Content
Triage and the pregnant patient
A pregnant woman presenting to an ED raises a number of unique challenges to the Triage Nurse.
• The Triage Nurse needs to be aware of the normal physiological and anatomical adaptations of pregnancy because these will influence assessment.
• Triaging should consider the wellbeing of both the mother and the foetus and potential threats to either.
• The pregnant woman may present with any disease.
The presentation of some diseases is modified by pregnancy and some diseases only occur in pregnancy.
Pregnancy and the primary survey
Airway Any pregnant women presenting to the ED with a potentially compromised airway needs urgent medical attention. Pregnant women are often difficult intubations due to patient size, patient positioning and different induction agent requirements due to cardiovascular physiological changes.
51
Breathing Progesterone is thought to be responsible for altering the sensitivity of the respiratory centre and increasing the drive to breathe. 119
• Pregnant women commonly experience increased nasal and airway vascularisation and mucosal oedema. This presents as an increase in complaints about nasal congestion.
• About one-third of women with asthma suffer a deterioration of their illness during pregnancy. 120
Circulation Pregnancy is described as a hyperdynamic state and physiological changes occur as early as 6 – 8 weeks gestation. Progesterone causes widespread vasodilatation and oestrogen is thought to contribute to a 40 – 50 per cent increase of blood volume. The diastolic blood pressure falls on average 6 – 17 mmHg, with BP lowest during the second trimester. Cardiac output( CO) increases by 30 – 50 per cent.
At 20 weeks gestation, the weight of the uterus compresses the inferior vena cava if the woman is lying on her back. The subsequent reduction in placental flow is enough to compromise foetal wellbeing and the drop in venous return reduces maternal CO and BP. Unspecified changes occur to blood vessels that predispose pregnant women to spontaneous arterial dissections.
Department of Health and Ageing – Emergency Triage Education Kit