Pregnancy causes many physiologic changes, which may be challenging during trauma resuscitations. A few pearls on the ABC’s:

Airway

• Increased progesterone levels cause mucosal hyperemia and edema, increasing risk of bleeding and smaller (i.e., edematous) airway.
• PEARL: Have smaller tubes ready and let the most experienced person intubate.

Breathing

• The enlarging uterus pushes the diaphragms into the thorax, reducing the total lung capacity and the functional residual capacity.
• PEARL: During intubation, patients in late pregnancy may have less oxygenation reserve and apnea time, desaturating faster during RSI.

Circulation

• The late stage uterus can compress the IVC when supine, reducing venous return to the heart (i.e., the Supine-Hypotension syndrome) subsequently reducing cardiac output.
• PEARL: Have a 30-degree wedge placed under patient's right hip, moving the uterus off IVC and improving venous return.
• BONUS PEARL: During resuscitation, ask medical students to manually move the uterus midline, relieving the compressed IVC. They will appreciate that you got them clinically involved.

References

Chesnutt, A. Physiology of normal pregnancy. Crit Care Clinics 2004 Oct;20(4):609-15.

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