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

In late pregnancy, the gravid uterus compresses the IVC when the patient is supine, reducing venous return by up to 30%. Tilting the board 15-30 degrees left (or manually displacing the uterus) immediately relieves the compression.

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

Pregnancy creates multiple aspiration risk factors: hormonal relaxation of the gastroesophageal sphincter, delayed gastric emptying, increased intra-abdominal pressure from the uterus, and upward stomach displacement, making regurgitation and aspiration more likely during airway management.

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

Perimortem cesarean section is recommended at ≥23-24 weeks gestational age, with delivery within 4-5 minutes of cardiac arrest. The dual purpose is fetal survival and improvement of maternal hemodynamics by relieving aortocaval compression.

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

Placental abruption (premature separation of the placenta from the uterine wall) presents with vaginal bleeding, rigid/tender uterus ('board-like'), severe abdominal pain, and is the most common life-threatening obstetric complication of trauma.

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

Pregnancy increases blood volume by 30-50% (1-2 liters extra). This physiologic hypervolemia allows the mother to lose significant blood before showing maternal signs of shock, while the fetus—dependent on placental perfusion—shows distress much earlier.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS Trauma in Pregnancy 2