What will happen if a pregnant patient in her third trimester is transported supine?
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Treatment Show
Prehospital CareAs in any trauma patient, the ABCs of trauma resuscitation must be followed in treating the pregnant patient. The mother should always receive supplemental oxygen. Several additional issues must be considered in treating the trauma patient who is pregnant. Note the following:
Emergency Department CarePatients who have minor trauma and who are at less than 20 weeks' gestation do not require specific intervention or monitoring. All pregnant women beyond 20-24 weeks' gestation who have direct or indirect abdominal trauma should undergo at least 4 hours of cardiotocographic monitoring. Resuscitation of the more serious trauma patient must focus on the mother because the most common cause of fetal death is maternal shock or death. It is important to remember that the mother will maintain her vital signs at the expense of the fetus. Because plasma volume is increased 50% and the mother is able to shunt blood away from the uterus, maternal shock may not manifest itself until maternal blood loss exceeds 30%. During the initial ABC assessment, the fetus is addressed only during evaluation of circulation. If the patient is more than 20-24 weeks' pregnant, the patient should be tilted 15° to the left. Alternatively, one person may be designated to manually displace the uterus to the left. If the patient does not require spinal immobilization, then she can be asked to assume the left lateral decubitus position. A study conducted at a level I trauma center found that implementation of a perinatal emergency response team reduced the mean time to obstetrical evaluation by 30 minutes. [10] Airway and breathingAll pregnant trauma patients should receive supplemental oxygen because the fetus is extremely sensitive to hypoxia and because the oxygen reserve is significantly diminished in the pregnant patient. In general, pregnancy does not affect the decision to intubate, although the risk of aspiration is increased (decreased gastric tone, delayed gastric emptying, and cephalad displacement of intra-abdominal organs). The use of medications for rapid sequence intubation in pregnancy is not well studied; however, no absolute contraindications exist. If a chest tube is placed, enter the chest 1 or 2 interspaces higher than usual, because the diaphragm is elevated during pregnancy. CirculationIt is extremely important to maintain adequate maternal blood volume as a first step in fetal resuscitation. A decrease in maternal blood pressure may result in a decrease in uterine blood flow, even without uterine artery vasoconstriction. Resuscitate the patient with warmed crystalloid administered through large-bore catheters placed for intravenous lines because the relative hypervolemia of pregnancy allows for a 30-35% loss of blood volume before hypotension develops. Rule out occult sources of bleeding because maternal blood flow is maintained at the expense of fetal blood flow. If blood is needed on an emergency basis, use Rh-negative blood unless the patient's Rh status is known. Blood pressure returns to prepregnancy levels as the gestational age approaches 40 weeks. Fetal assessment should be performed early as part of the maternal secondary survey. Admission and discharge criteria for pregnant trauma patientsHospitalization is warranted in pregnant trauma patients with the following:
All serious trauma victims who are beyond 23 weeks EGA require 24 hours of fetal monitoring. Discharge criteria include no abnormal obstetric findings and normal fetal heart tracings. Instruct the patient to return in the event of decreased fetal activity, vaginal bleeding, uterine contractions and/or cramping, or spontaneous premature rupture of the membranes. TransferTransfer the patient to a level I trauma center with obstetric and neonatal intensive care units (NICUs). ConsultationsThe pregnant patient with serious traumatic injury requires a multidisciplinary team, which includes an obstetrician, trauma surgeon, and neonatologist.
Author Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE Chief, Department of Emergency Medicine, Sentara Norfolk General Hospital; Medical Ditector, Sentara Transfer Center; Professor and Assistant Program Director, Core Academic Faculty, Department of Emergency Medicine, Eastern Virginia Medical School; Board Member, American Academy of Emergency Medicine Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE is a member of the following medical societies: American Academy of Emergency Medicine, American Association for Physician Leadership, American College of Emergency Physicians, American College of Healthcare Executives, American Institute of Ultrasound in Medicine, Emergency Nurses Association, Medical Society of Virginia, Norfolk Academy of Medicine, Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Additional Contributors Why should a pregnant woman avoid supine position?This is probably because when the woman lies on her back the gravid uterus is known to compress the inferior vena cava (Kerr et al. 1964). This can result in a range of negative sequelae such as maternal hypotension and reduced blood flow to the fetus (Holmes, 1960).
What is the recommended position for transporting a pregnant patient who is in her third trimester and not in labor?Pregnant women should be transported in a position of lateral tilt.
What are the complications in the 3rd trimester of pregnancy?Common pregnancy complications in the third trimester include: pre-eclampsia. gestational diabetes. too much or too little fluid around your baby.
Is supine position safe during pregnancy?The supine sleep position in late pregnancy is a major risk factor for stillbirth, with a population attributable risk of 5.8% and one in four pregnant women reportedly sleeping in a supine position.
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