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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
- This removes the weight of the uterus OFF the inferior vena cava (IVC)
- 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
- Primary utility is to reassure mother that baby is OK
- Step 4: Obtain type and screen
- If mother is Rh NEGATIVE…
- Give RhoGAM
- Prevents Rh isoimmunization in mothers with Rh positive babies
- If mother is Rh NEGATIVE…
- 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)
I’m an NP working ER for 12yrs. Generally, we don’t have formal ER rotations in our educational programs, but tons of ERs utilize us. Hired into ER, we tend to learn peicemeal and creates a disjointed patchwork of a working knowledge base. We depend on thoughtful articulate concerned ER attendings to teach us same as juniors/residents in most settings, as well as Texts. It’s especially important when we staff outlying rural clinics…
Your podcast fills this role also very well. Just getting the overall approach and reasons in a quick 10min lesson with rationale icing on top for understanding is invaluable.
Thank you so much and I recommend you address your NP and PA audience too as this is a market tailored made with the needs your content fills.
Kirby in austin TX
Wow, you have more experience than me! We should have you on the show sometime. Shoot me an email if you are interested.