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
Mother’s
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?