ITLS Trauma in Pregnancy 2

Question 1

A 32-week pregnant patient is involved in an MVC and is placed supine on a backboard. Her blood pressure drops significantly. What is the most likely cause and immediate intervention?

Accepted Answer

Supine hypotensive syndrome from the gravid uterus compressing the inferior vena cava; tilt the backboard 15-30 degrees to the left

Answer

Hemorrhagic shock requiring massive fluid resuscitation

Answer

Cardiac tamponade from steering wheel impact

Answer

Neurogenic shock from spinal injury

Question 2

Why is the pregnant trauma patient at increased risk for aspiration during emergency airway management?

Accepted Answer

Progesterone-mediated relaxation of the lower esophageal sphincter, decreased gastric motility, increased intra-abdominal pressure, and mechanical upward displacement of the stomach all increase regurgitation risk

Answer

Pregnant patients have larger mouths making intubation messier

Answer

Pregnancy does not affect airway management

Answer

Only in the first trimester due to morning sickness

Question 3

At what gestational age does ITLS recommend performing a perimortem cesarean section in a pregnant patient in cardiac arrest, and what is the goal?

Accepted Answer

At approximately 23-24 weeks viable gestation, ideally within 4-5 minutes of arrest, to both save the fetus and improve maternal resuscitation by relieving aortocaval compression

Answer

Only at full term (40 weeks)

Answer

Only after 30 minutes of unsuccessful CPR

Answer

Perimortem cesarean section is never performed prehospitally

Question 4

A pregnant patient at 36 weeks has vaginal bleeding and severe abdominal pain after an MVC. The uterus feels rigid and tender. What complication is most likely?

Accepted Answer

Placental abruption—premature separation of the placenta from the uterine wall

Answer

Normal labor onset from the accident

Answer

Placenta previa

Answer

Urinary bladder rupture

Question 5

How does the physiologic increase in blood volume during pregnancy affect the assessment of hemorrhagic shock?

Accepted Answer

A pregnant woman can lose 30-35% more blood volume (1000-1500 mL) before showing signs of shock, potentially masking significant hemorrhage while fetal distress develops earlier

Answer

It has no effect on shock assessment

Answer

Pregnant patients go into shock faster because of the added demand

Answer

Blood volume decreases during pregnancy making them more sensitive to blood loss

Question 6

What is the ITLS approach to medication administration in the pregnant trauma patient?

Accepted Answer

Treat the mother aggressively—maternal survival is the best chance for fetal survival; life-saving medications should not be withheld due to pregnancy

Answer

No medications should be given to pregnant patients under any circumstances

Answer

Only give medications approved for pregnancy (Category A)

Answer

All medications cross the placenta and harm the fetus