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Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
Trauma & Pregnancy
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Trauma & Pregnancy

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LTC Brenda Sowards, Chief Nurse, …

LTC Brenda Sowards, Chief Nurse,
141st MDG
Washington Air National Guard

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  • 1. TRAUMA AND PREGNANCY LTC Brenda Sowards, Chief Nurse, 141 st MDG Washington Air National Guard
  • 2. Epidemiology
    • Trauma is the leading cause of death in women during reproductive years
    • The leading nonobstetric cause of death and disability in pregnant women
    • Resuscitation priorities are the same
    • Obtain early OB consult
    Proper seat belt placement Improper seat belt placement
  • 3. Mechanisms of Injury and Biomechanics
    • Blunt trauma most frequent cause of maternal and fetal injury (motor vehicle crashes, falls)
    • Gun shot wounds most common penetrating
    • Stab wounds less common
    (Used with permission from Good Samaritan Hospital. Downers Grove, IL.)
  • 4. Types of Injuries
    • Head injury: Major cause of maternal death
    • Pelvic fractures can result in severe hemorrhage and fetal death
    • Other injuries
      • Diaphragmatic tear
      • Urinary bladder injury
      • Uterine injury
      • Fetal injury
  • 5. Cardiovascular Changes
    • Hypervolemic (by 10th week)
    • Hyperdynamic (increased cardiac output)
    • “ Anemia” of pregnancy
    • Increased heart rate
    • Decreased systolic and diastolic pressures
    • Hypertension may indicate OB complication
    • Fetus compromised with maternal blood loss (15 to 30%)
  • 6. Respiratory Changes
    • Tidal volume increased by 40%
    • Vital capacity increased 100 to 200 ml
    • Respiratory rate increased slightly
    • Arterial blood gases reflect compensated respiratory alkalosis due to hyperventilation
      • PaCO 2 : 30 mm Hg (4.0 KPa)
      • PaO 2 : 101 to 104 mm Hg (13.5 to 13.9 KPa)
    • Decreased functional residual capacity
  • 7. Abdominal Changes
    • Physiologic ileus: Decreased gastric motility
    • Vomiting/aspiration: Increased emptying time due to hormonal changes
    • Rebound tenderness decreased
    • Abdominal guarding decreased
  • 8. Urinary Changes
    • Urinary frequency: Increased glomerular filtration and increased pressure of uterus on bladder
    • Bladder elevated out of pelvis (late pregnancy)
    • Glycosuria (not proteinuria)
  • 9. Neurologic Changes
    • Pregnancy induced hypertension (PIH)
      • Increased blood pressure
      • Proteinuria
      • Edema
      • May result in seizures
    • Can mimic head injury
  • 10. Musculoskeletal Changes
    • Pelvis less susceptible to fractures
    • Relaxation of sacroiliac (SI) joint: Hormonal changes
    • Symphysis pubis widened 4 to 8 mm (3rd trimester)
  • 11. Premature Labor
    • Most frequent complication: Maternal injury
    • Signs and Symptoms
      • Uterine contractions greater than 6 per hour
      • Patient may or may not sense contractions
      • Back pain
      • Vaginal discharge
      • Cervical dilation or effacement
  • 12. Premature Labor (Used with permission from Good Samaritan Hospital. Downers Grove, IL.)
  • 13. Abruptio Placenta
    • Partial or total separation of placenta from uterine wall
    • Signs and Symptoms
      • Vaginal bleeding (absent if retroplacental)
      • Uterine tenderness
      • Premature labor
  • 14. Abruptio Placenta
    • Signs and Symptoms (continued)
    • Abdominal cramps
    • Maternal hemorrhage (shock)
    • Fetal distress
    • Increasing fundal height
    (Used with permission from Barbara Bires, Dayton, OH)
  • 15. Uterine Rupture
    • Seen in patients with extreme compression injury
    • Rare
    • History of cesarean section
    • Associated with bladder rupture
    • Fetal demise
    • Surgery: Hysterectomy
  • 16. Uterine Rupture
    • Signs and Symptoms
    • Abdominal pain
    • History of acute pain followed by no pain
    • Uterine tenderness
    • Difficulty identifying fundal height
    • Vaginal bleeding
    • Maternal hemorrhage and shock
    • Absent fetal heart tones
  • 17. Maternal Cardiopulmonary Arrest/Fetal Delivery
    • Successful outcome for fetus if:
      • Procedure within 5 minutes of arrest (70% fetal survival)
      • There is viable fetal gestational age ( > 26 weeks)
      • Continuation of CPR throughout cesarean section
      • Availability of a neonatal resuscitation team
      • Correction of maternal acidosis
  • 18. Nursing Care - Assessment
    • History
    • What was the mechanism of injury?
    • Was the patient wearing a restraint device?
    • Last menstrual period (LMP)?
    • Estimated date of confinement (EDC)?
  • 19. Nursing Care - Assessment
    • History (continued)
    • Problems or complications during this or other pregnancies?
    • Are uterine contractions or abdominal pain present?
    • Is there fetal activity?
  • 20. Nursing Care - Physical Assessment
    • Inspect
      • Perineum
      • Vaginal opening
    • Observe
      • Shape and contour of the abdomen
      • Abdomen for signs of fetal movement
  • 21. Nursing Care - Physical Assessment
    • Auscultation
    • Fetal heart tones (120 to 160 beats/min)
    • Maternal pulse and discriminate between the two pulses
  • 22. Nursing Care - Physical Assessment
    • Palpation
    • Height of fundus
      • Symphysis pubis: 12 weeks
      • Umbilicus: 20 weeks
      • Costal margins: 36 weeks
    (Reprinted with permission from Foundations of Maternal Newborn Nursing . WB Saunders; 1994.)
  • 23. Diagnostic Procedures
    • Radiographic Studies
      • Shield fetus from unnecessary radiographs
      • Intravenous pyelogram (IVP)
      • Computerized tomography scan
      • Ultrasonography
  • 24. Diagnostic Procedures
    • Laboratory Studies
      • Type and crossmatch
      • Bicarbonate and lactate
      • PT and PTT
      • Beta Human Chorionic Gonadotropin (BHCG)
      • Kleihauer-Betke Test
  • 25. Diagnostic Procedures
    • Other Procedures
      • Diagnostic peritoneal lavage
      • Pelvic exam
      • Monitor fetal heart tones (FHT) and rate
      • Monitor uterine contractions
      • Amniocentesis
  • 26. Nursing Diagnoses
    • Aspiration risk
    • Impaired gas exchange
    • Altered tissue perfusion
    • Fluid volume deficit
    • Infection risk
    • Anxiety and fear
    • Anticipatory grieving
    • Pain
  • 27. Planning and Implementation
    • Oxygen
    • Intravenous fluids
    • Maternal vital signs
    • Uterine contractions
    • Uterine/vaginal blood loss
    • Measure and record fundal height every 30 minutes
  • 28. Planning and Implementation
    • Insert gastric tube
    • Position on left side
    • Tilt backboard or displace uterus to the left
    • Administer medications to inhibit contractions
    • Obtain OB consult
    • Prepare for operative intervention, admission, or transfer
    • Provide psychosocial support
  • 29. Evaluation and Ongoing Assessment
    • Monitor maternal cardiovascular status for evidence of shock
    • Assess abdomen and uterine activity
    • Monitor fetal activity and heart rate
  • 30. Summary

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