Caring for traumatic injuries during pregnancy. (Role of the Obstetrician).

SARASOTA, FLA. -- Trauma during pregnancy is the leading cause of nonobstetrical death in women under age 35, and obstetricians need to play a major role in the care of injured pregnant patients, Dr. Roger Newman said at a perinatal symposium sponsored by Symposia Medicus.

"Trauma surgeons don't know enough about pregnancy," said Dr. Newman, professor and vice chairman of obstetrics and gynecology and director of maternal-fetal medicine at the Medical University of South Carolina in Charleston.

One important role of the obstetrician in caring for an injured pregnant patient is to provide trauma physicians with an understanding of the physiologic and anatomical alterations associated with pregnancy, which can be of particular importance when it comes to resuscitating the mother.

Perhaps the most important thing an obstetrician can do in the emergency room for an injured gravida is to encourage aggressive volume replacement. Volume and blood loss in pregnant patients is often underestimated; encourage the use of two large-bore (14-16 gauge) IVs, Dr. Newman advised. Give 1-2 liters of crystalloid rapidly, he added.

"Don't even think about it. It won't hurt, and it could be lifesaving," he said. Then give 3 cc of crystalloid/mL of estimated blood loss, and warn trauma physicians to avoid the use of vasopressors until volume is replaced.

Bladder catheterization is also advisable because it enables microscopic analysis of urine and can monitor urine output; oliguria in pregnancy is an early sign of hemorrhage.

Radiographic studies may be necessary and are not contraindicated in pregnancy Abdominal shielding should be used when possible, but the use of fewer than 5 rads, which is standard, is considered safe for the ...