scenario for the health care professional
The Victorian State Trauma System (VSTS) provides clinical support and retrieval services for critically injured patients requiring urgent transfer for definitive care and ongoing trauma management. This obstetric trauma guideline provides evidence-based advice on the initial clinical management and transfer of obstetric patients with major trauma who present to Victorian health services. It should be recognised that changes that occur during pregnancy can cause an increase in patient complexity.
This guideline is developed for clinical staff involved in the care of trauma patients throughout Victoria. It is intended for use by frontline clinical staff that provide initial care to major trauma patients; both those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS.
These guidelines provide the user with readily accessible resources to effectively and confidently provide early care for critically injured patients through the use of up to date and evidence-based guidelines. The guideline has followed the AGREE II methodology for guideline development and is under the auspice of the Trauma State Advisory Committee (TSAC).(1)
Clinical emphasis points
- Obstetric trauma patients present a complex scenario that requires multidisciplinary care of both the mother and unborn child.
Even minor trauma may lead to complications and require thorough investigation. - The normal physiological changes of pregnancy affect the clinical assessment and management of obstetric trauma patients.
- Obstetric trauma patients require careful positioning to reduce the impact of aortocaval compression.
- Best fetal outcomes are the result of early maternal resuscitation.
- Early management in obstetric trauma aims to carefully manage fluid status, maintain oxygenation and prevent hypothermia.
- Adult Retrieval Victoria (ARV) is the first point of call to initiate retrieval and transfer for adults and Paediatric and Infant Perinatal Emergency Retrieval (PIPER) for paediatrics.
- Time-critical patients are retrieved to the Royal Melbourne Hospital, with other obstetric patients transferred to a hospital with obstetric and trauma capability.
- The main goal of early care is to ensure optimum resuscitation in the emergency setting as well as activation of the retrieval network, with timely transfer to an appropriate facility.