Slide 2 – Introduction
Trauma in pregnancy is one of the key contributors to maternal and fetal mortality. The potential impediments include maternal injury or death, internal hemorrhage, shock, direct fetal injury, intrauterine fetal demise, uterine rupture and abruptio placentae. The leading causes of obstetric trauma are motor vehicle accidents, assaults, falls, gunshots, and ensuing injuries. Ensuing injuries are classified as pelvic fractures, or penetrating trauma, and blunt abdominal trauma. The assessments and managements aspects of obstetric trauma are distinctive to pregnancy, while initial evaluation and resuscitation is always being directed maternally. If maternal stability is established, then vigilant evaluation of fetal well-being is warranted.
A continuous fetal heart monitoring, computed tomography, ultrasonography, open peritoneal lavage, and exploratory laparotomy that indicates the case of obstetric trauma. In the important effect of trauma on a pregnant woman and her fetus, preventive strategies are vital. The traumatic injuries are common during pregnancy. As reported by the American College of Obstetricians and Gynecologist that one in every 12 pregnancies is complicated by a trauma. When a pregnant patient sustains a traumatic injury, the concern is to the mother and her unborn fetus. There is a change in the pregnancy progresses risk factors for both the mother and the unborn child. For example, earlier in the 13th week of pregnancy, the fetus is well protected and after the 13th week, it becomes less protected and more predominant in the abdomen.
Slide 3 – Physiologic Changes during Pregnancy
There are many physiologic changes during pregnancy. These changes lead to better evaluation and treatment of pregnant women; those who are injured traumatically. During pregnancy, the blood volumes of a woman increased by 45 percent till the end of the pregnancy. Her heart rate increased by 10 to 15 beats per minute or bpm. A decreased in vascular resistance resulted in a decrease in blood pressure. In the later stages, organs are displaced from its original position. The heart is pushed upwards, as the diaphragm. As the fetus grows, the abdominal organs are shifted and the uterus is enlarged. As the uterus enlarges with the growth of the fetus, spinal column curves that result in lower back discomforts.
Slide 4 – Treatment of Trauma in Pregnancy
Emergency care of the pregnant patient with trauma presents a distinctive set of conditions and challenges to the physicians. Pregnancy causes anatomic and physiologic changes that involve organ system in the body that makes treatment of the pregnant trauma patient complex (Desjardins). Other factors that make treatment complex are fear of upsetting the patient, harming the fetus, and lack of experience. The possibility of pregnancy is considered in every woman of reproductive age with trauma. A deep understanding of the pathophysiology of the pregnant trauma patient is aided that deals with the complex problems. In any trauma patient, the trauma resuscitations should be followed to treat the pregnant patient (Edgerly). The mother receives supplemental oxygen; several additional issues are considered to treat the trauma of the patient who is pregnant. For example, in the case of penetrating trauma to the abdomen or a gunshot and stabbing, the fetal mortality is higher than the maternal mortality. In addition to the injuries, it is associated with traumatic events commonly as fractures, pneumothorax, and wide arrays of abdominal injuries; other injuries are considered with the evaluation of a pregnant patient, who experienced traumatic events.
Slide 5 – Abruptio Placentae
Abruptio placentae and uterine rupture are associated with trauma in pregnancy. The abruptio placentae are the premature separation of the placenta from the uterine walls, and the separation is partial or total. With the separation, the bleeding occurs from the uterus and the placenta that placed both mother and fetus at risk. The mother and the fetus loose blood; the fetus suffers hypoxia because the oxygen exchange between the placenta and the uterus is stopped or altered. The abruptio placentae has an abdominal pain, and commonly with vaginal bleeding. It is significant to keep in mind that in some cases, the abruptio placentae occurs without vaginal bleeding. In addition, it is significant to note that there are no direct correlation between the presence of abruptio placentae and the mechanism.
Slide 6 – Uterine Rupture
Uterine rupture sounds; it is the rupturing or tearing of the uterus (Edgerly). The tear is
small that result in a slow bleeding on the abdominal part or severely bleeding. It results in the displacement of the fetus and the placenta in the abdominal cavity. This condition has a high mortality rate for mother and fetus.
Slide 7 – EMS (Emergency Medical Services)
Varieties of anatomic and physiologic changes happened during pregnancy. Generally, there is nominal impact on the health of the mother. However, there is the possibility that Emergency Medical Services or EMS providers are called to help pregnant women. In managing, the pregnant patients present exclusive challenges. EMS cares for the two patients, mother, and her unborn fetus. The quality out-of-hospital care is the express result of a comprehensive education, good judgment, accurate assessment of the patient, and quality improvement in a continuous manner. Every EMS personnel are projected to identify the protocols and understand the reasons for its use. It is necessary that EMS personnel be trained to perform the procedure or treatment.
