International Trauma Life Support
International Trauma Life Support
Trauma in
Pregnancy
CHAPTER 19
International Trauma Life Support for Emergency Care Providers, Eighth Edition
John Campbell • Alabama Chapter, American College of Emergency Physicians
Trauma in Pregnancy
• Unique challenges
– Vulnerability of pregnant trauma patient
– Potential injuries to unborn child
• Dual roles
– Provide care to mother
– Provide care to fetus
• Respiratory system
– Diaphragm elevated due to uterine size
– Decreased thoracic volume
– Relative alkalosis
– Predisposed to hyperventilation
• Anemia in pregnancy
• Absolute anemia
• Decreased gastric mobility
• Transport position
– Elevate right hip 4–6 inches (10–15 cm)
with towel
– If SMR and backboard needed, tilt or
rotate backboard 15–30° to patient’s
left
– Manually displace
uterus to left
• Transport position
– Better stabilized
with vacuum
backboard
– More comfortable
than standard
backboard
• Motor-vehicle collisions
• Penetrating injuries
• Domestic violence
• Falls
• Burns
• Physiologic changes
– Decreased sensitivity
Gradual stretching
Hormonal changes
Uterus very vascular
• Clinical presentation
– Guarding, rigidity, rebound response
absent
Abdominal trauma requires ED evaluation
• No exposure to radiation
• Rapid assessment
• Assess both mother and fetus
• Trauma in pregnancy
– Knowledge of physiological changes
Hypotension and hemorrhage easily
overlooked
– Rapid evaluation and interventions to
stabilize
Aggressive oxygen administration
Aggressive fluid resuscitation
– Prevent supine hypotension
• Fetal care depends on maternal care