Trauma in pregnancy

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

Symptoms

1. Vag bleed

2. Cramps/contractions

3. Uterine tenderness

4. Hypovolemia

5. Abnl fetal HR

US only 50% acurate

A. Nonviable fetus (<20-24wks)

    -Standard treatment for trauma

    -Consider RhoGAM

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)

Abrupion = risk DIC

3/29/06 DONALDSON (adapted from Rosen)

Authors: