Podcast
Questions and Answers
What should be done first if major primary survey problems are present in a patient?
What should be done first if major primary survey problems are present in a patient?
Why is it important to transport a pregnant woman beyond 20 weeks gestation in a lateral position?
Why is it important to transport a pregnant woman beyond 20 weeks gestation in a lateral position?
In the case of significant decreased consciousness in a pregnant woman, what intervention is necessary?
In the case of significant decreased consciousness in a pregnant woman, what intervention is necessary?
What key information should be gathered regarding the pregnancy during assessment?
What key information should be gathered regarding the pregnancy during assessment?
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What is the first step in managing a pregnant woman exhibiting signs of shock?
What is the first step in managing a pregnant woman exhibiting signs of shock?
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What aspect should be prioritized in the transportation of a pregnant woman experiencing complications?
What aspect should be prioritized in the transportation of a pregnant woman experiencing complications?
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What should be included in the ePCR documentation when managing a pregnant woman?
What should be included in the ePCR documentation when managing a pregnant woman?
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When assessing the capacity of a pregnant patient and gaining consent, what is paramount?
When assessing the capacity of a pregnant patient and gaining consent, what is paramount?
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What condition is considered the leading indirect cause of maternal death?
What condition is considered the leading indirect cause of maternal death?
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At what stage of pregnancy does the risk of compression of the inferior vena cava become significant?
At what stage of pregnancy does the risk of compression of the inferior vena cava become significant?
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Which vital sign change is typically the first to occur in response to a traumatic incident in a maternity patient?
Which vital sign change is typically the first to occur in response to a traumatic incident in a maternity patient?
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What is the primary aim of manual displacement in the management of maternal cardiac arrest?
What is the primary aim of manual displacement in the management of maternal cardiac arrest?
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What physiological change occurs during pregnancy related to blood volume?
What physiological change occurs during pregnancy related to blood volume?
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In the SBAR communication method, what does the 'R' stand for?
In the SBAR communication method, what does the 'R' stand for?
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What is a common cause of maternal trauma that holds a high risk for placental abruption?
What is a common cause of maternal trauma that holds a high risk for placental abruption?
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Which of the following should be included in the background portion of the SBAR communication?
Which of the following should be included in the background portion of the SBAR communication?
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Which of the following signs indicates the last vital change to occur in trauma situations for maternity patients?
Which of the following signs indicates the last vital change to occur in trauma situations for maternity patients?
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What action should be taken if maternal trauma and cardiac arrest occur?
What action should be taken if maternal trauma and cardiac arrest occur?
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How is NEWS2 applicable when assessing maternity patients?
How is NEWS2 applicable when assessing maternity patients?
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Which of the following factors should be considered due to the altered physiology in maternity patients?
Which of the following factors should be considered due to the altered physiology in maternity patients?
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What should always be considered when domestic or sexual abuse is suspected in a maternity trauma case?
What should always be considered when domestic or sexual abuse is suspected in a maternity trauma case?
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What is one of the primary considerations when managing a patient in cardiac arrest who is visibly pregnant?
What is one of the primary considerations when managing a patient in cardiac arrest who is visibly pregnant?
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Which of the following describes a necessary step in managing a maternal patient with suspected abuse?
Which of the following describes a necessary step in managing a maternal patient with suspected abuse?
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What is emphasized regarding calling for additional help in maternity emergencies?
What is emphasized regarding calling for additional help in maternity emergencies?
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What does the acronym 'IOL' refer to in maternal care?
What does the acronym 'IOL' refer to in maternal care?
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How is parity defined in maternity terminology?
How is parity defined in maternity terminology?
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Which of the following best describes 'VBAC'?
Which of the following best describes 'VBAC'?
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What does 'PP' indicate in a maternal context?
What does 'PP' indicate in a maternal context?
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Which of the following conditions is denoted by the acronym 'PIH'?
Which of the following conditions is denoted by the acronym 'PIH'?
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Study Notes
Maternal Trauma and Cardiac Arrest
- Cardiac disease is the leading indirect cause of maternal death in the UK; exacerbated by pregnancy.
- Trauma accounts for 5% of maternal deaths; most fatalities occur within 42 days postpartum.
- Maternal mortality in London is double the national average.
Maternal Considerations in Trauma
- Inferior vena cava compression risk increases after 20 weeks of gestation, necessitating manual uterine displacement.
- Signs of shock may not appear until more than 35% blood volume is lost.
- High risk of placental abruption can arise 3-4 days after trauma.
- Consider potential safeguarding issues if domestic or sexual abuse is suspected.
Maternal Physiology Changes
- Blood volume and cardiac output increase by 50% during pregnancy.
- Blood pressure typically decreases by 10 mmHg.
- The growing uterus can compress major blood vessels, potentially complicating airway management.
