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Objectives

Discuss anatomic and physiologic


alterations of pregnancy and effects on
patient management
Establish assessment and treatment
priorities
Identify elements / patterns of domestic
violence
Key Questions

How do I know if she is pregnant?


What changes occur during pregnancy?
What are the unique risks of pregnancy?
How do I evaluate / manage 2 patients?
How do I recognize domestic violence?
Is she pregnant?

Ask her!
Enlarged uterus?
Pregnancy test?
What are the changes / risks?

Uterus: Intrapelvic
and thick-walled
Fetus protected
from direct injury
Risks
Abortion
Isoimmunization
What are the changes / risks?

Uterus: Extrapelvic
Large volume of
amniotic fluid
Risks
Abruptio placenta
Amniotic fluid embolism
Isoimmunization
What are the changes?

Uterus: Thin walled


Maternal abdominal
viscera displaced
Inferior vena cava
compression
What are the risks?

Risks
Pelvic fractures with
maternal hemorrhage
and direct fetal injury
Abruptio placenta
Amniotic fluid embolism
Isoimmunization
What are the changes / risks?

Aspiration risk
Mothers
Hyperventilation
blood loss
Hypervolemia with first reflected
anemia in fetal
distress
Eclampsia
How do I manage 2 patients?

Primary survey / resuscitation of mother


Fetal assessment
Secondary survey of mother
Definitive care of mother and fetus
Early OB consult
How do I manage the mother?

Same as nonpregnant Chest tube


Same as nonpregnant placement
Displace uterus /
volume infusion Fetal shock
Eclampsia vs brain injury
Same as nonpregnant
How do I manage the fetus?

Resuscitate the mother


Monitor fetal heart tones
Consider fetal injury with
Vaginal bleeding Uterine rupture
Abruptio placenta Labor
Uterine tenderness
Recognize domestic violence?

A major cause of injury


May result in death and disability
Large number of emergency department
visits
Patterns / clues similar to child abuse
Refer to social / adult protective services
Partner Violence Screen

Have you ever been kicked, hit, punched


or otherwise hurt by by someone in the
last year? If so, by whom?
Do you feel safe in your current
relationship?
Is there a partner from a previous
relationship who is making you feel
unsafe now?
Is she pregnant?
What are the changes?
How do these changes effect injury
patterns?
How do you manage 2 patients?
What are the special issues related to
trauma in woman?