Trauma in pregnancy: Difference between revisions
| Line 18: | Line 18: | ||
#Nonviable fetus (<23-24wks) | #Nonviable fetus (<23-24wks) | ||
##Standard treatment for trauma | ##Standard treatment for trauma | ||
##Consider RhoGAM | ##Consider RhoGAM 50mcg in rh neg | ||
#Viable fetus (>23-24wks) | #Viable fetus (>23-24wks) | ||
##Consider RhoGAM | ##Consider RhoGAM 300mcg in rh neg | ||
##Avoid pressors | |||
##Monitor (fetal) all for 4-6hrs --> | ##Monitor (fetal) all for 4-6hrs --> | ||
##Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring | ##Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring | ||
===Risk Factors (ATLS)=== | ===Risk Factors (ATLS)=== | ||
Revision as of 17:39, 30 January 2013
Background
- Concern for trauma and abruption
- Viable = >23-24wk (~fundus above umbilicus)
- nl FHR = 120-160 beats/min
- For maternal vitals see Maternal Vitals and Labs in Pregnancy
Diagnosis (Abruption)
Symptoms
- Vag bleed
- Cramps/contractions
- Uterine tenderness
- Hypovolemia
- Abnl fetal HR
US only 50% acurate
Treatment & Disposition
- Nonviable fetus (<23-24wks)
- Standard treatment for trauma
- Consider RhoGAM 50mcg in rh neg
- Viable fetus (>23-24wks)
- Consider RhoGAM 300mcg in rh neg
- Avoid pressors
- 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
Abnormal Monitoring
- >3 contractions/hr
- Persistant uterine TTP
- Worisome strip
- Vag bleed
- PROM
- 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
- Fetal Maternal Hemorrhage (RhoGAM)
- Perimortum C-Section
- Abruption
- Maternal Vitals and Labs in Pregnancy
Source
3/29/06 DONALDSON (adapted from Rosen)