3. A pregnant trauma patient is physiologically and anatomically difficult to intubate. It requests well skilled and prepared team.
4. Bear in mind that fetal loss is higher when there is a maternal shock. You must identify the cause of the shock and treat. In particular a pregnant woman has an increasing circulating blood volume, that means that she loses more of her blood volume to manifest hypotension than if she were not pregnant.
5. Pregnant women were excluded from trials studying the efficacy of Tranexamic acid (TXA) in trauma patients. It classified as a category B drug in pregnancy, meaning that no animal studies have shown adverse outcomes with its use, but no human studies exist. TXA crosses the placenta. Despite the lack of published research, TXA may be of benefit in bleeding, seriously injured pregnant patients.
Remember to perform manual uterine displacement in all pregnant trauma patients over 20 weeks gestation.
Another caution to take is avoiding vasopressors wherever possible because they are associated with worse outcomes. In the specific case, they usually produce vasoconstriction of the placental bed, increasing the risk of fetal hypoxia.
6. Tilt the patient left lateral before starting resuscitation manouvers. The most usual way is keeping her supine, and then displace the uterus off the IVC, by pulling it from the left or pushing it to the right. In case this manouver should last for long time, it could be easier pushing the uterus from the right side instead pulling to the left.
7. Injured pregnant women should never be denied adequate analgesia.
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