Objectives Discuss anatomic and physiologic alterations of pregnancy and effects on patient managementEstablish assessment and treatment prioritiesIdentify elements / patterns of domestic violence

Key QuestionsHow do I know if she is pregnant?What changes occur during pregnancy?What are the unique risks of pregnancy?How do I evaluate / manage 2 patients?How do I recognize domestic violence?

Is she pregnant?Ask her!Enlarged uterus?Pregnancy test?

What are the changes / risks?Uterus: Intrapelvic and thick-walledFetus protected from direct injuryRisks AbortionIsoimmunization

What are the changes / risks?Uterus: ExtrapelvicLarge volume of amniotic fluid Risks Abruptio placentaAmniotic fluid embolismIsoimmunization

What are the changes?Uterus: Thin walledMaternal abdominal viscera displacedInferior vena cava compression

What are the risks?RisksPelvic fractures with maternal hemorrhage and direct fetal injuryAbruptio placentaAmniotic fluid embolismIsoimmunization

What are the changes / risks?Aspiration riskHyperventilationHypervolemia with anemiaEclampsia Mothers blood loss first reflectedin fetaldistress

How do I manage 2 patients?Primary survey / resuscitation of mother Fetal assessmentSecondary survey of motherDefinitive care of mother and fetusEarly OB consult

How do I manage the mother?Same as nonpregnantSame as nonpregnantSame as nonpregnantChest tube placementDisplace uterus / volume infusionFetal shockEclampsia vs brain injury

How do I manage the fetus?Resuscitate the mother Monitor fetal heart tones Consider fetal injury withVaginal bleedingAbruptio placentaUterine tenderness Uterine rupture Labor

Recognize domestic violence?A major cause of injuryMay result in death and disabilityLarge number of emergency department visits Patterns / clues similar to child abuseRefer to social / adult protective services

Partner Violence ScreenHave you ever been kicked, hit, punched or otherwise hurt by by someone in the last year? If so, by whom?Do you feel safe in your current relationship?Is there a partner from a previous relationship who is making you feel unsafe now?

Is she pregnant?What are the changes?How do these changes effect injury patterns?How do you manage 2 patients?What are the special issues related to trauma in woman?