I promise I don’t mean to keep referencing supermodels in my posts…it just seems to happen! Today is a short post but includes my vodcast on the pregnant trauma patient. (Apologies in advance for my sniffles in the background!). As Jay Leno says, its still just one patient. Treating the mother is the primary objective.  I’ve tried to keep the talk to about 6 mins so its not too long and you don’t lose concentration.

The pregnant trauma patient will invariably create a stressful situation. In times of stress I try and keep things simple. There are some great online resources to read including Scott Weingart’s podcast and Salil Bhandari’s PK talk on perimortem C-section

My 3 learning points:

1) Treat the mother as a priority: the primary aim of a resuscitative hysterotomy is to improve the maternal haemodynamics. Foetal survival is a secondary objective. Remember in blunt traumatic cardiac arrests to go through whichever algorithm you use first (bilateral thoracostomies, give blood, manual displacement of uterus etc) before going on to do the perimortem C-section.

2) Give blood earlier: can lose 1500mls of blood before signs of hypovolaemia are present. Think uterine rupture, placental abruption and retroperitoneal haemorrhage/ splenic injury.

3) Remember 24 and 4 for resuscitative hysterotomy. It is worth going through in your mind how you would do the procedure,  where will you find the equipment (scalpel and tough cut scissors), what are you going to say to people (“the aim is to save the mother not the fetus…”) etc. This procedure isn’t something you do everyday. If you’ve gone over it in your mind several times, if you do need to do it at least you’ve rehearsed it before.

“In times of stress you do not rise to the occasion but sink to the level of your training…” (slightly altered quote, but you get my drift!)

Hope this was useful!

KR

N