Your Standard of Practice for Maternity MVC Patients

**canoehead, BSN, RN** · Mar 30, 2003

Straight to the labor unit unless they have obvious traumatic injury that needs to be handled in the ER. If that is the case we send an OB nurse down with a moniter.

RNCENCCRNNREMTP · Mar 30, 2003

All trauma patients, no matter how far along in their pregnancy, get an ED evaluation first. Biggest cause of fetal mortality after trauma is maternal mortality. OB may miss subtle signs of injury that could lead to problems.

Once a complete ED evaluation is done, then they go to OB for at least 6 hours of TOCO/FHR monitoring.

See the following articles for good info/guidelines:

"Pregnancy outcome and fetomaternal hemorrhage after non-catastrophic trauma" American Journal of Obstetrics and Gynecology 1990;162:665-671

"Evaluation and treatment of the gravida and fetus following trauma during pregnancy" Obstetric and Gynecologic Clinics of North America 1991;18:371-381

Summary of articles is below:

Perform trauma assessment and treatment as usual with the following additions:

Assess FHR early

Tocodynamic monitoring ASAP and for 6 hours after trauma

Need continuous monitoring to better evaluate for decelerations and beat to beat variability

Patients admitted for other reasons should be monitored throughout their hospitalization

Patients with significant risk factors

MHR > 110

ISS > 9

Absent FHT

FHR 160

Ejection

MCC

Pedestrian collision

ALL get monitored for at least 24 hours

Others

Monitor for 6 hours

If no evidence of frequent contractions or FHR changes may be discharged

3rd trimester status without other risk factors is not an indication for prolonged (24 hour) monitoring

ernurse728, LPN · Mar 31, 2003

We do not have OB at our facility...we do an ED eval and transport them to the closest L&D hospital for further observation.

Uptoherern, RN · Apr 2, 2003

20 weeks, straight to ob

RNCENCCRNNREMTP · Apr 2, 2003

Originally posted by erdiane
20 weeks, straight to ob

What if your patient has head or chest trauma? Still straight to OB?? Original question was for minor or major trauma.

jeannet83 · Apr 3, 2003

The reason I was asking the initial question is that we are in the process of revamping our standards of practice for pregnant females in the ED.

For really basic, low impact MVC >20 weeks who has not sustained major trauma, we are now planning on having OB/GYN set up at least continuous FHR monitoring while being evaluated in ED (obviously same for pregnant major traumas). (Even though as stated earlier that major indication for fetal death is major maternal injury). Previously for low impact MVC's, we would do spot check FHR.

For those of you who evaluate >20 weeks pregnant females in ED first before sending to L+D, do you do continuous FHR monitoring and/or tochometer (am I spelling that right? ie., contraction monitor).

Just curious what other places are doing for their Standards of Practice. Thanks! :) Jeanne

BrandyBSN · Apr 3, 2003

we send them to OB if they are over 20 weeks, unless there is an obvious trauma issue happening. if so, OB nurse comes to er with a monitor. :)

dm2 · Oct 4, 2003

All trauma pts seen in ED first, After cleared of other needs, to OB if over 20 weeks.

KKERRN · Oct 8, 2003

under 20 weeks to the ER and over 20 weeks are cleared medically first, then to L&D.

KKERRN · Oct 8, 2003

We ususally do FHT spot checks too, but can call L&D for monitor in ER and L&D nurse does the monitoring and charting for this.