The pregnant trauma patient
Resuscitate the mother to resuscitate the foetus.
physiology
airway
↑ soft tissue swelling
↑ pulmonary aspiration risk - due to ↑ intra-abdominal pressure
breathing
↓ FRC
↑ TV is physiological = ↑ MV
↓ thoracic compliance
↑ position of diaphragm = chest drains should be sited 1-2 spaces up
aiming for lower etCO2 would be physiological
circulation
Physiologically: ↑ circulating volume, ↓ BP and ↑HR
- due to prostaglandin, NO, etc. → physiological vasodilation
Uterine blood flow is not autoregulated - fluid resuscitation++ will benefit foetal circulation
Pre-eclampsia predisposes to fluid overload
- 30 deg left lateral tilt
- "A pink cannula is useless" PREACH \o/
foetal monitoring
CTG for 4-6h if gestation >24/40
- Transplacental hemorrhage
- All Rhesus-negative mothers should be given 300 mcg of anti-D IgG within 72 hours of injury unless the trauma is trivial or distant from the uterus.
patterns of injury
more commonly injured:
- liver
- spleen
- retroperitoneal
- uterus
bowel injury is less common (hidden in upper abdomen)
placental injury
- Placenta is not elastic
- Placental vessels are extremely sensitive to vasoconstrictors = catecholamine excess → compromise to foetal circulation
- Placental abruption can happen with relatively minor trauma
- O/E: PV bleeding; uterine tenderness, contractions, irritability
uterine injury
- uterine rupture
- O/E: unable to palpate uterus