Trauma in Pregnancy
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 6 December 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
Mom is Scared. You are Scared. Don’t Be Scared.
General Principles
* Evaluate for intimate partner violence in all poorly explained traumas during pregnancy* Get the scans you would order in a non-pregnant patient, even CTs!* Shield the uterus if necessary
Basic Approach to Trauma in Pregnancy
* Step 1: Place mother in left lateral decubitus position* This removes the weight of the uterus OFF the inferior vena cava (IVC)* Can significantly improve patient’s hemodynamics* Step 2: Palpate the fundus* If fundus is palpable at umbilicus, fetus is approximately 20 weeks* Add 1 week of pregnancy for every 1cm above umbilicus* Step 3: Pelvic ultrasound* Primary utility is to reassure mother that baby is OK* Calculate fetal heart rate* Also identifies SOME placental abruptions and pelvic free fluid* Step 4: Obtain type and screen* If mother is Rh NEGATIVE…* Give RhoGAM* Prevents Rh isoimmunization in mothers with Rh positive babies* Step 5: Consult OBGYN for fetal heart monitoring (tocodynamometry)* Best test to rule out placental abruption and uterine irritability* Only necessary if patient is >20 weeks gestational age
Additional Reading
* Trauma Basics (EM Clerkship)* Trauma in Pregnancy (AAFP)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson and thank you for downloading this episode of the EM |
| 0:08.3 | Clerkship Podcast. This is it today. I'm excited. Trauma is almost done. And to be quite honest, |
| 0:17.2 | I'm like super sick of trauma. This week we are going to cover the last part of trauma. |
| 0:24.5 | We're going to cover a quick approach to trauma in the pregnant patient, and then that's it. |
| 0:32.2 | So this is big. And this is scary too, because mom's scared. You're going to be scared, |
| 0:36.7 | but don't be scared. |
| 0:37.7 | It's actually pretty easy. |
| 0:39.0 | If a pregnant patient gets injured, just breathe and do five extra steps. |
| 0:47.7 | It's only five steps. |
| 0:48.6 | It's going to be okay. |
| 0:50.2 | Mother on her side, Pelpe the Fundus, ultrasound type and screen, and then most importantly, Cardiotococytinamometry. |
| 0:59.3 | I think I said that right, which is fetal heart monitoring. |
| 1:03.6 | So let's go through each of these, kind of one at a time. |
| 1:09.7 | You have a pregnant patient that gets injured. |
| 1:13.0 | First step, step one, mother on her side. |
| 1:17.4 | Specifically, you want to put the mother in the left lateral decubitous position. |
| 1:22.0 | This is especially important in the third trimester when that big baby can basically lay |
| 1:27.4 | on the IVC and then it |
| 1:29.4 | cuts off half of the heart's blood from preloading. In trauma, that's pretty much enough to kill |
| 1:35.9 | somebody who's kind of on the edge and has lost a lot of blood already. So all pregnant women, |
| 1:41.1 | especially in the third trimester, need to be placed in the left lateral decubitous position. |
| 1:47.2 | You need to roll that uterus off the inferior vina cava. |
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