Trauma Guideline Manual - SUNY Upstate Medical University

Trauma Guideline Manual______________SUNY Upstate Trauma Center117PRACTICE GUIDELINES: PREGNANT TRAUMA PATIENTSOBJECTIVES:1. Define guidelines to be applied to the initial evaluation of the pregnant patient who hassustained a traumatic injury.2. Outline the process for Obstetrical care of these patients.DEFINITIONS:Traumatic injury: Any injury or mechanism that qualifies as a trauma activation or consult.Pregnant: Any indication of pregnancy by examination, laboratory studies, imaging studies orhistory.GUIDELINES:1. Follow the ATLS protocols including initial assessment, resuscitation and secondarysurvey. (See Initial Assessment Protocol.) Remember that the mother’s welfare comes firstso that all of the initial assessment should be directed to the mother while keeping the fetus’welfare in mind. This includes X-rays and CT scanning.2. Assess for pregnancy and gestational age by one or more of the following:a. History and last menstrual period.b. Beta-HCG.c. Prior sonogram.d. Discussion with primary care obstetrician.3. Notify patient’s primary obstetrician of the trauma event. If not available, call the in-houseobstetrician on-call. Call neonatology consult for impending delivery.4. If 24 weeks or greater (viable fetus) by any indicator, including physical exam, contact theOB resident on call STAT( NOTE for 20 weeks pregnant) on the left side to take uterine pressure off vena cava.If the patient cannot be positioned on her left side, manually displace the uterus to the left,off of the inferior vena cava.6. Obtain standard trauma labs dependent on injuries and D-dimer. Order a Kliehauer-Betketest to determine fetal hemoglobin in the maternal circulation.