Trauma in pregnancy: uterine rupture.
Trauma during pregnancy is a unique situation. Understanding injury patterns, anatomic and physiologic changes, and the initial approach to resuscitation is essential for all emergency nurses. Maternal resuscitation is the only means of fetal resuscitation. Meticulous attention must be given to the ABC's, with some minor modifications. Cervical spine immobilization is done in conjunction with positioning on the left side. Oxygen is used liberally, but may not benefit the fetus if hypovolemia exists. IV access and aggressive fluid resuscitation should proceed quickly. Diagnostic testing, including radiologic evaluation, is performed as necessary--the mother's life must not be jeopardized on the basis of fetal risk. Continuous fetal monitoring should be instituted, even with seemingly minor injuries. In the rare event of maternal arrest, a postmortem cesarean section may be lifesaving for the infant. Policies should be formulated jointly by ED, obstetric, and neonatal staffs in advance to speed this difficult decision-making process. The keys to survival, for both mother and infant, are an organized approach to resuscitation and teamwork among all professionals.
Manley
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Santanello
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D000293:Adolescent; D016529:Emergency Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D009104:Multiple Trauma / Q000451:nursing* / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000451:nursing* / Q000503:physiopathology; D014597:Uterine Rupture / Q000451:nursing* / Q000503:physiopathology