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Trauma in
pregnancy (Types (Placental abruption
Deceleration injury can…
Trauma in
pregnancy
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Pathophysiology
Anatomy in pregnancy
Bony pelvis less likely to fracture
Uterus and bladder out of pelvis so increased injury risk
Increased vascularity of retroperitoneum (haemorrhages)
Diaphragm lies higher (damage in chest trauma)
Pituitary doubles in size (risk of infarction)
Physiology
May tolerate up to 35% blood loss before shock by compromising the foetal circulation
High venous pressure so inc bleeds from peripheral wounds
May get supine hypotension
Increased O2 demand and reduced functional reserve, so hypoxia develops quickly
Coagulation may be deranged
Risk of gastric regurgitation
Types
Placental abruption
Deceleration injury can shear the placenta from uterus
Haemorrhage and DIC
PR bleeding, uterine tenderness, foetal distress
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Direct foetal injury
Blunt or penetrating trauma direct to foetus
More commonly due to maternal hypoxia/hypovolemia
or placental abruption
Amniotic fluid embolism
Rare
Sudden SOB, syncope, hypotension, seizures and bleeds (DIC)
Diagnosis
Examination
Vaginal: bleeding, membrane rupture
Uterine: palpate foetus, tenderness, contractions
Foetal: heart sounds, rate
Investigations
Bedside
Mother: obs (shock), ECG
Child: cardiotocograph (distress)
Bloods
FBC (anaemia), CRP, U+Es, LFTs,
clotting (may be deranged), group&save,
Rh antigen status, Kleihauer test
Imaging
FAST scan (intra-abdo fluid)
USS (foetal viability, placenta, free fluid)
Erect CXR (gas under diaphragm)
AXR (injuries)
History
PC/HPC: type of trauma, injuries
Gest history: gest age, prev problems
PMH: coagulation disorder etc.
DH: anticoagulants, allergies
SH: smoking, alcohol, drugs
Management
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Definitive
Conservative
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IVC decompression
E.g. 15 degree R lateral (Cardiff) wedge, manual
MOA: IVC decompression to increase
venous return by manually displacing uterus to left
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