Trauma During Pregnancy - 3 Nursing CEs

Author: Kristi Hudson RN MSN CCRN

Written: 12/24/05

Updated: September 25, 2009

Course Description:

This course is designed to provide the latest statistics regarding trauma and pregnancy. In addition this course will provide an overview of the care and management of the pregnant trauma victim. Focus will be placed on first understanding the physiologic differences between the pregnant and non-pregnant women (lab values, and hemodynamic values) and the need to adapt normal resuscitation efforts. Fetal physiology and potential for fetal injury during a traumatic event will also be presented. Nursing assessment (both maternal and fetal) will be the final focus of this course.

Course Objectives:

Upon completion of this course the student will be able to:

• Have a better understanding of the frequency in which pregnant woman become trauma patients
• List the types of trauma that most frequently lead to maternal death
• Differentiate lab values between the pregnant and non-pregnant patient
• Describe the physiologic changes that are seen during pregnancy
• Discuss the hemodynamic parameter differences experienced during pregnancy
• Discuss fetal physiology and potential fetal injuries that may occur with trauma
• Describe important nursing assessments for both mother and fetus who have sustained a traumatic injury

Trauma and Pregnancy Statistics:

• Trauma is the number one cause of maternal death in the United States
• In the United States 6% to 7 % of all women experience some sort of trauma during pregnancy (most occur in the last trimester)
• Maternal Shock is the number one cause of fetal demise during trauma (80%)
• Placentae Abruptio is number two cause of fetal demise during trauma (30%-68%)
• Placentae Abruptio occurs in 30%-50% of major trauma and 5% for minor trauma during pregnancy
• Motor vehicle accidents account for 60%-67% of all major trauma during pregnancy
• Falls and abuse account for 10%-31% of all major trauma during pregnancy
• In 70% of all penetrating abdominal injuries, the fetus is injured
• The mean age for a pregnant trauma patient is 25 yrs old (range 14-45)

The following mechanisms of maternal death are listed by percentage:

• Gunshot wounds 23%
• Motor vehicle accidents 21%
• Stab wounds 14%
• Strangulation 14%
• Blunt head injury 9%
• Burns 7%
• Falls/Toxic Exposure 4%
• Drowning/Iatrogenic injury 2 %

Physiologic Changes Seen in Pregnant Trauma Patients:

Lab Values in Pregnancy:

Of all of the physiologic changes that are seen with pregnancy, lab value differences in the pregnant vs. non-pregnant woman are thought to be very significant. In caring for the pregnant trauma patient, understanding these values is important in order to avoid unnecessary tests, treatments and procedures. The following is a chart of lab differences seen between pregnant and non-pregnant women:

Note: These changes are most often due to changes in specific organ systems during pregnancy and revert back to normal post delivery.

Cardiovascular Physiology:

·         Increases in cardiac output and blood volume begin early in the first trimester and are 30-40% greater in the pregnant women by week 28. This hypervolemia is to prepare the pregnant women from blood loss that occurs at the time of delivery (500ml for vaginal, 1000ml for cesarean).

• In healthy pregnancies, oxygen consumption (VO₂) is increased because of the increasing fetal metabolic demands as well as maternal vasodilation and arteriovenous shunting to the placenta.
• Therapeutic management is aimed at maintaining optimal oxygen delivery and consumption. This can by done by assuring that fluid volume, hemoglobin and oxygen are all maximized.
• In the third trimester patient positioning can be crucial to the delivery of optimal cardiac output. 30% increases can be seen with displacement of the uterus to the left side of the abdominal cavity.
• In supine positions up to 40% decreases in cardiac output can be seen. For unstable C-Spine patients this can be of great concern. If possible log roll patients on their left side.
• Despite the increase in blood volume and cardiac output; pregnant woman are susceptible to hypotension from aortocaval compression in the supine position.
• 40% of maternal blood loss may occur before signs and symptoms of shock occur.
• The use of vasopressors may lead to restriction of uterine blood flow and should be used with caution.

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