EM · Trauma in pregnancy
Trauma in pregnancy
Pregnant trauma is two patients resuscitated as one. ANZCOR: mother first, manual uterine displacement from 20 weeks, perimortem caesarean in the second half of pregnancy without a mandated start minute. SOGC: electronic fetal monitoring at least 4 hours from 23 weeks, anti-D for every Rh-negative patient, and perimortem caesarean by 4 minutes when possible. ACEM-primary, globally tagged.
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A 32-year-old woman, G2P1 at 32 weeks, arrives an hour after a restrained moderate-speed motor-vehicle collision. BP 100/65, HR 108, abdominal pain and tightenings; CTG shows a baseline of 160 with late decelerations. Two questions: is maternal perfusion adequate, and is there abruption? The late decelerations are a maternal-flow problem first. Manual left uterine displacement, oxygen to saturation greater than 95%, two large-bore upper-limb cannulae, bloods including fibrinogen and Kleihauer, obstetric and neonatal teams now — not a fetal-first caesarean while she is under-resuscitated.[2]
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- [1]Murphy NJ, Quinlan JD. Trauma in pregnancy: assessment, management, and prevention Am Fam Physician, 2014.PMID 25403036
- [2]Jain V, Chari R, Maslovitz S, et al. Guidelines for the Management of a Pregnant Trauma Patient J Obstet Gynaecol Can, 2015.PMID 26334607
- [3]El-Kady D, Gilbert WM, Anderson J, et al. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population Am J Obstet Gynecol, 2004.PMID 15284764
- [4]El Kady D. Perinatal outcomes of traumatic injuries during pregnancy Clin Obstet Gynecol, 2007.PMID 17762411
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- [6]Zelop CM, Einav S, Mhyre JM, et al. Characteristics and outcomes of maternal cardiac arrest: A descriptive analysis of Get with the guidelines data Resuscitation, 2018.PMID 30170022
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- [8]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
- [9]Klinich KD, Flannagan CA, Rupp JD, et al. Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint Am J Obstet Gynecol, 2008.PMID 18395036
- [10]Owattanapanich N, Lewis MR, Benjamin ER, et al. Motor vehicle crashes in pregnancy: Maternal and fetal outcomes J Trauma Acute Care Surg, 2021.PMID 33496550
- [11]American College of Obstetricians and Gynecologists Committee on Obstetric Practice Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation Obstet Gynecol, 2017.PMID 28937575