The purpose of this session is to offer practicing bedside nurses a look at the collaborative approach to assessing and intervening for obstetrical patients with trauma and sequelae. A clear understanding of the physiologic changes in pregnancy and how those changes impact the plan of care will promote patient safety and enhance nursing care.

The Scope

Utilizing a case analysis method, this session will focus on the indications for alternatives in the plan of care when the trauma patient is pregnant. Key content that will be covered includes: blood volume and composition changes, changes in cardiac output, tidal volume changes in respiratory status, as well as impact of the gravid uterus on anatomy and physiology of systems, special consideration will be given to pharmacologic agents and their use during pregnancy and lactation.  Patient outcomes are enhanced when nurses understand the implications of changes to anatomy and physiology in the pregnant patient.  The target audience for this session includes progressive and critical care bedside nurses, obstetrical nurses, educators and advance practitioners.  Participants should have a basic understanding of hemodynamics, trauma and pregnancy.

Case: The complex trauma case presented involved a automobile crash in which the victim suffered multiple fractures to her cervical spine and subsequently quadriplegia. The care she received during a 51 day acute care hospital stay involved many disciplines and coordination of interdisciplinary care. Her care was complex and collaborative right to the final transfer of her care to another facility. Her case study will be used as teaching points to outline best practice for all trauma patients. A discussion of medications used in her care will be if interest to both the staff nurse and the advance practice nurse. This case study is the result of severe, life-threatening injury to the woman.A second case will be briefly described in which the mother was seriously injured and although not life-threatening, the fetus sustained life-threatening injuries.

Conclusion: Care of the OB trauma patient is at once simple and complex. If there is no damage to the pelvis/fetus with the proper care the pregnancy remains intact and the fetus can be expected to grow and thrive. Conversely the care for the pregnant can become very complex. Conversely the type of injuries can adversely affect the fetus while care to the mother remains relatively simple.

Keywords: Trauma, Hemodynamics, injuries, interdisciplinary care