Anesthetic Management of abdominal Trauma with Pregnancy
Nayra Shaalan Mohammed Hanfy;
Abstract
SUMMARY
T
rauma is a significant cause of morbidity and mortality in women of childbearing age. Injury during pregnancy occurs in up to 8% of pregnant women and is the most frequent cause of non-obstetric maternal and fetal mortality.
Anatomical and physiological changes during pregnancy influence patterns of injury and the patho- physiological responses of the patient to the injury.
Trauma from road traffic, falls and domestic violence are the most common causes of blunt trauma. Other modes of trauma includes penetrating trauma, head injuries, thoracic trauma and burns.
Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anesthetist and critical care physician play an important role in the fetomaternal care, from initial assessment, resuscitation and intraoperative management. Primary goals are resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanism of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality.
Primary survey must be done by identifying & treating life-threatening conditions. Then secondary survey include completing patient history, physical examination & investigations. Fetal evaluation: estimate gestational age, fetal heart sounds (Pinnard or Doppler probe), fetal lie. Tertiary survey includes specialist consultation, need for transfer, specific treatment or operative intervention. Deep venous thrombosis, tetanus & antibiotic prophylaxis. Analgesia must be considered.
The experienced anesthesiologist can play an important role along with the multidisciplinary team, regarding prioritization of different surgical procedures on the trauma victim. Aggressive resuscitation of the mother should take priority over concerns for fetal well being. The secondary effects of trauma result in an increase in the morbidity and mortality of pregnant trauma victims, an anesthesiologist can play a major role in preventing these secondary effects.
T
rauma is a significant cause of morbidity and mortality in women of childbearing age. Injury during pregnancy occurs in up to 8% of pregnant women and is the most frequent cause of non-obstetric maternal and fetal mortality.
Anatomical and physiological changes during pregnancy influence patterns of injury and the patho- physiological responses of the patient to the injury.
Trauma from road traffic, falls and domestic violence are the most common causes of blunt trauma. Other modes of trauma includes penetrating trauma, head injuries, thoracic trauma and burns.
Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anesthetist and critical care physician play an important role in the fetomaternal care, from initial assessment, resuscitation and intraoperative management. Primary goals are resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanism of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality.
Primary survey must be done by identifying & treating life-threatening conditions. Then secondary survey include completing patient history, physical examination & investigations. Fetal evaluation: estimate gestational age, fetal heart sounds (Pinnard or Doppler probe), fetal lie. Tertiary survey includes specialist consultation, need for transfer, specific treatment or operative intervention. Deep venous thrombosis, tetanus & antibiotic prophylaxis. Analgesia must be considered.
The experienced anesthesiologist can play an important role along with the multidisciplinary team, regarding prioritization of different surgical procedures on the trauma victim. Aggressive resuscitation of the mother should take priority over concerns for fetal well being. The secondary effects of trauma result in an increase in the morbidity and mortality of pregnant trauma victims, an anesthesiologist can play a major role in preventing these secondary effects.
Other data
| Title | Anesthetic Management of abdominal Trauma with Pregnancy | Other Titles | التعامل تخديريا مع الاصابات في البطن اثناء الحمل | Authors | Nayra Shaalan Mohammed Hanfy | Issue Date | 2016 |
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