Clinical Challenges in Trauma Surgery: The Pregnant Trauma Patient

Behind The Knife: The Surgery Podcast

Has anyone else ever felt the anxiety of hearing the EMS radio call in a pregnant trauma patient, knowing you will soon be getting two patients in one? How do we prioritize our assessment, diagnostic work up, and treatment options for our patient when we have a second patient growing in her uterus? Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan as they discuss how to navigate the physiologic changes and management considerations for the pregnant trauma patient!
Learning Objectives:
- Understand the physiology of the pregnant patient and how it changes how we clinically assess them in the trauma bay
- Emphasize the basics of the primary and secondary assessment in the pregnant patient
- Identify when radiology adjuncts are appropriate
- Identify laboratory and diagnostic adjuncts that are unique to the pregnant patient’s work up
- Discuss treatment options for mom and fetus depending on clinical status
Quick Hits:
1. Sick mom before sick baby - stick to basics and treat mom like any other trauma patient
2. Misuse of seatbelts are an important risk factor for morbidity and mortality in pregnant patients. The lap belt must lie below the uterus and shoulder strap should lie between the breasts.
3. Injured pregnant women should be screened for intimate partner violence.
4. Despite changes in pregnant patient physiology, they can still present with compensated shock. Always have a high index of suspicion when interpreting vital signs and remember to offload patient to the left in order to decompress the IVC.
5. For fetal viability: get FHT when mother’s condition allows. Remember- Fetal distress could be the first sign of maternal hypovolemia
6. NEVER withhold indicated imaging just to avoid radiation in a pregnant patient. Try shielding the uterus when possible, but always proceed with diagnostic imaging when necessary.
7. One more time- sick mom = sick baby!
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