Trauma in pregnancy: Difference between revisions

(Created page with "==Background== Viable = >20-24wk (~fundus above umbilicus) nl FHR = 120-160 beats/min For maternal vitals see OB/GYN: Vitals Concern for trauma and abruption ==Diagnosis...")
 
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==Background==
==Background==
Viable = >20-24wk (~fundus above umbilicus)
Viable = >20-24wk (~fundus above umbilicus)


Line 9: Line 7:


Concern for trauma and abruption
Concern for trauma and abruption


==Diagnosis (Abruption)==
==Diagnosis (Abruption)==
Symptoms
Symptoms
 
#Vag bleed
1. Vag bleed
#Cramps/contractions
 
#Uterine tenderness
2. Cramps/contractions
#Hypovolemia
 
#Abnl fetal HR
3. Uterine tenderness
 
4. Hypovolemia
 
5. Abnl fetal HR
 


US only 50% acurate
US only 50% acurate


==Treatment & Disposition==
==Treatment & Disposition==
#Nonviable fetus (<20-24wks)
##Standard treatment for trauma
##Consider RhoGAM
#Viable fetus (>20-24wks)
##Consider RhoGAM
##Monitor (fetal) all for 4-6hrs -->
##Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring


===Risk Factors (ATLS)===
#Maternal heart rate > 100
#Injury  Severity Score > 9
#Evidence of placental abruption
#Fetal heart rate  > 160 or  <120
#Ejection during a motor vehicle crash
#Motorcycle or pedestrian collisions


A. Nonviable fetus (<20-24wks)
===Abnormal Monitoring===
 
#>3 contractions/hr
    -Standard treatment for trauma
#Persistant uterine TTP
 
#Worisome strip
    -Consider RhoGAM
#Vag bleed
 
#PROM
#Serious maternal injury
 
B. Viable fetus (>20-24wks)
 
    -Consider RhoGAM
 
    -Monitor (fetal) all for 4-6hrs -->
 
    -Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring
 
 
Risk Factors (ATLS)
 
1. Maternal heart rate > 100
 
2. Injury  Severity Score > 9
 
3.  Evidence of placental abruption
 
4. Fetal heart rate  > 160 or  <120
 
5. Ejection during a motor vehicle crash
 
6.  Motorcycle or pedestrian collisions
 
 
Abnormal Monitoring
 
1. >3 contractions/hr
 
2. Persistant uterine TTP
 
3. Worisome strip
 
4. Vag bleed
 
5. PROM
 
6. Serious maternal injury
 


Partial abrution w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)
Partial abrution w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)


Abrupion = risk DIC
Abrupion = risk DIC


==See Also==
==See Also==
See OB/GYN: Fetal Maternal Hemorrhage (RhoGAM)
See OB/GYN: Fetal Maternal Hemorrhage (RhoGAM)


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See OB/GYN: Vitals
See OB/GYN: Vitals


==Source==
==Source==
3/29/06 DONALDSON (adapted from Rosen)
3/29/06 DONALDSON (adapted from Rosen)


[[Category:Trauma]]
[[Category:Trauma]]
[[Category:OB/GYN]]

Revision as of 16:11, 12 March 2011

Background

Viable = >20-24wk (~fundus above umbilicus)

nl FHR = 120-160 beats/min

For maternal vitals see OB/GYN: Vitals

Concern for trauma and abruption

Diagnosis (Abruption)

Symptoms

  1. Vag bleed
  2. Cramps/contractions
  3. Uterine tenderness
  4. Hypovolemia
  5. Abnl fetal HR

US only 50% acurate

Treatment & Disposition

  1. Nonviable fetus (<20-24wks)
    1. Standard treatment for trauma
    2. Consider RhoGAM
  2. Viable fetus (>20-24wks)
    1. Consider RhoGAM
    2. Monitor (fetal) all for 4-6hrs -->
    3. Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring

Risk Factors (ATLS)

  1. Maternal heart rate > 100
  2. Injury Severity Score > 9
  3. Evidence of placental abruption
  4. Fetal heart rate > 160 or <120
  5. Ejection during a motor vehicle crash
  6. Motorcycle or pedestrian collisions

Abnormal Monitoring

  1. >3 contractions/hr
  2. Persistant uterine TTP
  3. Worisome strip
  4. Vag bleed
  5. PROM
  6. Serious maternal injury

Partial abrution w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)

Abrupion = risk DIC

See Also

See OB/GYN: Fetal Maternal Hemorrhage (RhoGAM)

See Procedures: Perimortum C-Section

See OB/GYN: Abruption

See OB/GYN: Vitals

Source

3/29/06 DONALDSON (adapted from Rosen)

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