Prehospital Care

An effort to ascertain the possibility of pregnancy should be made during the initial evaluation of all acutely injured women of childbearing age. As in the care of all trauma victims, initial priorities remain the ABCs of resuscitation. All pregnant trauma patients should receive supplemental oxygen, as the gravida becomes less able to compensate for hypoxia. Similarly, early intubation must be considered when indicated by the nature or severity of injuries. Peripheral intravenous lines with crystalloid infusions should be initiated in the prehospital setting.

For pregnant patients beyond 20 weeks of gestation who must be transported in the supine position or in whom spinal immobilization is indicated, a wedge should be placed under the right hip area tilting the patient toward her left side to avoid hypotension from inferior vena cava compression by the gravid uterus. Alternatively, the uterus may be manually maneuvered to the left side of the abdomen by transport personnel. Pneumatic antishock trousers are rarely used now, but if considered in a pregnant patient, the abdominal compartment must not be inflated, because that may cause uteroplacental compression and impair venous return to the heart. An integral part of the prehospital role in trauma management is the appropriate triage to receiving facilities. If pregnancy in a trauma patient is identified or suspected, transport should be initiated to a designated trauma center with sufficient capabilities to manage such patients. Advanced notification of the receiving facility should be made to enable the assembly of the appropriate hospital personnel to continue the resuscitation and management efforts.

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