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Questions and Answers
What percentage of maternal deaths in the UK are attributed to trauma?
What percentage of maternal deaths in the UK are attributed to trauma?
What position should a conscious woman over 20 weeks pregnant be transported in if compromised?
What position should a conscious woman over 20 weeks pregnant be transported in if compromised?
What physiological change occurs in blood pressure during pregnancy?
What physiological change occurs in blood pressure during pregnancy?
What is the primary concern when assessing a pregnant woman with a significant decreased level of consciousness?
What is the primary concern when assessing a pregnant woman with a significant decreased level of consciousness?
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When managing a pregnant trauma patient, what is a common delay in clinical signs of shock?
When managing a pregnant trauma patient, what is a common delay in clinical signs of shock?
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Which of the following is a critical step if a pregnant woman is exhibiting signs of shock?
Which of the following is a critical step if a pregnant woman is exhibiting signs of shock?
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Which vital sign is the first to change during a primary survey in a pregnant trauma patient?
Which vital sign is the first to change during a primary survey in a pregnant trauma patient?
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What should be monitored closely in a pregnant woman during transport?
What should be monitored closely in a pregnant woman during transport?
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What should be considered if domestic or sexual abuse is suspected in a maternity patient?
What should be considered if domestic or sexual abuse is suspected in a maternity patient?
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What action should be taken first if major primary survey problems are identified?
What action should be taken first if major primary survey problems are identified?
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How is the inferior vena cava affected in a pregnant patient after 20 weeks gestation?
How is the inferior vena cava affected in a pregnant patient after 20 weeks gestation?
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What is the impact of emergency assessment tools like NEWS2 in pregnancy?
What is the impact of emergency assessment tools like NEWS2 in pregnancy?
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What condition should prompt the use of a maternal assessment card?
What condition should prompt the use of a maternal assessment card?
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What must be documented on the electronic patient care record (ePCR) when implementing Manual Uterine Displacement?
What must be documented on the electronic patient care record (ePCR) when implementing Manual Uterine Displacement?
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What physiological change occurs in blood volume during pregnancy?
What physiological change occurs in blood volume during pregnancy?
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What is a serious implication of administering oxygen as per JRCALC without assessing the patient's condition?
What is a serious implication of administering oxygen as per JRCALC without assessing the patient's condition?
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What is the primary aim of interventions such as manual displacement and ALS in cases of cardiac arrest during pregnancy?
What is the primary aim of interventions such as manual displacement and ALS in cases of cardiac arrest during pregnancy?
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Which vital component should be included in the SBAR communication framework when handing over a maternal trauma case?
Which vital component should be included in the SBAR communication framework when handing over a maternal trauma case?
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What should be done urgently following a maternal trauma and cardiac arrest in terms of reporting?
What should be done urgently following a maternal trauma and cardiac arrest in terms of reporting?
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What physiological changes should be considered when managing maternity patients in emergency settings?
What physiological changes should be considered when managing maternity patients in emergency settings?
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In the context of managing obstetric emergencies, what is a key reason to make safeguarding referrals?
In the context of managing obstetric emergencies, what is a key reason to make safeguarding referrals?
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What is a significant risk in delaying the call for help while managing an emergency in a pregnant patient?
What is a significant risk in delaying the call for help while managing an emergency in a pregnant patient?
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Which of the following best describes the physiological signs and symptoms of decompensation in maternity patients?
Which of the following best describes the physiological signs and symptoms of decompensation in maternity patients?
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What is the suggested action regarding the management of critically ill maternity patients after 20 weeks gestation?
What is the suggested action regarding the management of critically ill maternity patients after 20 weeks gestation?
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Study Notes
Maternal Trauma and Cardiac Arrest
- Cardiac disease is the leading indirect cause of maternal death in the UK.
- Pregnancy exacerbates pre-existing cardiac conditions.
- 5% of maternal deaths are caused by trauma.
- Maternal mortality in London is double national rates.
- Most deaths occur in the early post-natal period (within 42 days of birth).
Maternal Considerations in Trauma
- Risk of compression of inferior vena cava after 20 weeks gestation.
- Manual uterine displacement is required to decompress the vena cava.
- Signs of shock in pregnant women may be delayed.
