Trauma in Pregnancy
	Date: Sat, 6 Jul 1996 14:41:54 From: Teodoro J. Herbosa [therbosa@kulog.upm.edu.ph] I'm interested in information on Trauma in Pregnancy. Anyone in the list with information (data) would be most welcome. What I want to know is how often do you see such cases in your center. I'm particularly interested in cases with abdominal trauma in pregnancy who undergo laparotomy in their late trimester.
	Date: Sat, 6 Jul 1996 05:08:30 From: Evelyn Cardenas MD [Emjogger@aol.com] I read your post regarding a request for information regarding trauma in pregnancy. While I do not have specific information to tell you that is different from basic trauma protocol, I do have some comments regarding the use of ultrasound in the ED. Trauma in pregnancy is one of the many reasons, I and other Emergency Medicine MDs are advocating having the skill to use an ultrasound machine in the eval of blunt trauma. Having the skill to do a quick scan of the abdomen for fluid would allow one to make quick management decisions. It also allows for a quick assessment of fetal viability and position. I think that ultrasound to assess for hemoperitoneum would be a better/easier imaging modality in blunt trauma in pregnancy.(this is my opinion) Are the surgeons and emergency physicians using ultrasound in your department?
	Date: Sat, 6 Jul 1996 17:57:06 From: Teodoro J. Herbosa [therbosa@kulog.upm.edu.ph] Surgeons in our deparment are now being trained to do intraoperative ultrasoung specifically for hepatobiliary surgery. Because of this exposure, they now utilize the ultrasound for some preoperative diagnostic techniques most specifically diagnosing hemoperitoneum in abdominal trauma. Our Ob-Gyne residents as wel are proficient in ultrasound of the pelvis. However I find the the skills for these tests have beeen fragmented. I've read articles from German and Japanese institutions that use the ulltrasound like the stetoscope, I however think that the resistance of some sonologists is giving this turf may also have some valid claims. Anecdotically, I've seen OB-GYN residents misdiagnose a pancreatic cyst as a huge Ovarian cyst. Emergency Physicians are still not using ultrasound in our institution. I believe that this will greatly improve the diagnosis in the ED specially in traumatized pregnant patient. I had however wanted specifically more data are the epidemiology of trauma in pregnant patient from the different subscribers. I wanted to know the frequent causes of trauma and outcomes of treatment (laparotomy) in terms of Maternal mortality and morbidity and fetal mortality and morbidity. Thank you for your very quick response.
	Date: Sun, 7 Jul 1996 19:54:23 From: Bradley K. Mosiman [wmosiman@feist.com] Only the surgeons are credentialled to use ultrasound in the resuscitation room for the evaluation of blunt trauma at our facility. None of them feel totally comfortable using US to determine viability, etc of fetus. Generally the OB surgeon is called in. We have had great success with US, have decreased the number of CT scans needed, and have an opportunity to do easy serial exams if necessary.
	Date: Mon, 8 Jul 1996 20:00:49 From: Dr David Ulyatt [dulyatt@medeserv.com.au] There is a Valuable article in Annals of Surgery, May 1996: " infant survival after Cesarean section for trauma" Morris et al multicenter origin US. 8 yr retrospective survey of trauma adms level 1 trauma centers, 414 pregnant with 32 emergency C sections. No surviving fetus without preop FHS, or > 26 weeks gest'n. Fetal survival independent of maternal ISS! Of 5 dead fetuses judged potentially salvageable all had delayed recognition of foetal distress, and 60% of these mothers were ISS< 16! There is more.
	Date: Fri, 12 Jul 1996 20:49:20 From: [MSaxena123@aol.com] I am a emergency physian, work at a level 1 trauma center.We have a very good trauma team organization etc., but unfortunately do not have a good back-up of Ob. On calls Gyn. are very reluctant to come and get involved even to evaluate pregnant trauma patients. For severe trauma, there is not much problem as 'taking care of mother will take care of fetus' dictim holds true.Problem arises in mild to moderate trauma of MVA when mother is a little tender in lower abdomen , and usually anxious to know whether the fetus is OK? A one time doppler demonstration of adequate FHS ideally should not be sufficient and monitoring of uterine contraction and fetal heart is recommended. Is this how it is usually practised in other institutions? I would like to know from others. We usually have to transfer our pregnant trauma patints to other hospital with ob.facility. What are the indications for such monitoring? Is it also indicated in early pregnancy? I would appreciate different points of view. Thanks
	Date: Sat, 13 Jul 1996 04:32:54 From: Eric Frykberg M.D. [ERF.TRAUMAONE@mail.health.ufl.edu] We are fortunate to have a responsive OB service, which I think is as essential as is a committed ortho or neurosurgery service, altho fortunately OB trauma is less common. OB immediately responds to trauma in pregnant patients, and those intermediate patients you are most concerned about, who are admitted for observation, are admitted to the labor deck for monitoring, with trauma seeing them in conjunction. OB is also involved in any laparotomy and post-op monitoring, and is an important input for decisions as to the need for C-section in late pregnancies.