ITLS Trauma in Pregnancy 3

Question 1

A restrained pregnant driver at 34 weeks gestation is involved in a moderate-speed MVC. She has no complaints and vital signs are normal. Should she be transported for evaluation?

Accepted Answer

Yes, all pregnant trauma patients beyond 20 weeks require minimum 4-6 hours of fetal monitoring regardless of apparent injury severity, as placental abruption can be delayed

Answer

ALL pregnant trauma patients beyond 20 weeks should be transported for fetal monitoring, regardless of complaint severity. Placental abruption can be occult initially, with delayed presentation of fetal distress or maternal hemorrhage.

Question 2

What is the significance of Rh factor in pregnant trauma patients, and what intervention may be needed?

Accepted Answer

Rh-negative mothers may develop antibodies against Rh-positive fetal blood cells if fetomaternal hemorrhage occurs from trauma; Rh immune globulin (RhoGAM) should be administered within 72 hours

Answer

Trauma can cause fetomaternal hemorrhage, exposing the Rh-negative mother to Rh-positive fetal red blood cells. Without RhoGAM administration within 72 hours, the mother may develop anti-D antibodies that threaten current and future pregnancies.

Question 3

During CPR on a 38-week pregnant patient, how should chest compressions be modified?

Accepted Answer

Perform standard chest compressions but with continuous manual left uterine displacement to improve venous return, and place hands slightly higher on the sternum to account for the elevated diaphragm

Answer

CPR in late pregnancy requires manual left uterine displacement to relieve IVC compression during compressions, and hand placement may be slightly higher on the sternum to account for the diaphragm and heart being displaced superiorly by the gravid uterus.

Question 4

A 28-week pregnant patient has sustained blunt abdominal trauma. She reports decreased fetal movement. What does this finding suggest and what is the management priority?

Accepted Answer

Decreased fetal movement may indicate fetal distress from abruption, cord compression, or fetal hemorrhage; this finding elevates the urgency to critical and demands immediate transport for fetal monitoring

Answer

Decreased fetal movement after trauma is a maternal-reported warning sign of fetal compromise. Potential causes include placental abruption, umbilical cord compression, fetal hemorrhage, or fetal hypoxia from maternal shock.

Question 5

What anatomical changes during pregnancy provide some protection to the fetus during early gestation but increase vulnerability in later gestation?

Accepted Answer

In early pregnancy, the small uterus is protected within the bony pelvis; as it grows above the pelvic brim (12-14 weeks) and becomes an abdominal organ, it loses bony protection and becomes increasingly vulnerable to direct trauma

Answer

Before 12-14 weeks, the small uterus is sheltered within the bony pelvis. As it grows above the pelvic brim in the second and third trimesters, it becomes an abdominal organ without bony protection, increasingly exposed to direct blunt and penetrating trauma.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS Trauma in Pregnancy 3