Trauma in Pregnancy EMS Professions Temple College

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Trauma in PregnancyEMS ProfessionsTemple
College
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Morbidity Mortality Rates

• Accidental Injury complicates 6-7 of all
  pregnancies.
• Most common cause of death of fetus is the death
  of the mother
• fetal death with maternal survival occurs with
  placental seperation or ruptured uterus
• fetal skull fractures are more common than
  maternal pelvic fractures

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Trauma in Pregnancy

• Unique challenge for the provider
• Two Patients each with unique needs
• All female patients are pregnant until proven
  otherwise

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Changes During Pregnancy
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Cardiovascular

• Cardiac output increase 20 - 30
• Heart rate increases by 10 - 15 bpm
• Systolic and Diastolic pressure decrease 10 -15
  mmHg
• Hypervolemia of pregnancy
• ? red blood cells and plasma (45)
• relative anemia (greater ? of plasma than RBC)
• Increased blood flow to uterus (2 to 20)

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Respiratory

• Respiratory rate may ? due to upward pressure of
  uterus on diaphragm
• ? Respiratory rate may ? PCO2
• ? Tidal volume and minute ventilation in late
  pregnancy

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GI/GU

• Delayed gastric emptying
• Movement of abdominal organs
• intestines
• bladder
• Uterus is the largest abdominal organ
• Placenta

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Shock

• Body protects the mother
• uterine vasoconstriction (20-30)
• decreased blood flow to fetus
• Loss of 30 - 35 blood volume before developing
  hypotension
• Slower onset of sign/symptoms

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Mechanism of Injury

• Motor Vehicle Collisions
• Penetrating Injuries
• Falls
• Burns

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Assessment

• Mother
• Initial
• Rapid Trauma Assessment/ Focused Assessment
• Fetus
• Abdominal tenderness, guarding, rigidity, rebound
  tenderness
• Uterus
• Abnormal fetal position
• Fundus
• Fetal body
• Contractions/Tetany

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Management

• C-Spine Motion Restriction IF indicated
• Airway
• Assist ventilations if needed
• High flow O2
• O2 requirements 10 - 20 greater
• Control External Bleeding
• Transport on left side to appropriate Facility

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Management

• En route
• Treat shock
• MAST/PASG application w/o inflation
• May be helpful in pelvic fracture
• IV of LR/NS enroute
• Titrate fluids to BP 90 - 100mm Hg
• Aggressive fluid therapy