Trauma In Pregnancy

Section 7 - PEDIATRIC / OBSTETRICAL

7.12 Trauma in Pregnancy

INITIAL TRAUMA CARE PRACTICE PARAMETER (2.02) OXYGEN @ 100% via NRB mask or assist with BVM.

• Check for uterine contractions, vaginal bleeding and / or leaking amniotic fluid. Assess for fetal movements.
• Raise right side of backboard approximately 30 degrees.
• If hypotension / shock present, refer to SHOCK PRACTICE PARAMETER (5.13).
• If patient in labor refer to the EMERGENCY CHILDBIRTH PRACTICE PARAMETERS (7.06).

EMERGENCY C-SECTION

• Maternal health and well being should not be compromised to save a fetus of any gestational age.
• Emergency C-Section should only be considered when maternal death has verified and is determined to be irreversible
  • Trauma that cannot support life accompanied by a rhythm that cannot support life.
  • Trauma with ASYSTOLE (4.02) or No vitals with ASYSTOLE (4.02)
  • “Injuries and rhythm that is inconsistent with life.”
• Fetus viability- 24 weeks gestational age or greater.
• For optimal survival C-Section should be performed within 4 minutes of maternal death
• Assess fetal heart tones if possible
• Prepare Equipment- OB kit, trauma pads, and infant resuscitation equipment.
• Locate anatomical landmarks for incision-Xiphoid Process and Pubis
• Using a scalpel, perform vertical incision midline between-Xiphoid Process and Pubis
  • Cut through each layer of the abdominal wall with the scalpel and/or scissors.
  • Lift skin and pull apart working through the layers
  • Using the scalpel make initial incision in the uterus.
  • Using scissors cut the uterine wall.
  • Remove neonate,
  • Suction the neonate’s airway.
  • Double clamp the cord
  • Keep the infant lower than the mother.
  • Wait for the cord to stop pulsating,
  • Record APGAR at 1 and 5 minutes.
  • Transport to the appropriate facility.

Fundal Heights