Académique Documents
Professionnel Documents
Culture Documents
2010
OBJECTIVES
Review aspects of trauma
related to pregnancy
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Trauma and Pregnancy
ATLS Protocol the same
Second Trimester
First Trimester
http://craniosacral-therapy.ca/baby.jpg
ALSO (advanced life support in obstetrics), 200
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Anatomic Changes
Dias. BP 70 60 63 70
C. Output 4.5 4.5 6 6
CVP 9.0 7.5 4.0 3.8
Bld V (ml) 4000 4200 5000 5600
Hct with Fe (%) 40 36 34 36
WBC (cell/mm3 ) 7200 9100 9700 9800
(1) Milson I, Forssman L: Factors influencing aortocaval compressionin late pregnancy, Am J Obtst
Gynecol 148: 764-771, 1984
Nabil Alzadjali, McGill University
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Modalities for Evaluating
Trauma
Plain Films – X-rays
Ultrasound
CT & MRI
Cardiotocographic
Monitoring
DPL
Laparotomy
REMEMBER:
Hypertension 24%
Embolism 23%
Hemorrhage 21%
Infection 12%
Cardiomyopathy 6%
Anesthesia 3%
Other causes 11%
ALSO (advanced life support in obstetrics), 2005
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
Etiology of Cardiac Arrest
DISEASE ASSOCIATED COMPLICATIONS
Hanya untuk Pendidikan dan ALSO (advanced life support in obstetrics), 2005
Kesehatan JJE-2010/03/07
Etiology of Cardiac Arrest
DISEASE ASSOCIATED COMPLICATIONS
Breathing
Confirm placement
Secure device
Confirm adequate oxygenation
Differential Diagnosis
Search for, treat identified reversible
causes
ALSO (advanced life support in obstetrics), 200
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
Drugs for Fib or Pulseless V-
Tach
Discharge criteria:
Resolution of contractions
Reassuring FHT’s with intact membranes
No uterine tenderness or vaginal bleeding
ALSO (advanced life support in obstetrics), 2005
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
Automobile Accidents
Seatbelt use declines in pregnancy
Seatbelt use in pregnancy decreases severe injury
and death by 50%
Proper seatbelt positioning important:
Lap belt passes below abdomen, across anterior
superior iliac spines
Shoulder belt should be between breasts
Airbag deployment not associated with increased
maternal or fetal injury
ALSO (advanced life support in obstetrics), 2005
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
http://www.vahealth.org/Injury/safetyseat/images/Pregnancy_Seatbelts_clip_image003.jpg
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The American College of Obstetricians and Gynecologists recommends
proper seat belt use by all pregnant women (Brown, Haywood L, ACOG, 2009)
http://www.smartmotorist.com/images/news/ideal_seat_belt_position_during_pregnancy.jpg
http://www.health.com/health/static/hw/media/medical/hw/h9991085.jpg
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Maternal Cardiac Arrest
Airway
Human Wedge
Chest Compression
27% left tilt
A
L
S
O
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(
Pre-requisites for Perimortem
Cesarean
Skilled personnel and equipment
No spontaneous maternal circulation
for four minutes
Potential fetal viability: singleton @ ≥ 23 –
24 weeks
Facilities and personnel available to care
for mother and infant postoperatively
ALSO (advanced life support in obstetrics), 2005
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
Steps in Perimortem Cesarean
Personal protective devices
Modified sterile technique
Midline vertical or modified Joel-Cohen
abdominal incision
Vertical uterine incision
Dry and warm infant
Pack uterus, remove lateral tilt, continue CPR
Repair anatomically, when stable
ALSO (advanced life support in obstetrics), 2005
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
Perimortem Cesarean Delivery Kit
Obstetrics supplies Obstetrics supplies
Knife handle, # 10 scalpel Hemostats
blade Needle driver
Bladder blade retractor Finger forceps or
Bandage scissors pickups
Laparotomy sponges 0-Chromic sutures
Medium Richardson 1-Vicryl sutures
retractors Sterile gloves
Kocher clamps
ALSO (advanced life support in obstetrics), 200
Hanya untuk Pendidikan dan Kesehatan JJE-2010/03/07
Perimortem Cesarean Delivery Kit
Pediatric supplies Pediatric supplies
Pediatric blankets Bulb syringe
Self inflating bag: DeLee suction
infant, child Cord clamps
Face masks:
neonate, infant