ITLS In Pregnancy 4 — Questions and Answers
Question 1: Why is the semi-recumbent left lateral tilt position preferred over full lateral decubitus when immobilizing a pregnant trauma patient on a backboard?
- It prevents aspiration more effectively
- It relieves aortocaval compression while maintaining spinal precautions (Correct answer)
- It improves venous access to the arm
- It reduces pain from uterine contractions
Correct answer: It relieves aortocaval compression while maintaining spinal precautions
A 15–30 degree left tilt with wedging under the right side of the board relieves IVC compression while still allowing spinal immobilization.
Question 2: A pregnant patient in her third trimester is found unconscious after a fall. Her GCS is 8. What airway intervention is most appropriate?
- Nasopharyngeal airway and BVM only
- Endotracheal intubation with cricoid pressure considered (Correct answer)
- Supraglottic airway as definitive airway
- Jaw-thrust maneuver only
Correct answer: Endotracheal intubation with cricoid pressure considered
Definitive airway management via endotracheal intubation is indicated with cricoid pressure considered due to high aspiration risk in pregnant patients.
Question 3: What physiologic change in pregnancy can cause a pregnant patient to tolerate more blood loss before becoming tachycardic?
- Increased red blood cell mass
- Increased plasma volume of 40–50% (Correct answer)
- Decreased systemic vascular resistance
- Elevated baseline heart rate
Correct answer: Increased plasma volume of 40–50%
Plasma volume increases by 40–50% in pregnancy, creating a dilutional state that allows greater volume loss before tachycardia appears.
Question 4: Which organ is MOST protected from direct traumatic injury in early pregnancy compared to late pregnancy?
- Spleen
- Liver
- Uterus (Correct answer)
- Bladder
Correct answer: Uterus
In early pregnancy the uterus remains within the bony pelvis and is relatively protected; as it enlarges it becomes more exposed to abdominal trauma.
Question 5: What is the significance of Kleihauer-Betke (KB) testing in pregnant trauma patients?
- It measures maternal blood loss volume
- It detects fetal red blood cells in maternal circulation indicating fetomaternal hemorrhage (Correct answer)
- It diagnoses placental abruption
- It estimates gestational age
Correct answer: It detects fetal red blood cells in maternal circulation indicating fetomaternal hemorrhage
KB testing detects fetal blood in the maternal circulation, which guides Rh-immune globulin dosing for Rh-negative mothers.
Question 6: A 32-week pregnant patient has seat-belt marks across her lower abdomen after a high-speed MVC. What injury pattern should be suspected?
- Lumbar spine fracture only
- Uterine rupture or hollow viscus injury (Correct answer)
- Isolated pelvic fracture
- Diaphragmatic tear
Correct answer: Uterine rupture or hollow viscus injury
Lap-belt injuries across the lower abdomen in pregnancy are associated with uterine rupture, bowel injury, and lumbar spine fractures.
Question 7: How does pregnancy alter the normal location of abdominal organs, potentially changing the presentation of intra-abdominal injury?
- The liver is displaced into the pelvis
- The bowel is displaced superiorly, moving pain referral zones upward (Correct answer)
- The spleen enlarges and descends into the lower quadrants
- The stomach is displaced posteriorly
Correct answer: The bowel is displaced superiorly, moving pain referral zones upward
As the uterus enlarges, it displaces bowel loops superiorly, so bowel injuries may cause pain and tenderness in atypical upper abdominal locations.
ITLS In Pregnancy 4
Why is the semi-recumbent left lateral tilt position preferred over full lateral decubitus when immobilizing a pregnant trauma patient on a backboard?