The splenic artery, subclavian artery and aorta, for example, have an increased tendency to spontaneous dissection, even in women with no previous medical history.
Domestic violence is more common during pregnancy and is associated with an increase in obstetric complications for the mother and adverse neonatal outcomes. 123
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Important points to note:
• Pregnant women often describe palpitations during pregnancy, which is usually due to the hyperdynamic flow.
• The high volume and dynamic blood flow is thought to contribute to the increased likelihood of cerebral haemorrhage( especially sub-arachnoid haemorrhage( SAH)) in pregnancy.
• It is not uncommon for pregnant women to experience a sudden and serious deterioration of their condition therefore pregnant women showing signs of haemodynamic de-compensation require urgent medical assessment. 124
• All pregnant women > 20 weeks gestation should have a left lateral tilt( wedge under their right hip, or whole bed tilted if wedge is contraindicated) if they are lying down.
• Pulmonary embolus is relatively common during pregnancy due to the changes in the coagulation system associated with pregnancy.
• In the setting of trauma, all usual trauma criteria should be considered. Additional considerations include trauma to the uterus, placenta or foetus, particularly in the third trimester when the foetus is viable. The maternal vital signs may remain stable even when loss of one-third of blood volume may have occurred. 125
•‘ The best initial treatment for the foetus is the optimum resuscitation of the mother.’ 125
Common conditions that present to ED according to gestational age
Problems occurring prior to 20 weeks
Pregnant women frequently present to the ED with vaginal bleeding. Common causes include the various types of miscarriage( i. e. threatened, inevitable, complete, incomplete and septic).
• Knowledge of the volume and colour of per vaginal( PV) loss will assist the Triage Nurse with categorising the urgency of the case.
• Bright red blood loss is usually indicative of active bleeding, while brownish red blood loss is usually old.
• Many women may also complain of associated abdominal pain that may be likened to severe period pain.
• Shoulder tip pain can be indicative of a bleeding ectopic pregnancy.
• The first and foremost diagnosis to exclude in the female of child-bearing age, including those who have undergone sterilisation procedures presenting with vaginal bleeding, is an ectopic pregnancy. 126
Department of Health and Ageing – Emergency Triage Education Kit