SAQ 121 – Trauma – pregnancy and foetal monitoring after MVC

Question 9. pregnancy and foetal monitoring after MVC.

a. Assessing foetal viability

• Antenatal history, including prior ultrasound, single or multiple pregnancy, and abnormalities detected.
• Vaginal examination or speculum for vaginal bleeding, rupture of membranes, or show as signs of first stage of labour.
• Ultrasound for foetal heart rate, movements, and evidence of abruption.
• Continuous CTG monitoring for more than 4 hours.

b. Treatment principles

• Manage two patients; maternal resuscitation is the best method of foetal resuscitation.
• Nurse in left lateral position or wedge the right hip while maintaining spinal immobilisation.
• Early consultation with obstetrics and surgeons.
• Theatre if significant abdominal trauma is identified.
• Provide analgesia.
• Prevent Rh isoimmunisation with immunoglobulin as indicated.
• Admit for observation.

c. Arguments for pan scan

• High-risk mechanism.
• If going to theatre, ongoing spinal immobilisation and potential occult injuries remain undefined.
• May improve directed surgical management.
• A diagnostic modality needed for maternal evaluation should not be withheld solely because of potential fetal radiation hazard.

d. Arguments against pan scan

• Large radiation dose and some scans may not be indicated, such as CT brain.
• May delay definitive treatment if indicated clinically or by positive eFAST.
• Other screening plain x-rays may be sufficient, such as chest x-ray.

e. Information from monitoring

• Uterine contractions are occurring about every 2 minutes.
• Late decelerations.
• Foetal heart rate between 140 and 160.

f. Signs of foetal distress

• Lack of beat-to-beat variability.
• Resting tachycardia greater than 160 bpm.
• Deep decelerations, for example less than 100 bpm.
• Late decelerations.
• Prolonged decelerations greater than 90 seconds.
• Variable decelerations.