ITLS - International Trauma Life Support Trauma in Pregnancy Questions and Answers

Question 1

You are treating a 30-year-old female, 32 weeks pregnant, who was involved in a motor vehicle collision. She is secured to a long backboard. Her initial BP was 110/70 mmHg, but it has now dropped to 90/50 mmHg with an increased heart rate. What is the most appropriate immediate intervention?

Accepted Answer

Manually displace the uterus to the left.

Answer

In a pregnant patient beyond 20 weeks gestation, lying supine can cause the gravid uterus to compress the inferior vena cava, which reduces venous return to the heart and causes hypotension. This is known as supine hypotensive syndrome. [1, 6] The most critical and immediate intervention is to relieve this compression, which can be done by manually displacing the uterus to the left or by tilting the entire backboard 15-30 degrees to the left. [14, 24]

Question 2

Following blunt abdominal trauma in a pregnant patient, which of the following is the most common serious pregnancy-specific complication that can lead to fetal distress or demise?

Accepted Answer

Placental abruption

Answer

Placental abruption, the premature separation of the placenta from the uterine wall, is the most common cause of fetal death following maternal trauma in which the mother survives. [4, 7] The shearing forces from trauma can cause this separation, disrupting oxygen and nutrient supply to the fetus. [15]

Question 3

Why can a pregnant patient in her third trimester lose a significant amount of blood before showing classic signs of shock, such as a significant drop in blood pressure?

Accepted Answer

Maternal blood volume increases by 40-50% during pregnancy.

Answer

During pregnancy, the maternal blood volume increases by up to 50%. [8, 14] This state of hypervolemia allows the mother to lose a larger quantity of blood (up to 30%) before classic signs of shock like hypotension become apparent. [3, 25] Tachycardia is often an earlier and more sensitive sign of hypovolemia in this population. [13]

Question 4

When managing a critically injured pregnant patient, what is the single most important principle for ensuring the well-being of the fetus?

Accepted Answer

Aggressively resuscitating and stabilizing the mother.

Answer

The primary principle in managing trauma in pregnancy is that the best treatment for the fetus is the optimal resuscitation of the mother. [14, 22] Maternal stability, including maintaining adequate blood pressure and oxygenation, is essential for uterine perfusion and fetal survival. [28] Efforts to assess the fetus are secondary to life-saving interventions for the mother. [4]

Question 5

A 28-year-old female who is 26 weeks pregnant has signs of hemorrhagic shock after a fall. How should fluid resuscitation for this patient differ from that for a non-pregnant patient?

Accepted Answer

Resuscitation should be more aggressive due to physiological hypervolemia.

Answer

Due to the 40-50% increase in maternal blood volume, a pregnant patient requires more aggressive fluid resuscitation to restore perfusion. [8] Uterine blood flow is not autoregulated and is dependent on maternal blood pressure; therefore, permissive hypotension is generally avoided as it can severely compromise fetal oxygenation. [27, 28] It is crucial to err on the side of hyper-hydration to support both mother and fetus. [27]

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Trauma in Pregnancy Questions and Answers