Critical Care Obstetrics part 51 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Trauma in Pregnancy obtained must be interpreted in reference to what is normally found during pregnancy. A decreased serum bicarbonate level may be indicative of significant risk for fetal loss. One series reported that initial serum bicarbonate levels were significantly lower L versus L in pregnant major trauma victims in which fetal loss was noted 10 . C refers to circulation. Pulse quality blood pressure and capillary refill are basic clinical determinants of the adequacy of perfusion. As mentioned earlier clinical evaluation of maternal intravascular homeostasis is altered by the underlying physiologic changes of pregnancy. Also fetal effects from maternal hypovolemia are not addressed by basic hemodynamic physical diagnosis 10-13 . In any case because of the ongoing hemorrhage often present in any severely-injured trauma patient immediate assessment and treatment of hypovolemia must be provided. In nearly all trauma cases a large-bore 14 or 16G intravenous IV access should be established Customarily patients with multiple trauma should have a large-bore IV inserted in both an upper and lower extremity. Central venous access is not immediately indicated provided adequate peripheral access can be established. An appropriately sized peripheral IV 14 or 16G will provide the ability to rapidly instill large amounts of volume. Hypotension in the trauma patient is assumed to be hypovolemia until proven otherwise. Because of the blood volume changes described previously it is not uncommon for pregnant patients to seemingly tolerate 1500-2000mL of blood loss with only subtle hemodynamic changes. 1 Splanchnic and uterine blood flow may be but are not always compromised 12 13 and deterioration of the patient can develop rapidly with additional blood loss. Initial therapy for hypotension found during the primary survey is the rapid infusion of up to 2000 mL of crystalloid solution and preparation for blood transfusion as necessary. Cardiopulmonary
