ITLS - International Trauma Life Support Trauma in Pregnancy 1

Question 1

A 30-week pregnant trauma patient is placed supine on a long backboard for spinal precautions.
In addition to treating for shock, what modification to her positioning is recommended by ITLS to optimize hemodynamics?

Accepted Answer

Tilt the entire backboard 15–30 degrees to the left to relieve aortocaval compression

Answer

Elevate the head of the board 30 degrees to reduce risk of aspiration

Answer

Position her in right lateral decubitus to maximize liver perfusion

Answer

Keep her fully supine to ensure accurate blood pressure measurement

Question 2

A 34-week pregnant patient involved in a moderate MVC has a heart rate of 116 bpm, pale skin, and a blood pressure of 114/72 mmHg. The fetal heart rate is 94 bpm. How should you interpret this clinical picture?

Accepted Answer

Early compensated maternal hemorrhagic shock — the fetus is already showing distress before maternal BP drops

Answer

Stable presentation; tachycardia is normal in pregnancy and the blood pressure is adequate

Answer

Fetal bradycardia is a normal finding and does not require expedited transport

Answer

The maternal vital signs indicate mild anxiety; monitor and reassess in 10 minutes

Question 3

During the secondary survey of a 38-week pregnant trauma patient, you note sudden relief of her abdominal pain, diffuse rigidity across the entire abdomen, fetal parts palpable through the abdominal wall, and absent fetal heart tones. Which condition does this presentation most likely represent?

Accepted Answer

Uterine rupture

Answer

Placental abruption with concealed hemorrhage

Answer

Placenta previa with active bleeding

Answer

Severe preterm labor with rapid cervical dilation

Question 4

An Rh-negative pregnant patient at 28 weeks is assessed after a low-speed MVC with minor abdominal wall contusion. Her vital signs are stable and fetal heart tones are normal. What critical piece of information must you relay to the receiving facility team regardless of apparent injury severity?

Accepted Answer

She must receive Rh immunoglobulin (RhoGAM) within 72 hours to prevent Rh sensitization

Answer

She requires immediate cesarean section to evaluate the fetus directly

Answer

She should receive prophylactic anticoagulation for possible placental thrombosis

Answer

She should be placed on oxygen indefinitely to prevent fetal hypoxia

Question 5

When assessing a third-trimester pregnant trauma patient's airway and breathing, which anatomical change of advanced pregnancy most significantly increases her risk of rapid oxygen desaturation during apnea or assisted ventilation?

Accepted Answer

Elevation of the diaphragm by the gravid uterus, reducing functional residual capacity

Answer

Increased tidal volume, which paradoxically reduces respiratory efficiency

Answer

Decreased respiratory rate caused by progesterone-mediated respiratory depression

Answer

Enlarged thyroid gland narrowing the subglottic airway

Question 6

A pregnant patient at 32 weeks is in hypovolemic shock after trauma and requires IV fluid resuscitation. Which physiologic consideration is most important when interpreting her hemoglobin and hematocrit values obtained at the receiving facility?

Accepted Answer

Dilutional anemia of pregnancy means a hematocrit of 31–35% may be her normal baseline, not a sign of acute blood loss

Answer

Pregnancy causes polycythemia, so hemoglobin values will be falsely elevated

Answer

Fetal red blood cell production artificially raises the mother's CBC values

Answer

Hemoglobin rises progressively throughout pregnancy, so any value below 14 g/dL is abnormal