- Hypovolemia may not be clinically evident until >35% blood volume loss.
- High risk of placental abruption, which can occur up to 3-4 days after trauma.
- Falls, road traffic collisions, and assaults are the most common causes of maternal trauma.
- Domestic and sexual abuse must be considered and reported if suspected.
Maternal Physiology
- Blood volume and cardiac output increase by 50% during pregnancy.
- Blood pressure decreases by 10mmHg.
- Growing uterus compresses the aorta and the inferior vena cava.
- Vessels retain fluid leading to potential edema in the larynx, which can result in a difficult airway.
- NEWS2 is not validated for use in pregnancy.
- Pregnant women compensate well for physiological changes, making abnormal observations a late sign of deterioration.
- A lower threshold for conveyance is required for maternity patients compared to the general population.
Red Flags
- Increased respiratory rate (>21 breaths per minute) is the first vital sign change to occur.
- Increased heart rate (>110 beats per minute).
- Abdominal pain.
- Vaginal blood loss.
- Reduced fetal movements.
- Hypotension (the last vital sign change to occur).
Management
- Implement DR CAcBCDE, correcting any problems and donning relevant PPE.
- Request police assistance if required, and consider calling for paramedic, HEMS assistance, and a second crew.
- Look for major primary survey problems (time critical) and haemodynamic compromise (undertake blue light transfer with pre-alert).
- Assess patient capacity and gain consent.
- Examine the abdomen for external injuries.
- Administer oxygen as per JRCALC.
- Monitor vital signs and ECG.
- Apply relevant dressings at an appropriate time.
- Provide analgesia as required, such as Entonox.
- Consider other injuries.
- Transport to an appropriate hospital using major trauma tree (Step 4) and maternal assessment card.
- Bring the patient’s notes if available.
Optimisation
- Any conscious woman >20 weeks pregnant should be transported in a lateral position if compromised.
- When fully immobilised, the stable woman should be tilted to the left or right on the long board.
Manual Uterine Displacement
- Manual uterine displacement should be utilized if the woman has a significant decrease in level of consciousness.
- Displacement should be maintained on the left side and documented in the ePCR.
- Call for a second crew early to assist with maintaining displacement.
Additional History Required
- Assess for abdominal pain, location, constancy, vaginal blood loss (revealed/concealed), gestational age, fundal height, any complications during pregnancy, timing of last fetal movements, and availability of pregnancy notes.
Advanced Clinical Interventions
- Early call for help (paramedic/APP) or immediate transfer to an obstetric unit, ED, or MTC is required if a pregnant woman exhibits signs of shock.
- Do not delay on scene waiting for assistance.
Maternal Cardiac Arrest
- Causes of maternal cardiac arrest include heart failure, hypovolemia, anaphylaxis, embolism, and sepsis.
Cardiac Arrest Management
- In pregnancies over 20 weeks (visibly pregnant or fundus palpable at umbilicus), perform manual displacement, ALS, and early call to critical care and HEMS.
- Aim is to increase the probability of ROSC by reducing aortocaval compression and saving the mother.
Communication
- Utilize SBAR (Situation, Background, Assessment, Recommendation) for all hand-over communications.
- Provide clear and concise information about the patient's situation, background history, assessment, and recommendations.
Datrix
- All maternal traumas and cardiac arrests require an urgent Datrix for a rapid review by the maternal hospital team.
Further Information:
- JRCALC PLUS
- Maternity Lead CTMs
- Monthly maternity webinars
- The Pulse - Maternity page
- Maternity Care Policy
- MBRRACE reports: www.npeu.ox.ac.uk/mbrrace-uk
Summary
- Pregnant patients have altered physiology, and signs and symptoms can be a late indication of decompensation.
- Remember the pressures of pregnancy (large uterus, higher cardiac output).
- Make a safeguarding referral whenever abuse is suspected.
- Call for assistance early and consider the balance of risk when waiting for delayed resources.
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Description
This quiz explores the critical aspects of maternal trauma and its implications on cardiac health during pregnancy. It covers statistics, physiological changes, and the risks associated with trauma in pregnant women. Additionally, it addresses the importance of timely intervention and awareness of domestic and sexual abuse.
