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Review
. 2020 Dec;123(12):936-943.
doi: 10.1007/s00113-020-00901-8.

[Pregnant patients wirsth major trauma in the resuscitation room : Special (patho)physiological and therapeutic aspects]

[Article in German]
T Ninke  1 , A Bayer  2
Affiliations
Review

[Pregnant patients wirsth major trauma in the resuscitation room : Special (patho)physiological and therapeutic aspects]

[Article in German]
T Ninke et al. Unfallchirurg. 2020 Dec.

Abstract
in English, German

Background: Severely injured pregnant women are rarely encountered even in major trauma centers; at the same time high expectations are set for the best possible outcome of mother and child.

Objective: Summary of the main pathophysiological aspects of pregnancy and essential therapeutic implications for emergency room treatment from the perspective of anesthetists.

Methodology: Selective literature analysis with a focus on primary physiological literature and the synthesis of pregnancy-adapted recommendations of related guidelines.

Results: The essential physiological adaptations to pregnancy and their implications for acute care are presented.

Conclusion: Teamwork, structured decision making as well as airway management and goal-oriented hemodynamic treatment are the foundations for a good outcome of mother and child.

Zusammenfassung: HINTERGRUND: Schwer verletzte Schwangere werden auch in Traumazentren selten versorgt; gleichzeitig besteht eine hohe Erwartungshaltung für ein bestmögliches Outcome von Mutter und Kind.

Ziel der arbeit: Zusammenfassung der für die Schockraumversorgung wesentlichen pathophysiologischen Aspekte und therapeutischen Maßnahmen aus der Sicht des Anästhesisten.

Methodik: Selektive Literaturanalyse mit Fokus auf physiologischer Primärliteratur und die Synthese von schwangerschaftsadaptierten Empfehlungen themenverwandter Leitlinien.

Ergebnisse: Die wesentlichen physiologischen Anpassungen an die Schwangerschaft und deren Implikation für die Akutversorgung werden dargestellt.

Schlussfolgerung: Teamwork, strukturierte Entscheidungsfindung sowie Atemwegssicherung und zielgerichtete hämodynamische Therapie bilden die Grundlage für ein gutes Outcome von Mutter und Kind.

Keywords: Advanced trauma life support care; Airway management; Decision making; Emergency cesarean section; Resuscitation.

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References

Literatur

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    1. Bonica J, McDonald J (1994) Principles and practice of obstetric analgesia and anesthesia. Williams & Wilkins, Baltimore
    1. Chappell D, Helf A, Gayer J et al (2019) Antihypotensive drugs in cesarean sections : treatment of arterial hypotension with ephedrine, phenylephrine and Akrinor® (cafedrine/theodrenaline) during cesarean sections with spinal anesthesia. Anaesthesist 68:228–238 - DOI - PubMed
    1. Choi JW, Pai SH (2002) Tissue plasminogen activator levels change with plasma fibrinogen concentrations during pregnancy. Ann Hematol 81:611–615 - DOI - PubMed
    1. Croskerry P (2002) Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 9:1184–1204 - DOI - PubMed

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