Trauma

Question 1

Initial eval for OB trauma HPI

Answer 1

GA
seat belt use
air bag deploy
abd pain
VB
FM
resuscitation efforts
direct abd trauma

Question 2

OB trauma eval PE

Answer 2

*May defer pelvic exam if no VB or CNZ
US to assess:
- FHT
- placental location
- GA
- AFI

*do not use US to determine abruption

Question 3

OB trauma labs

Answer 3

CBC
T&S
PT, PTT, fibrinogen
KB stain
UDS

Question 4

if fetus has died of trauma…

Answer 4

1. assume massive placental abruption
2. anticipate massive coagulopathy
3. be prepared with 6 units PRBCs and FFP
4. Admit to L&D if >16-20 weeks per hosp

Question 5

OB trauma emergency C/S delivery when…

Answer 5

imminent maternal death
OR
stable patient with nonreassuring FHT pattern

Question 6

OB perimortem cesarean, why and how

Answer 6

bc pregnant uterus impedes the efforts of cardiopulmonary resuscitation, cesarean aids in maternal resuscitation

> 24w
w/in 4 minutes of maternal cardiac arrest
(unlikely fetal survival 15 m after maternal cardiac arrest)

midline from xyphoid to pubic symphysis, classical hysterotomy

Question 7

Plan for trauma on L&D

Answer 7

• continue coord. with trauma team
• H&P with pelvic exam
• US biometry and AFI
• 300 ug Rhogam IM if
  1. RhD negative
  2. >30 mL of feto-maternal bleeding on KB
• FHT for > 4h

Question 8

abruption unlikely if (history key)

Answer 8

< 6 CNX per hour over 4 hours