Trauma and Obstetrics
8/10/10
SP Notes
-
OH
- leading cause of non-obstetric maternal mortality -> also has a high chance of fetal loss
- ATLS approach (primary and secondary survey) including safe transport to trauma centre with obstetric care.
80% of women who survive haemorrhagic shock experience fetal death
Additional issues: anatomical and physiological changes of pregnancy
pregnancy specific complications
foetal issues
ANATOMICAL AND PHYSIOLOGICAL CHANGES IN PREGNANCY
aspiration risk
potentially difficult intubation (narrow airway, oedematous, bleeds easily, increased risk of
CICV)
may require: RSI with skilled staff, in-line stabilisation and have DA equipment
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smaller FRC c/o gravid uterus, high O2 consumption -> decreased apnoeic supply physiological respiratory alkalosis, with comp metabolic acidosis -> a PaCO2 of 35-40 may already indicate respiratory failure.
give additional high flow oxygen.
if intubated - controlled ventilation
fetus may not tolerate permissive hypercapnoea c/o increasing acidosis
physiologically lower SBP and DBP, lower SVR, increased HR and increased CO - must be
taken into account on evaluation physiologic anaemia and increased blood volume - may loose 1.2 - 1.5 L of blood volume before showing signs of hypovolaemia
avoid aortocaval compression syndrome - keep in L lateral position
- Rh compatible transfusions. Rh neg mothers will need Ig for the immunological risk of fetomaternal haemorrhage -> - Rh Ig 300g for all Rh D negative women within 72 hours
ECG changes: L axis, flat or inverted T waves, ectopics
- FAST scan/USS can be difficult c/o gravid uterus
- give blood early
- radiology: remember foetal exposure but generally can be done (more care in first trimester)
Jeremy Fernando (2011)

- uterus extrapelvic from week 12 - cephalad movement of bowel
PREGNANCY SPECIFIC ISSUES
- monitor baby (CTG)
- place chest drains slightly higher than normal c/o cephalad movement of diaphragm
- Kleihauer-Betke test can detect fetal blood in maternal circulation (can estimate volume of transplacental haemorrhage)
look for: retroperitoneal haemorrhage / placental abruption / foetal distress / premature labour / AFE / DIC / uterine rupture
pelvic binders in pelvic fracture may be unsuitable
FOETAL ISSUES
Call for help early - O&G, paeds and anaesthetics
continuous foetal monitoring with CTG (depending on gestational age, > 20 weeks)
intrauterine resuscitation: foetal oxygenation dependent on mothers oxygenation/ventilation and CO / uterine perfusion
maternal compensation for blood loss is at the expense of uteroplacental flow
Jeremy Fernando (2011)