Page 178 - PJ MED OPS Handbook 8th Ed

Obstetrics Trauma

NOTE: The pregnant patient has several anatomic and physiologic differences that make as-
sessment more challenging. Frequently the developing fetus will show distress before the
mother does.
A detailed history (including blood type or any medical problems or known problems with the
pregnancy) is a must!

The best way to treat the fetus is to treat the mother and call for medical support A.S.A.P.
A trimester is 3 months = roughly 13 weeks.
• 0–13 weeks = first trimester
• 13–26 weeks = second trimester
• 26–40 weeks = third trimester

Any significant vaginal bleeding in a pregnant female less than 24 weeks gestation should be man-
aged symptomatically, or as appropriate for level of injury sustained. At less than 24 weeks, the
likelihood of a viable fetus being delivered is extremely low, so urgent CSAR assets for immediate
CASEVAC should be weighed appropriately.

Anatomic Differences:
• The uterus remains within the pelvis until approximately 12 weeks.
• By 20 weeks, the uterus is at level of the umbilicus.
• By 34 weeks the uterus reaches the costal margin.
• As the uterus enlarges, it displaces the abdominal contents cephalad. This can protect the
intestines from blunt injury, though increases the risk of complex injury to abdominal struc-
tures in penetrating trauma.

NOTE: In the 3rd trimester, the fetus’ head is normally within the pelvis. Pelvic fracture in late
gestation may result in serious intracranial injury to the fetus, as well as massive hemorrhage
into the pelvic cavity.

Trauma Primary Survey:
Primary Survey in the Pregnant patient will follow standard MARCH PAWS algorithm, however, cer-
tain differences apply. Any female patient should ALWAYS be asked if they are/could be pregnant,
when their last menstrual period was, and if they are sexually active. In the unconscious female
patient, assume they ARE pregnant until proven otherwise.
M: – Standard blood sweep, direct pressure with hemostatic bandage/TQ
– MUST examine the vagina for presence of bleeding. Vaginal bleeding with abdominal/pelvic
pain resulting from blunt trauma in a pregnant patient is a MEDICAL EMERGENCY. Treat for
shock/hemorrhage. Transport immediately.
– Be suspicious for Uterine Rupture: Acute Abdomen with rigidity. This is an Emergency. Treat
for shock/hemorrhage. Immediate transport.

176 n Pararescue Medical Operations Handbook / 8th Edition