O+G
PREGNANCY - GENERAL QUESTIONS
PromptList + describe physiologic changes in pregnancy
ResponseCVS:
Plasma volume Increase ~50% - dilutional anaemia, reduced O2 carrying capacity, signs of shock appear late
Heart rate increase 15-20 bpm - Increased CPR demands
Uterine blood flow ~10% of cardiac output - potential for massive haemorrhage
Respiratory
RR increased - resp alkalosis is normal, Decreased buffering capacity, acidosis more likely (and more concerning)
Laryngeal oedema - difficult intubation
Upper airway blood supply increased - friable mucosa, increased bleeding, difficult airway
There are more
Plasma volume Increase ~50% - dilutional anaemia, reduced O2 carrying capacity, signs of shock appear late
Heart rate increase 15-20 bpm - Increased CPR demands
Uterine blood flow ~10% of cardiac output - potential for massive haemorrhage
Respiratory
RR increased - resp alkalosis is normal, Decreased buffering capacity, acidosis more likely (and more concerning)
Laryngeal oedema - difficult intubation
Upper airway blood supply increased - friable mucosa, increased bleeding, difficult airway
There are more
PromptList important considerations in pregnancy vs non pregnant patient
ResponsePhysiologic considerations
- Pregnancy vital sign “normal values” are different - lower BP, higher HR, Higher RR - May make interpretations/signs of shock more difficult
- Lab parameters may differ - eg: Physiologic anaemia, respiratory alkalosis expected
- Aortocaval compression - Left lateral tilt/manual displacement of uterus - avoid hypotension due to impaired venous return
- Distorted abdominal anatomy makes assessment of injuries less reliable
- More anatomy to wory about - Uterine rupture/abruption
- Intubation - high risk of aspiration (Double suction setup)
- Anticipate difficult airway due to oedema/habitus/breasts
- Anticipate faster desaturation due to lower FRC
- Avoid teratogenic medications
- ?resuscitative hysterotomy
- antiD/Kleihauer test
- CTG/O+G input
- FAST scan more difficult
- Psychosocial implications
PromptList physiological changes in the mother that occur during pregnancy, and their implications on your assessment and management in the context of trauma
Response
PromptWays to estimate gestational age
ResponseAsk mother about LMP
Fundal height (umbilicus at 20 weeks, xiphysternum 37 weeks, halfway 27 weeks)
Ultrasound measure femur length or head circumference (U/S machen often have tool to predict dates)
Fundal height (umbilicus at 20 weeks, xiphysternum 37 weeks, halfway 27 weeks)
Ultrasound measure femur length or head circumference (U/S machen often have tool to predict dates)