Assessment and Monitoring
- NEWS2 scoring is not validated for pregnant patients; abnormal vital signs indicate late-stage deterioration.
- Lower threshold for transferring maternity patients compared to general population standards.
Red Flags in Maternity Trauma
- Increased respiratory rate (>21) and heart rate (>110) are early indicators of distress.
- Other critical signs include abdominal pain, vaginal bleeding, reduced fetal movements, and hypotension.
Management Protocols
- Use DR CAcBCDE guidelines: address problems, don PPE, and consider police involvement if necessary.
- Major survey issues are time-critical; transport rapidly for hemodynamic instability with blue light transfer.
- Collect additional history related to abdominal pain, vaginal bleeding, pregnancy complications, and fetal movements.
Patient Transport Considerations
- Pregnant patients over 20 weeks should be transported in a lateral position to mitigate aortocaval compression.
- Use manual displacement of the uterus if consciousness is significantly decreased and maintain displacement.
Advanced Clinical Interventions
- Seek advanced clinical assistance for any sign of shock; prioritize rapid transfer to an obstetric unit if needed.
- Do not delay on scene for assistance if patient needs immediate care.
Maternal Cardiac Arrest Causes
- Commonly triggered by heart failure, hypovolaemia, anaphylaxis, embolism, or sepsis.
Management for Cardiac Arrest
- For patients over 20 weeks, implement manual displacement and ALS protocols immediately.
- Early engagement of critical care teams is vital to enhance chances of return of spontaneous circulation (ROSC).
Communication Protocol (SBAR)
- Situation: Clearly state your identity and the alert level concerning the patient.
- Background: Provide a concise history and risk status.
- Assessment: Conduct an A-G Assessment with clinical impressions.
- Recommendations: Clearly indicate immediate needs or actions required.
Additional Notes
- Urgent datix is necessary for maternal trauma and cardiac arrest cases for rapid maternity team assessment.
- Engage with available resources for further training and updates including Fire Safety guidelines, maternity webinars, and relevant reports.
Summary
- Recognize altered physiology in maternity patients; late signs of deterioration are common.
- Be aware of systemic pressures from pregnancy, including a large uterus and elevated cardiac output.
- Always consider safeguarding referrals for suspected abuse.
- Request assistance early but prioritize patient safety over waiting for additional resources.
Maternal Acronyms
- Gravida (G): Total count of pregnancies, including the current one.
- Parity (P): Number of births after 24 weeks, including live or stillborn; twin births count as one event.
- Gestation (Gest): Refers to the duration of the pregnancy.
- Induction of Labour (IOL): A medical intervention to stimulate childbirth.
- Assisted Rupture of Membranes (ARM): A procedure to intentionally rupturing the amniotic sac.
- Female Infant / Male Infant (FI / MI): Classification of newborns by sex.
- Lower Segment C Section (LSCS): A surgical procedure for delivering a baby through the lower segment of the uterus.
- Emergency C Section (EmCS): A C-section performed under urgent circumstances.
- Elective C Section (ElCS): A planned C-section that is scheduled in advance.
- Vaginal Birth after Caesarean (VBAC): A vaginal delivery attempt following a previous C-section; associated with scar dehiscence risk.
- Trial of Scar (TOS): An attempt at VBAC while monitoring the integrity of the previous surgical scar.
- Pre-eclampsia Toxaemia (PET): A pregnancy complication characterized by high blood pressure and signs of damage to another organ system.
- Pregnancy Induced Hypertension (PIH): High blood pressure that develops during pregnancy.
- Intra-uterine Death (IUD): The death of a fetus during the second or third trimester.
- Still Birth (SB): The birth of a baby that has died in the womb after 24 weeks.
- Neonatal Death (NND): The death of a live-born baby within the first 28 days of life.
- Group B Strep infection (GBS): A bacterial infection that can be passed from mother to baby during childbirth.
- Breech Presentation (Br): A birth position where the baby is positioned to deliver buttocks or feet first.
- Transverse Lie (Trans): A fetal position where the baby lies sideways in the uterus.
- Cephalic / Vertex Presentation (Ceph): The most common position for delivery, where the baby is head down.
- Occiput Posterior (OP): A position where the baby’s back is facing the mother's back (back-to-back).
- Occiput Anterior (OA): A favorable position for delivery with the baby’s face facing the mother’s back.
- Placenta Previa (PP): A condition where the placenta partially or completely covers the cervix.
- Normal Vaginal Delivery (NVD): The typical birth process through the vaginal canal.
- Spontaneous Rupture of Membranes (SROM): The natural breaking of the amniotic sac during labor.
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Description
This quiz covers the critical aspects of maternal trauma, including anatomy, physiology, and the specific assessment and management of pregnant patients in distress. It highlights key modifications needed for effective care in traumatic situations and during cardiac arrest. Suitable for health professionals aiming to enhance their knowledge in maternal health emergencies.
