Trauma For Two-The Paramedic Review of Trauma in the Pregnant Patient

May 7th, 2019

Trauma has become the most frequent cause of death of the OB patient in the United States. Although maternal mortality due to other causes such as infection, hemorrhage, hypertension, and thromboembolism, has declined over the years, the number of maternal deaths due to penetrating trauma, suicide, homicide and motor vehicle accidents has risen steadily. Accidental injuries occur in 6 to 7 % of all pregnant patients. Penetrating trauma accounts for as many as 36 % of maternal deaths.  In this podcast the student will:

1.  review the statistics that deal with death of mother an baby after trauma;

2.  understand the importance of aggressive resuscitation of the mother as a treatment modality;

3.  grasp the role of IV infusion and its effect on the secretion of oxytocin.

Additional Resources

Bosson, Nichole, et al. “Evaluation of Trauma Triage Criteria Performance in a Regional Trauma System.” Prehospital Emergency Care, 2019, pp. 1–10.

 
Cairo, Sarah B., et al. “Prehospital Education in Triage for Pediatric and Pregnant Patients in a Regional Trauma System without Collocated Pediatric and Adult Trauma Centers.” Journal of Pediatric Surgery, vol. 53, no. 5, 2018, pp. 1037–1041.

 
Nawrocki, Philip S., et al. “Interfacility Transport of the Pregnant Patient: A 5-Year Retrospective Review of a Single Critical Care Transport Program.” Prehospital Emergency Care, vol. 23, no. 3, 2018, pp. 377–384.
 
TMM Review
Your patient is a 25 year, 28 week gestational female.  She has been shot twice in the abdomen.  The best course of action for survival of the fetus would be to

  1. apply MAST trousers and inflate the legs only
  2. aggressively resuscitate the mother
  3. infuse 20 cc/kg of normal saline
  4. rapidly transport to the local medical center

The best course of action for the survival of the fetus after any trauma to the mother is to be aggressive in her resuscitation.  Keep in mind that the baby is dependent upon the mother for oxygenation, glucose delivery as well as waste removal.  Any disruption of this could be fatal to the fetus. 

 

A bolus of 20 cc/kg of fluid will stimulate the secretion of what hormone that may help with the reduction of bleeding in the pregnant patient?

  1. Oxytocin
  2. Vasopressin
  3. ADH
  4. Epinephrine

Because it is secreted from the same area of the pituitary gland as is vasopressin (also known as anti diuretic hormone or ADH), the administration of a bolus of fluid will stimulate oxytocin. 

Which of the following is the MOST useful in determining the fetal age?

  1. Fundal height
  2. Abdominal circumference
  3. Conception date
  4. Date of last menses

Determining fetal age is very useful when considering factors that may influence survival of the baby after an early delivery.  The MOST useful as well as the most accurate is the conception date of the fetus, although this may not be known. 

 
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