Trauma In Pregnancy

Question 1

For patients who are pregnant and are being treated as a trauma patient, is it the baby or mother who received the initial treatment priority?

Answer 1

The mother

Question 2

At what week of gestation does the uterus no longer remain an intrapelvic organ?

Answer 2

12 weeks

Question 3

At how many weeks gestation is the uterus at the umbilicus?

Answer 3

20 weeks

Question 4

At how many weeks gestation does the uterus reach the costal margin?

Answer 4

34-36 weeks

Question 5

What happens during the last 2 weeks of pregnancy?

Answer 5

The fundus frequently descends as the foetal head engages with the pelvis

Question 6

What happens to the bowel as the uterus enlarges?

Answer 6

It is pushed upwards so that it lies in the upper abdomen

Question 7

What can an abrupt decrease in maternal intravascular volume result in?

Answer 7

Profound increase in uterine resistance, reducing foetal oxygenation despite normal maternal vital signs

Question 8

What is maximally dilated throughout gestation and is exceptionally sensitive to catecholamine stimulation?

Answer 8

The placental vasculature

Question 9

At what week of gestation does the increasing plasma blood volume plateaus?

Answer 9

34 weeks

Question 10

What does an increase of red blood cells cause?

Answer 10

Decreased haematocrit

Question 11

In a healthy pregnant patient how much blood loss can she have prior to any symptoms of hypovolemia being exhibited?

Answer 11

1.2-1.5l blood loss

Question 12

What clotting factors increase during pregnancy?

Answer 12

White blood cells count and serum fibrinogen

Question 13

After what week of pregnancy does cardiac output increase by 1-1.5L/min because of the increase in plasma volume and decrease in vascular resistance of the uterus and placenta?

Answer 13

10 weeks

Question 14

During which trimester of pregnancy dose the placenta receives 10% of cardiac output?

Answer 14

Third

Question 15

During pregnancy systolic and diastolic pressures fall by how much during the second trimester

Answer 15

5 mmHg to 15 mmHg

Question 16

Why does minute ventilation increase during pregnancy?

Answer 16

Increased tidal volume

Question 17

What is common in late pregnancy?

Answer 17

Hypocapnia

Question 18

Why is it important to maintain adequate arterial oxygenation during resuscitation for pregnant patients?

Answer 18

Oxygen consumption increases during pregnancy

Question 19

What acts as a buffer to direct foetal injury from blunt trauma?

Answer 19

Abdominal wall, uterine myometrium and amniotic fluid

Question 20

How does indirect injury to the foetus occur?

Answer 20

From rapid compression, deceleration, the contrecoup effect or a shearing force resulting in abruptio placentae

Question 21

In early pregnancy, what can absorb a significant amount of energy from penetrating objects, decreasing their velocity and lowering the risk of injury to other viscera?

Answer 21

Dense uterine musculature

Question 22

What can help slow a penetrating object in a pregnant patient?

Answer 22

Amniotic fluid and the foetus

Question 23

What is the foetal outcome when there is penetrating trauma to the uterus?

Answer 23

Generally poor

Question 24

What can you do to relieve uterine compression of the vena cava to stop reduced venous return to the heart, decreased cardiac output and aggravate shock?

Answer 24

Manually displace the uterus to the left side

Question 25

Why can pregnant patients lose a significant volume of blood prior to signs of hypovolemia causing the foetus to become distressed and placenta deprived of oxygen?

Answer 25

Increased intravascular volume

Question 26

What should be used as a last resort in restoring maternal blood pressure because they further reduce uterine blood flow which results in foetal hypoxia?

Answer 26

Vasopressors

Question 27

Why is abdominal examination following trauma in pregnancy critically important?

Answer 27

To quickly identify serious maternal injuries as well as establishing foetal well being

Question 28

What are the 2 leading causes of foetal death?

Answer 28

Maternal shock and death
Placenta abruption

Question 29

When would should you suspect abruptio placentae in a pregnant trauma patient?

Answer 29

Vaginal bleeding
Uterine tenderness
Guarding
Rigidity or rebound tenderness

Question 30

What is the most likely diagnosis in the presence of profound shock following blunt trauma in pregnancy?

Answer 30

Placental abruption