title: Midwifery triage and management of trauma and second/third trimester bleeding.
abstract: Trauma affects approximately 8% of all pregnancies, and bleeding affects nearly 5% of gestations. These two conditions are potentially life-threatening and require immediate management by the midwife. Trauma in pregnancy is commonly caused by motor vehicle accidents, falls, and assault. Although abruption resulting from trauma is a rare occurrence, injury caused by domestic violence, is associated with the greatest risk of obstetric complications. Bleeding in pregnancy has a number of etiologies. Midwives are well-prepared to safely and competently make a differential diagnosis of bleeding in the second and third trimesters. A sequence for midwifery triage of clients who present to the emergency room/triage area for trauma and bleeding is presented. Considerations for stabilization, history, physical examinations, diagnostic testing, initial management, and follow-up are described. Practical considerations for midwifery services incorporating provisions for triage into their caseloads are also provided.
authors.affiliation: Nurse-Midwifery Center, Sinai Samaritan Medical Center, Milwaukee, WI 53201, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tillett
authors.forename: L
authors.initials: L
authors.lastname: Hanson
mesh_terms: D005260:Female; D006801:Humans; D009721:Nurse Midwives; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000451:nursing*; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D014218:Triage / Q000379:methods* / Q000458:organization & administration; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000451:nursing*; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis / Q000451:nursing*