Trauma Care and Managing the Injured Pregnant Patient

Ruffolo, Daria C.

doi:10.1111/j.1552-6909.2009.01072.x

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…[ 12 ] Peripheral vasodilation causes a decrease in systemic vascular resistance so that cardiac output increases by 30%–50% as compensation during pregnancy and it is reported that progesterone has a significant role in decreasing total vascular systemic resistance. [ 16 ] The decrease in total vascular resistance causes blood pressure to decrease gradually between 5 and 15 mmHg in both systolic and diastolic pressure, while oxygen consumption continues to increase because of 15% increased metabolic requirements and 20% increased oxygen consumption delivered to the fetus [ Table 2 ]. This causes an increase in the oxygen-carrying capacity of red blood cells, an increase in blood volume, to an increase in cardiac output and heart rate by 10–15 times/min [ Table 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hemorrhage produced during vaginal or cesarean actions ranges from 500 to 1,000 ml and does not affect significant hemodynamic changes. [ 16 ] Bleeding >2500 ml can undergo rapid and significant clinical deterioration. [ 2 ] Pregnancy that exceeds 20 weeks has an enlarged uterus which can compress the inferior vena cava (IVC) on the abdomen, because of that the venous and the cardiac output decrease 30%.…”

Section: Discussionmentioning

confidence: 99%

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Algorithm of traumatic brain injury in pregnancy (Perspective on neurosurgery)

et al. 2021

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Background: The maternal deaths due to obstetrical cases declined, but the maternal deaths that caused by nonobstetrical cases still increase. The study reported that traumatic cases in pregnancy are the highest causes of mortality in pregnancy (nonobstetrical cases) in the United States. Another study reported that 1 in 12 pregnant women that experienced traumatic accident and as many as 9.1% of the trauma cases were caused by traumatic brain injury (TBI). The female sex hormone has an important role that regulates the hemodynamic condition. Anatomical and physiological changes during pregnancy make the examination, diagnosis, and treatment of TBI different from non-pregnant cases. Therefore, it is very important to lead the algorithm for each institution based on their own resources. Case Series: A 37-year-old woman with a history of loss of consciousness after traffic accident. She rode a motorbike then hit the car. She was referred at 18 weeks' gestation. Glasgow Coma Scale (GCS) E 1 V 1 M 4 , isochoric of the pupil, reactive to the light reflex, and right-sided hemiparesis. The non-contrast head computed tomography (CT) scan revealed subdural hematoma (SDH) in the left frontal-temporal-parietal region, SDH of the tentorial region, burst lobe intracerebral hemorrhage, and cerebral edema. There was not a fetal distress condition. The next case, a 31 years old woman, in 26 weeks gestation, had a history of unconscious after motorcycle accident then she fell from the height down to the field about 3 m. GCS E 1 V 1 M 3 , isochoric of the pupil, but the pupil reflex decreased. Noncontrast CT scan revealed multiple contusion, subarachnoid hemorrhage, and cerebral edema. She had a good fetal condition. Discussion: We proposed the algorithm of TBI in pregnancy that we already used in our hospital. The main principle of the initial management must be resuscitating the mother and that also the maternal resuscitation. The primary and secondary survey is always prominent of the initial treatment. Conclusion: The clinical decision depends on the condition of the fetal, the surgical lesion of the intracranial, and also the resources of the neonatal intensive care unit in our hospital.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Algorithm of traumatic brain injury in pregnancy (Perspective on neurosurgery)

et al. 2021

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“…Aside from pregnancy-related issues, trauma is the leading cause of maternal death. Although ,1% of pregnant patients who sustain trauma require hospital admission, 24% of the patients who do require hospitalization die from their injuries 3 . Fetal death secondary to maternal trauma affects 2.3 per 100,000 live births, often stemming from placental abruption 4 .…”

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confidence: 99%

“…Studies have suggested that multidisciplinary care for pregnant patients with orthopaedic trauma should involve an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, and radiologist 3 . Because of the need for specialist care, pregnant patients may benefit from being diverted to trauma centers directly from the scene of injury rather than being transferred later so as not to delay appropriate care 4 .…”

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confidence: 99%

Evaluation and Resuscitation of the Pregnant Orthopaedic Trauma Patient

et al. 2019

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Orthopaedic injuries warranting trauma activation in pregnant patients are associated with increased risks of preterm birth, placental abruption, and infant and maternal death.» Physiological changes associated with pregnancy can mask the severity of orthopaedic injury sustained during trauma. Providers must perform all appropriate imaging studies associated with the mechanism of injury and perform a careful clinical examination in order to avoid missing injuries.» Pregnancy is a hypercoagulable state, and adequate prophylaxis for blood clots includes low-dose heparin as well as mechanical prophylaxis. Additionally, patients who have sustained orthopaedic trauma must be assessed frequently for thrombophlebitis.Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A519).

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