beats/minute
BP decreases by 10-15mmHg
Increased resting respiratory rate
Elevation of diaphragm by uterus
decreases thoracic volume

TRAUMA IN
PREGNANCY
6
SYSTEMIC BLOOD
VOLUME
Increased plasma volume
Increased red cell volume
Blood volume increases 45-50%
Anemia of Pregnancy
Rise in plasma volume is greater than
the rise in red cell volume
Results in a relative anemia
TRAUMA IN
PREGNANCY
7
ABDOMEN
Delayed gastric emptying
Increased risk of vomiting and
aspiration
Uterus becomes the largest
abdominal organ
More likely to be injured from either
blunt or penetrating trauma
TRAUMA IN
PREGNANCY
8
URINARY SYSTEM
CHANGES
Bladder is displaced upward and
forward by enlarging uterus
Increased risk of bladder injury
from blunt or penetrating trauma
TRAUMA IN
PREGNANCY
9
CHANGES IN THE
UTERUS
Uterine blood flow increases
Nonpregnant = 2% cardiac output
Pregnant = 20% cardiac output
Uterine vessels constrict in
response to catecholamine
release in early shock
20-30% decrease in uterine blood flow
Risk fetal hypoxia and death
TRAUMA IN
PREGNANCY
10
CAUSES OF TRAUMATIC
FETAL DEATH
#1 - Maternal death
#2 - Maternal shock
#3 - Abruptio placenta

TRAUMA IN
PREGNANCY
11
FETAL
DEVELOPMENT
TRAUMA IN
PREGNANCY
12
SUPINE HYPOTENSION
SYNDROME
The enlarging uterus can
compress the inferior vena cava
when the mother is in the supine
position
Reduces venous return and cardiac
output by up to 30%
More likely after the 20th week of
pregnancy

TRAUMA IN
PREGNANCY
13
COMPRESSION OF THE
VENA CAVA CAN CAUSE
Maternal
hypotension
Syncope
Fetal bradycardia
TRAUMA IN
PREGNANCY
14
PACKAGING OF PREGNANT
TRAUMA PATIENTS
Full spinal immobilization
Tilt backboard 20-30 degrees to
the left
May manually displace the uterus
to the left but not as effective
Short backboards and similar
devices not useful because of
difficulty attaching straps
TRAUMA IN
PREGNANCY
15
ASSESSMENT
Assessment sequence same as for
nonpregnant patients
BTLS Primary Survey
Initial Assessment
Rapid Trauma Survey or Focused Exam
Detailed Exam
Ongoing Exam
Priorities same as for nonpregnant
patients
TRAUMA IN
PREGNANCY
16
DO NOT CONFUSE
NORMAL VITAL SIGNS
IN PREGNANCY FOR
SIGNS OF SHOCK
Pulse is 10-15 beats/min. faster
BP is 10-15mmHg lower
TRAUMA IN
PREGNANCY
17
SHOCK IN
PREGNANCY
Can lose 30% of blood volume
before having significant change
in BP
Can have significant occult
intrauterine or abdominal bleeding
Uterus is very vascular
May not have abdominal tenderness
early even with significant bleeding
TRAUMA IN
PREGNANCY
18
MANAGEMENT
100% oxygen
Very important
You are treating the fetus also
Transport with full spinal
packaging
Tilt backboard to the left
Treat specific injuries
TRAUMA IN
PREGNANCY
19
MANAGEMENT OF
SHOCK
IV access
Two large bore IVs of NS or RL
May require larger volume of
fluids for resuscitation
Blood should be given early
If PASG is indicated, inflate leg
compartments only
TRAUMA IN
PREGNANCY
20
MATERNAL
CARDIAC ARREST
Manage same as the nonpregnant
patient
Perform CPR
Notify hospital to be prepared for
possible emergency c-section
TRAUMA IN
PREGNANCY
21
SUMMARY
Treating two patients
Physiologic changes increase the
risk of injury and shock
Treat shock early
Prevent and treat hypoxia
Prevent supine hypotension
syndrome
Frequent reassessment

TRAUMA IN
PREGNANCY
22
QUESTIONS?