156 Obstetrics and Gynecology Board Review •••
INTENSIVE CARE/TRAUMA
❍ What are the major causes of pulmonary edema in pregnancy?
Gestational hypertension and preeclampsia, sepsis, acute hemorrhage, and tocolysis, especially with beta agonists
such as terbutaline.
❍ What is the most common cause of respiratory failure in pregnancy?
ARDS
❍ Name the most frequent causes of sepsis in pregnancy.
Pyelonephritis, chorioamnionitis, and puerperal pelvic infection.
❍ What are the goals of ventilation of a pregnant woman?
Maintain the partial pressure of oxygen in arterial blood (PaO 2 ) at or above 60 mmHg and the oxygen saturation
90% at <50% oxygen content of inspired air, along with positive end-expiratory pressures <15 mmHg.
❍ What percentage of pregnant women experience physical trauma?
10% to 20%.
❍ When is screening for intimate partner violence recommended during pregnancy?
All women should be screened at the initial prenatal visit, each trimester, and again postpartum.
❍ What is the most common cause of serious life threatening or fatal blunt trauma during pregnancy?
Motor vehicle accidents.
❍ How frequent is traumatic placental abruption?
Some degree of abruption complicates 1% to 6% of “minor” injuries and up to 50% of major injuries.
❍ What are signs and symptoms of traumatic placental abruption?
Uterine tenderness and uterine contractions (greater than one every 10 minutes is concerning). Vaginal bleeding
may be present or absent
❍ How common is uterine rupture due to blunt trauma?
<1%.
❍ What is the most common cause of fetal maternal hemorrhage associated with blunt trauma?
Placental tear or “fracture” caused by stretching of the placenta.
❍ How long after a trauma should a pregnant woman be monitored, and what conditions should be met for
discharge?
Monitoring can be discontinued after 4 hours if coagulation studies are normal and uterine contractions are
less than one every 10 minutes. If contractions are more frequent than every 10 minutes, there is a 20% risk of
placental abruption.