Trauma in pregnancy: Difference between revisions
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##Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery | ##Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery | ||
##Monitor (fetal) all for 4-6hrs --> | ##Monitor (fetal) all for 4-6hrs --> | ||
##Extend Monitoring to 24hrs, if | ##Extend Monitoring to 24hrs, if abnormal 6hr monitoring | ||
###The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes. <ref>Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–10.</ref> | |||
Revision as of 04:08, 18 January 2014
Background
- Concern for trauma, premature labor, and abruption
- Viable = >23-24wk (~fundus above umbilicus)
- nl FHR = 110-160 beats/min
- The leading cause of death in women during their reproductive years
- The leading non-obstetric cause of death and disability in pregnant women
- Trauma or accidental injury complicates up to 7% of all pregnancies
- For maternal vitals see Maternal Vitals and Labs in Pregnancy
Diagnosis (Abruption)
Symptoms
- Vag bleed 70% (may be absent if retroplacental)
- Cramps/contractions
- Uterine tenderness
- Hypovolemia
- Abnl fetal HR
US only 50% accurate
Signs of fetal distress on toco monitor are often the earliest indicator
- decelerations, tachycardia, bradycardia, and loss of variability
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 - compromises blood flow to uterus leading to decreased fetal O2 delivery
- Monitor (fetal) all for 4-6hrs -->
- Extend Monitoring to 24hrs, if abnormal 6hr monitoring
- The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes. [1]
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
- Persistent uterine TTP
- Worrisome strip
- Vag bleed
- PROM
- Serious maternal injury
Partial abruption w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)
Abruption = risk DIC
See Also
- Fetal Maternal Hemorrhage (RhoGAM)
- Perimortum C-Section
- Abruption
- Maternal Vitals and Labs in Pregnancy
Sources
- ↑ Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–10.