Trauma in pregnancy: Difference between revisions
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===Abnormal Monitoring=== | ===Abnormal Monitoring=== | ||
#>3 contractions/hr | #>3 contractions/hr | ||
# | #Persistent uterine TTP | ||
# | #Worrisome strip | ||
#Vag bleed | #Vag bleed | ||
#PROM | #PROM | ||
#Serious maternal injury | #Serious maternal injury | ||
Partial | Partial abruption w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section) | ||
Abruption = risk DIC | |||
==See Also== | ==See Also== |
Revision as of 23:02, 9 January 2014
Background
- Concern for trauma, premature labor, and abruption
- Viable = >23-24wk (~fundus above umbilicus)
- nl FHR = 110-160 beats/min
- The leading cause of death in women during their reproductive years
- The leading non-obstetric cause of death and disability in pregnant women
- Trauma or accidental injury complicates up to 7% of all pregnancies
- For maternal vitals see Maternal Vitals and Labs in Pregnancy
Diagnosis (Abruption)
Symptoms
- Vag bleed 70%
- Cramps/contractions
- Uterine tenderness
- Hypovolemia
- Abnl fetal HR
US only 50% acurate
Treatment & Disposition
- Nonviable fetus (<23-24wks)
- Standard treatment for trauma
- Consider RhoGAM 50mcg in rh neg
- Viable fetus (>23-24wks)
- Consider RhoGAM 300mcg in rh neg
- Avoid pressors
- Monitor (fetal) all for 4-6hrs -->
- Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring
Risk Factors (ATLS)
- Maternal heart rate > 100
- Injury Severity Score > 9
- Evidence of placental abruption
- Fetal heart rate > 160 or <120
- Ejection during a motor vehicle crash
- Motorcycle or pedestrian collisions
Abnormal Monitoring
- >3 contractions/hr
- Persistent uterine TTP
- Worrisome strip
- Vag bleed
- PROM
- Serious maternal injury
Partial abruption w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)
Abruption = risk DIC
See Also
- Fetal Maternal Hemorrhage (RhoGAM)
- Perimortum C-Section
- Abruption
- Maternal Vitals and Labs in Pregnancy
Source
3/29/06 DONALDSON (adapted from Rosen)