Slide 8 – EMS assessments
Patient assessment is the vital skill that every EMS should know to do an excellent help. EMS providers need to zero in on complaints, correct diagnose, and proper treatment on the condition of the patient. There are three types of assessment, the Primary assessment, Secondary assessment, and Ongoing assessment. All the three types are important to paramedics to determine the condition of the patient.
Slide 9 – Primary assessment
This is the rapid assessment in EMS toolkit; the first impression made to the patient. To quickly identify the condition that is life threatening and immediately facilitate the treatment to stabilize the patient. It is excellent to do the following: check airway patency or openness, rate, quality, and presence of breathing, and Circulation. Circulation is the blood pressure, pulse, and color, moisture, or temperature of the skin of the patient. In addition, check the major trauma or blood loss, gross deformity, or anything that caused the pain. Do an immediate stabilizing treatment to the patient; determine the core complaint, the necessity for spinal immobilization, and overall impression.
Slide 10 – Secondary assessment
This is the head to toe assessment, a detailed examination physically. This is to check the following in minimal manner: skin color, moisture, and temperature, condition of the eye and pupil using the PERRL acronym the pupils equal, round, and reactive to light, the jugular venous distention or JVD, the neck or trachea condition, rise and fall chest condition, and extremities. EMS providers should extend by looking over from head to toe if there are hidden injuries or appearing not normal in condition. Always remember the DCAP-BLS-TIC acronym to check deformity, contusion, abrasion, penetration, burn, laceration, swelling, tenderness, inflammation, and crepitus.
Slide 11 – Ongoing assessment
This is to determine the baseline presentation of the patient and make a work field diagnosis. This assessment is used to monitor any changes in the condition of the patients, the good or bad progressions. For example, asking the patient if he is feeling good or feeling worse. It is necessary to recheck the vital organs, or redo the entire secondary assessment to assure a close monitor for any changes. It is to recheck the vital organs every five to ten minutes for compromised patients and ten to fifteen minutes for a stable patient.
Slide 12 – The Importance of Airway Monitoring
During an assessment, it is required to have a continuous airway monitoring and to assure that the paramedics have the capability to identify closely the condition of the patient. It is important to use the advanced airway management and rapid sequence of intubation in the pre-hospital with trauma. On-road paramedics can apply the basic airway management; it is utilized unless the patient is unconscious, and in this case, an advanced airway management is used or laryngeal mask insertion is authorized, as well.
Slide 13 – C-Spine
This is to assess the need of the patient or trauma victims for full immobilization who injured their neck. The effort to reduce patient discomfort and the strain on the EMS and hospital systems, a decision aid to immobilize victims is used by paramedics in the field. Standard pre-hospital practice includes frequent immobilization of blunt trauma patients, based solely on mechanism. Cervical spine (c-spine) immobilization has disadvantages that include morbidity such as low back pain and splinting, an increased scene time and costs, and patient-paramedic conflict.
Slide 14 – Treatment of Trauma in Pregnancy
Emergency care of the pregnant patient with trauma presents a distinctive set of conditions and challenges to the physicians. Pregnancy causes anatomic and physiologic changes that involve organ system in the body that makes treatment of the pregnant trauma patient complex. Other factors that make treatment complex are fear of upsetting the patient, harming the fetus, and lack of experience. The possibility of pregnancy is considered in every woman of reproductive age with trauma. A deep understanding of the pathophysiology of the pregnant trauma patient is aided that deals with the complex problems. In any trauma patient, the trauma resuscitations should be followed to treat the pregnant patient. The mother receives supplemental oxygen; several additional issues are considered to treat the trauma of the patient who is pregnant. For example, in the case of penetrating trauma to the abdomen or a gunshot and stabbing, the fetal mortality is higher than the maternal mortality. In addition to the injuries, it is associated with traumatic events commonly as fractures, pneumothorax, and wide arrays of abdominal injuries; other injuries are considered with the evaluation of a pregnant patient, who experienced traumatic events.
Slide 15 – Video
Please click the link; http://www.youtube.com/watch?v=XoeIos_HH0k
Slide 16 - Reference
Colwell, Chris, Paul Murphy and Tamara Bryan. Prehospital Management of the Pregnant
Patient. 1 March 2004.
Desjardins, Georges. Management of the Injured Pregnant Patient. Miami, FL, 2013.
Edgerly, Dennis. Tips for Assessing Pregnant Trauma Patients. 13 April 2011.
Tsuei, Betty J. "Assessment of the pregnant trauma patient." INJURY: International Journal of
the Care of the Injured 37 (2005): 367—373.