Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
26 - Trauma in Pregnancy
Published online by Cambridge University Press: 18 January 2010
Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
Summary
Objectives
Review the etiology of trauma in pregnant patients.
Discuss the physiologic changes of pregnancy and their impact on anesthetic management of a pregnant trauma patient.
List the various causes of maternal and fetal morbidity and mortality associated with different types of trauma.
Be able to triage a pregnant trauma patient and know the impact of gestational age on resuscitation.
Review the principles of cardiorespiratory resuscitation in a pregnant patient, including perimortem cesarean delivery.
Trauma complicates approximately 7 percent of all pregnancies and is responsible for 0.3 percent to 0.4 percent of maternal hospital admissions [2]. Trauma is the most common cause of maternal death in the United States [1]. Mechanisms of trauma during pregnancy include motor vehicle accidents, domestic violence [3], falls [4], and penetrating injuries [5]. Pregnancy has its own unique injuries due to the expanding uterus and developing fetus that must be taken into consideration in the pregnant trauma patient.
Many providers are involved in the care of the pregnant patient from the trauma scene, to the emergency department, and to the operating room. The anesthesiologist can play a key role in the care and management of the pregnant trauma victim. All anesthesiologists have training in obstetric anesthesia during their residency and frequently cover obstetric units in hospitals where pregnant patients are cared for. On the other hand, most nonobstetric physicians have little obstetric exposure and may be uncomfortable caring for the pregnant patient because of unfamiliarity with the physiologic changes of pregnancy or the evaluation of fetal well-being.
- Type
- Chapter
- Information
- Trauma Anesthesia , pp. 402 - 416Publisher: Cambridge University PressPrint publication year: 2008
References
, . Trauma in pregnancy: Assessment and treatment. Scand J Surg 2006;95: 4–10.CrossRefGoogle ScholarPubMed
, , . Causes of maternal mortality in the United States. Obstet Gynecol 1985;65: 605.Google ScholarPubMed
, , . Factors influencing pregnancy outcome after trauma. Am Surg 1992;58: 595–8.Google ScholarPubMed
, , , et al. Blunt trauma during pregnancy: Factors affecting fetal outcome. J Trauma 1992;32: 213–6.CrossRefGoogle ScholarPubMed
, . Damage control for the obstetric patient. Surg Clin N Am 1997;77: 835–52.CrossRefGoogle ScholarPubMed
, . Abdominal trauma in the pregnant patient. Am Family Physician 1996;53: 1269–74.Google ScholarPubMed
, , , et al. Trauma in pregnancy: Maternal and fetal outcomes. J Trauma Inj Infec Crit Car 1998;45(1):83–6.CrossRefGoogle ScholarPubMed
, . Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol 1988;168(6):1449–53.Google Scholar
, , , . Maternal physiological adaptations to early human pregnancy. Am J Obstet Gynecol 1988;159: 1456–60.CrossRefGoogle ScholarPubMed
, . Maternal cardiovascular hemodynamics. III. Labor and delivery under local and caudal analgesia. Am J Obstet Gynecol 1969;103: 8–17.CrossRefGoogle Scholar
, , , et al. Maternal cardiovascular hemodynamics. VI. Cesarean section under epidural anesthesia without epinephrine. Am J Obstet Gynecol 1972;114: 775–80.CrossRefGoogle ScholarPubMed
, , . Supine hypotension syndrome in late pregnancy. Obstet Gynecol 1953;1: 371–7.Google ScholarPubMed
Gamann WR, Ostheimer GW. Understanding the mother. In , ed. Manual of Obstetric Anesthesia. New York: Churchill and Livingstone, 1992, pp 1–11.Google Scholar
, , , et al. Pregnancy and the lung. Am Rev Respir Dis 1980;121: 559–81.CrossRefGoogle ScholarPubMed
, . Implications for the pregnant patient. Am J Respir Crit Care Med 2001;163(5):1051–4.CrossRefGoogle ScholarPubMed
, , , et al. Trauma in pregnancy. Mayo Clin Proc 2000;75: 1243–8.
ACOG Technical Bulletin: Trauma in pregnancy. 1991a;161: 1.
