diagnostic AND Laboratory procedures
Diagnostic and laboratory procedures in pregnant trauma patients should follow institutional protocols and be appropriate to the patient's underlying condition.
Laboratory studies- Suggested laboratory studies for moderate to severely injured pregnant trauma patients include a type and cross-match, a hemoglobin and hematocrit or complete blood count, serum electrolytes, BUN and creatinine, serum glucose, AST and ALT, amylase, lipase, urinalysis, urine drug screen and urine pregnancy test. Further testing could include a coagulation profile, serum lactate, and an arterial blood gas as there is an association between maternal acidosis and fetal demise. A Kleinhauer-Betke stain may also be performed to measure the amount of fetal red blood cells in the maternal circulation.
Tips to remember:
-An initial hemoglobin of less than 8 g/dL has been associated with ongoing hemorrhage and increased mortality in nonpregnant trauma patients.
- PT and PTT are not affected by pregnancy
- Fibrinogen increases in pregnancy. A low/normal fibrinogen suggests a coagulopathy
- Although electrolyte levels are usually normal in healthy pregnant patients, a low bicarbonate level has been associated with an increase in fetal demise in pregnant trauma patients.
- Determining a baseline creatinine level is helpful if renal complications develop
- Elevation of the AST or ALT is associated with a six fold increase in the risk of intra-abdominal injury and is an indication to pursue diagnostic imaging.
- Lactate may have decreased sensitivity due to increased renal clearance in the pregnant patient.
- Substance use is common in trauma patients. The results of testing provide information that is important for both medical and legal reasons. The physiologic effects of some substances can alter the patient's response to the stress of trauma.
Diagnostic/Radiologic Studies- These studies are performed once the initial resuscitation is completed and mother and baby are stabilized. Radiographic screening should include cervical spine, chest and pelvis films. Computed Tomography (CT) scanning should be performed to examine the chest, abdomen and pelvis of hemodynamically stable patients who have unreliable or equivocal findings on physical examination or with multiple injuries. A FAST exam should be performed at the bedside on hemodynamically stable patients.
The patient's abdomen should be shielded whenever possible for these examinations. Testing should not be omitted due to the patient's pregnancy. Recent studies have shown that the amount of radiation the fetus is exposed to is less than 5 rads during the trauma evaluation and not associated with increased pregnancy loss or fetal abnormalities.
Laboratory studies- Suggested laboratory studies for moderate to severely injured pregnant trauma patients include a type and cross-match, a hemoglobin and hematocrit or complete blood count, serum electrolytes, BUN and creatinine, serum glucose, AST and ALT, amylase, lipase, urinalysis, urine drug screen and urine pregnancy test. Further testing could include a coagulation profile, serum lactate, and an arterial blood gas as there is an association between maternal acidosis and fetal demise. A Kleinhauer-Betke stain may also be performed to measure the amount of fetal red blood cells in the maternal circulation.
Tips to remember:
-An initial hemoglobin of less than 8 g/dL has been associated with ongoing hemorrhage and increased mortality in nonpregnant trauma patients.
- PT and PTT are not affected by pregnancy
- Fibrinogen increases in pregnancy. A low/normal fibrinogen suggests a coagulopathy
- Although electrolyte levels are usually normal in healthy pregnant patients, a low bicarbonate level has been associated with an increase in fetal demise in pregnant trauma patients.
- Determining a baseline creatinine level is helpful if renal complications develop
- Elevation of the AST or ALT is associated with a six fold increase in the risk of intra-abdominal injury and is an indication to pursue diagnostic imaging.
- Lactate may have decreased sensitivity due to increased renal clearance in the pregnant patient.
- Substance use is common in trauma patients. The results of testing provide information that is important for both medical and legal reasons. The physiologic effects of some substances can alter the patient's response to the stress of trauma.
Diagnostic/Radiologic Studies- These studies are performed once the initial resuscitation is completed and mother and baby are stabilized. Radiographic screening should include cervical spine, chest and pelvis films. Computed Tomography (CT) scanning should be performed to examine the chest, abdomen and pelvis of hemodynamically stable patients who have unreliable or equivocal findings on physical examination or with multiple injuries. A FAST exam should be performed at the bedside on hemodynamically stable patients.
The patient's abdomen should be shielded whenever possible for these examinations. Testing should not be omitted due to the patient's pregnancy. Recent studies have shown that the amount of radiation the fetus is exposed to is less than 5 rads during the trauma evaluation and not associated with increased pregnancy loss or fetal abnormalities.