Violence and Trauma in Pregnancy

Violence and Pregnancy

• Violence can escalate during pregnancy, increasing risks of spontaneous abortion, premature delivery, and low birth weight.
• Suspect abuse if injury explanations are inconsistent; prioritize patient stability (ABCs), control bleeding, and treat shock.
• Mandatory reporting is required for suspected abuse cases.

Trauma Considerations

• Pregnant women and fetuses are more vulnerable to trauma due to anatomical changes and blood volume redistribution.
• Severe hemorrhage can occur from injuries to the uterus; substantial maternal bleeding endangers the fetus.
• Evaluate pregnant women involved in motor vehicle accidents or falls in the ED.
• Use a left-side transport position with legs elevated to reduce supine hypotensive syndrome.

Shock Management

• Begin CPR with chest compressions and manual left uterine displacement during maternal cardiac arrest.
• Maintain airway, breathing, and circulation as top priorities.
• Abdominal examinations may reveal abnormal fetal positions, vaginal bleeding, or palpated fetus.

Suspected Domestic Abuse

• Maintain a high suspicion for domestic abuse during pregnancy, particularly if injury narratives are inconsistent.

Assessments During Labor

• Perform assessments away from parents for teenagers who may deny pregnancy; protect patient privacy.
• For imminent delivery, focus on telegraphing and managing contractions.

Patient Assessment

• Use OPQRS to evaluate complaints, ask about gravida, para, fetal movement, and any complications from previous pregnancies.
• Identify signs of emergency situations like vaginal bleeding or severe abdominal pain.

Stages of Labor

• First stage: onset of contractions to full cervical dilation.
• Second stage: full dilation to delivery.
• Third stage: delivery of the newborn to expulsion of the placenta.

Delivery Preparation

• Oxygen should be administered as needed; avoid holding the pregnant woman's legs together to facilitate delivery.
• Prepare a sterile environment, cover the patient for modesty, and ensure that appropriate tools and kits are accessible.

Newborn Delivery

• Monitor for crowning and guide delivery; encourage deep breathing during contractions.
• After birth, perform the Apgar scoring at one and five minutes, evaluating heart rate, respiratory effort, muscle tone, reflex irritability, and color.

Umbilical Cord Management

• Delay clamping the umbilical cord for 30 seconds unless the newborn needs immediate resuscitation.
• Tie or clamp the cord carefully to prevent bleeding after birth.

Postpartum Care

• Apply a sterile pad after delivery and monitor for postpartum hemorrhage.
• Firmly massage the uterine fundus to help limit bleeding; support lactation to assist uterine contraction.
• Postpartum hemorrhage is defined as blood loss exceeding one pint within 24 hours after delivery. Rapid transport is crucial if complications arise.

Violence and Pregnancy

• Increased risk of spontaneous abortion, premature delivery, and low birth weight associated with violence during pregnancy.
• Inconsistent injury explanations may indicate abuse; stabilize the patient by addressing airway, breathing, and circulation (ABCs), control bleeding, and treat any shock.
• Mandatory reporting obligations exist for all suspected abuse cases.

Trauma Considerations

• Anatomical changes and blood volume shifts during pregnancy heighten vulnerability to trauma.
• Injuries to the uterus can lead to severe hemorrhage, posing threats to fetal safety through substantial maternal bleeding.
• Assessment of pregnant women following motor vehicle accidents or falls is crucial in the emergency department (ED).
• Use a left-side transport position with elevated legs to help mitigate supine hypotensive syndrome.

Shock Management

• During maternal cardiac arrest, initiate CPR with chest compressions while performing manual left uterine displacement.
• Prioritize maintaining the patient's airway, breathing, and circulation.
• Abdominal examinations should focus on potential abnormal fetal positions, vaginal bleeding, or palpation of the fetus.

Suspected Domestic Abuse

• Maintain vigilance for signs of domestic abuse during pregnancy, especially when injury narratives appear inconsistent.

Assessments During Labor

• If assessing pregnant teenagers, conduct evaluations away from parents to safeguard privacy; be aware they may deny pregnancy.
• Focus on managing contractions and facilitating imminent delivery.

Patient Assessment

• Utilize the OPQRS method to evaluate patient complaints; inquire about gravida, para status, fetal movements, and complications from prior pregnancies.
• Be alert for emergency indicators such as vaginal bleeding or severe abdominal pain.

Stages of Labor

• The first stage encompasses the onset of contractions until full cervical dilation is achieved.
• The second stage spans from full dilation to the actual delivery of the baby.
• The third stage covers the delivery of the newborn until the placenta is expelled.

Delivery Preparation

• Administer oxygen as needed and avoid the practice of holding the pregnant woman's legs together, which may obstruct delivery.
• Ensure the delivery environment is sterile, modesty is upheld, and that necessary tools and kits are readily available.

Newborn Delivery

• Guide delivery as crowning occurs while encouraging deep breathing to assist during contractions.
• Perform Apgar scoring at one and five minutes after birth, assessing heart rate, respiratory effort, muscle tone, reflex irritability, and color.

Umbilical Cord Management

• Delay umbilical cord clamping for at least 30 seconds unless the newborn requires immediate resuscitation.
• Carefully tie or clamp the cord to prevent post-delivery bleeding.

Postpartum Care

• After delivery, apply a sterile pad and observe for signs of postpartum hemorrhage.
• Execute firm uterine fundus massage to curb bleeding while promoting lactation for uterine contraction aid.
• Define postpartum hemorrhage as blood loss exceeding one pint within the first 24 hours after delivery; rapid transport is essential in the event of complications.

This quiz explores the complex issues surrounding violence and trauma during pregnancy, focusing on the associated risks and management strategies. It addresses the critical considerations for healthcare providers in identifying abuse, managing shock, and providing care to pregnant patients in emergency situations.