, , . Fetal deaths related to maternal injury. JAMA 2001;286(15):1863–8.CrossRefGoogle ScholarPubMed
, . Safety of lap-belt restraint for pregnant victims of automobile collisions. N Engl J Med 1971;284: 632–6.CrossRefGoogle ScholarPubMed
, , , , , . A retrospective cohort study of seatbelt use and pregnancy outcome after a motor vehicle crash. J Trauma 1993;34: 116–9.CrossRefGoogle ScholarPubMed
, , , , . Effect of motor vehicle crashes on adverse fetal outcome. Obstet Gynecol 2003;102: 279–86.Google Scholar
, , . Prevalence of seat belt use among reproductive-aged women and prenatal counseling to wear seat belts. Am J Obstet Gynecol 2005;192: 580–5.CrossRefGoogle ScholarPubMed
, , . Occult placental abruption after maternal trauma. Obstet Gynecol 1988;223: 481–8.Google Scholar
, , , , . Profile of mothers at risk: An analysis of injury and pregnancy loss in 1,195 trauma patients. J Am Coll Surg 2005;200(1):49–56.CrossRefGoogle ScholarPubMed
, , . A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162: 1502–10.CrossRefGoogle ScholarPubMed
, , , et al. Trauma in pregnancy: Role of interpersonal violence. Am J Obstet Gynecol 1996;174: 1873–5.CrossRefGoogle ScholarPubMed
, , , et al. Thermal injury in the pregnant patient. Surg Gynecol Obstet 1985;161: 209–12.Google ScholarPubMed
. . Management of moderate to severe trauma in pregnancy. Obstet Gynecol Clin N Am 1995; 22(1):69–90.Google ScholarPubMed
, . Maternal trauma during pregnancy. Clin Obstet Gynecol 1994;37(2):274–93.CrossRefGoogle ScholarPubMed
, . Carbon monoxide uptake and elimination in fetal and maternal sheep. Am J Physiol 1997;232(3): H324–30.Google Scholar
. Carbon monoxide in the pregnant mother and fetus and its exchange across the placenta. Ann N Y Acad Sci 1970;174(1):312–41.CrossRefGoogle ScholarPubMed
, , , et al. Fetal toxicity associated with maternal carbon monoxide poisoning. Ann Emerg Med 1988;17(7):714–7.CrossRefGoogle ScholarPubMed
. Fetal death due to accidental carbon monoxide poisoning. J Toxicol Clin Toxicol 1982;19(3):297–301.CrossRefGoogle Scholar
, , , et al. Positional changes and central hemodynamic profile during normal third trimester pregnancy and post partum. Am J Obstet Gynecol 1991;164: 883–7.CrossRefGoogle Scholar
National Safety Council. Accidents facts. Nail Safety Counc Bull Chicago 1997.
, , . Is adverse pregnancy outcome predictable after blunt abdominal trauma?Am J Obstet Gynecol 1998;179: 1140–4.CrossRefGoogle ScholarPubMed
Knudson MM, Rozycki GS, Pacquin MM. Reproductive system trauma. In , , , ed. Trauma, 5th edition. New York: McGraw-Hill, 2004, p 851.Google Scholar
, , , et al. Detection of fetal red cells in fetomaternal hemorrhage using a fetal hemoglobin monoclonal antibody by flow cytometry. Transfusion 1998;38: 749–56.CrossRefGoogle ScholarPubMed
, , Drug use and physical trauma: Risk factors for preterm delivery. J Miss State Med Assoc 1997;38: 301–5.Google ScholarPubMed
, . Fetal complication related to minor maternal trauma. J Obstet Gynecol Neonatal Nurs 1996;25: 121–4.Google Scholar
, , . Abdominal ultrasound examination in pregnant blunt trauma patients. J Trauma ICC 2001; 50(4):689–94.CrossRefGoogle ScholarPubMed
, , , et al. Emergency physician use of ultrasonography in blunt abdominal trauma. Acad Emerg Med 1996;3(10):931–7.CrossRefGoogle ScholarPubMed
, , . Use of ultrasonography for the evaluation of pregnant trauma patients. J Trauma ICC 1996; 40(4):665–8.Google ScholarPubMed
, , , et al. Diagnostic peritoneal lavage for blunt trauma in pregnant women. Am J Obstet Gynecol 1977;129(5):479–81.CrossRefGoogle ScholarPubMed
, , , et al. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma ICC 1995;38(6):879–85.Google ScholarPubMed
, . The role of ultrasound in pregnancy related emergencies. Radiol Clin N Am 2004;42: 315–27.CrossRefGoogle ScholarPubMed
Eliot G, Rao D: Pregnancy and radiographic examination. In: Trauma and Pregnancy. (Ed). PSG Publishing, p 69. Littleton, MA. 1985Google Scholar
, . Complete maternal and fetal recovery after prolonged cardiac arrest. Ann Emerg Med 1988;17: 346–9.CrossRefGoogle ScholarPubMed
, , . Pregnancy outcome after repeated blunt abdominal trauma. Eur J Obstet Gynecol Reprod Biol 1998;80: 85–6.CrossRefGoogle ScholarPubMed
, , , et al. Major trauma in pregnant women: Maternal/fetal outcome. J Trauma 1990;30: 574–8.CrossRefGoogle ScholarPubMed
, . High Risk Pregnancy: A Team Approach, 2nd edition. Philadelphia: WB Saunders, 1993, p 241.Google Scholar
, . Maternal esmolol administration resulting in fetal distress and cesarean section in a term pregnancy. Anesthesiology 1992;77(4):829–32.CrossRefGoogle Scholar
, , . Effects of intravenous anesthetic agents on pregnant myometrium. Pol J Pharmacol 1999;51(6): 505–10.Google ScholarPubMed
, , . Interactions of volatile anesthetics with neurodegenerative-disease-associated proteins. Anesth Clin N Am 2006;24: 381–405.CrossRefGoogle ScholarPubMed
Murphy N, Reed S. Maternal resuscitation and trauma. In , , ed. Advanced Life Support in Obstetrics (ALSO) Provider Course Syllabus. Leawood, KS: American Academy of Family Physicians, 2000, pp 1–25.Google Scholar
Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 1992;268: 2199–241.
, . Cardiopulmonary arrest in the pregnant patient: A report of a successful resuscitation. J Clin Anesth 1994;6: 66–8.CrossRefGoogle Scholar
, , . Postmortem cesarean section with recovery of both mother and offspring. JAMA 1982; 248: 971–3.CrossRefGoogle Scholar
, , , . Cardiopulmonary resuscitation of pregnant women. Am J Med 1986;81: 311–8.CrossRefGoogle ScholarPubMed
, , . Cardiopulmonary resuscitation and somatic support of the pregnant patient. Crit Care Clin 2004;20: 747–61.CrossRefGoogle ScholarPubMed