Thread by @OBsleepmerchant

@matmedicine presents the first NOVEL content session of #SOAPAM2023 virtual #OBAnes highlights: Trauma in Pregnancy for the Non-Obstetric Provider. Objectives. Goals. All live from Italy - somewhat jealous @matmedicine

Physiological changes during pregnancy (1): Cardiac/ hemodynamic changes. Haematological changes. Are these protective? #OBAnes #SOAPAM2023

Physiological changes during pregnancy (2): Respiratory effects - displacement of diaphragm is key? ABG changes important - lactate the same in pregnant and non-pregnant @matmedicine? #OBAnes #SOAPAM2023

@matmedicine touches on epidemiology. Trauma a leading indirect cause of maternal mortality. MVC’s, falls and other accidents = leading traumas. Risk factors predictable. #OBAnes #SOAPAM2023

Injury Severity Score (cf. AIS score). GCS still applies in pregnant trauma patients. Maternal outcomes (1) Certain injuries more common. #OBAnes #SOAPAM2023

Blunt vs penetrating trauma - the gravid uterus has an impact on both. #OBAnes #SOAPAM2023

Maternal outcomes (2). Pregnant trauma victims 2-fold higher mortality. Risk factors: violent trauma, higher ISS, transfusion and intubation (RR = 6.00). Conflicting evidence. #OBAnes #SOAPAM2023

No autoregulation at placenta, what you see is what you get. Abruption overt and covert - potential for large EBL. Mechanism of placental abruption - uterus has give and is quite malleable, placenta is rigid. What minor trauma is is unclear in pregnancy - tbh is a NPV of 80%… twitter.com/i/web/status/1…

The big three pregnancy and fetal outcomes. Traumatic uterine rupture is NOT same as L&D uterine rupture - with grave consequences. Direct fetal intuited can occur. #OBAnes #SOAPAM2023

Treatment guidelines. EBM-free world? @acog has no formal trauma guidelines, imaging guidelines worthwhile. EAST - avoid MRI is out of date, as is 24 week cut off (not a fetal indication). ATLS no alteration (manual uterine displacement?) #OBAnes #SOAPAM2023

Management (1) Trauma team and OB team (incl #OBAnes). Level 1-3 classification for general trauma. Level A-C for OB trauma. #SOAPAM2023

Clinical management of the pregnant trauma patient. #OBAnes #SOAPAM2023

What about incidental pregnancy in trauma patients? Fetus less likely to survive if unknown pregnancy. Fetal radiation doses for common investigations, and health effects on fetus dependent on gestation. #OBAnes #SOAPAM2023

As concerned as you may be about the radiation effects on the fetus from a necessary investigation, please remember the fundamental truth below: #OBAnes #SOAPAM2023

Perimortem cesarean section. Who: anyone who’s uterus is palpable at the umbilicus. Why: delivery results in massive maternal autotransfusion. When: initiate at 4mins, delivery by 5min. #OBAnes #SOAPAM2023

Perimortem cesarean section. Where: at the site of the arrest, increased survival, especially in hospital. How: midline vertical abdominal incision, pick a uterine incision, deliver, can leave placenta in situ and pack abdo until ROSC. #OBAnes #SOAPAM2023

References - light reading. #OBAnes #SOAPAM2023

@threadreaderapp unroll please