PHYSICAL REHABILITATION OF TRAUMATIC INJURY IN PREGNANT WOMEN.
BY: DAODU TOPE – Topeblessing13@gmail.com
Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. Trauma during pregnancy is the leading cause of non obstetric maternal mortality, with 20% of maternal deaths directly attributable to injuries. This article is expected to facilitate optimal and uniform care for pregnancies complicated by trauma.
Traumatic injuries do result through the following mean:
- Motor Vehicle Collision
- Electrical Trauma
- Penetrating Trauma injuries ; caused primarily by gunshot, stab wounds, incidence of domestic or intimate partner violence and so on
Every pregnant woman should visit their doctor following ANY accident or if you experience any of these conditions in the hours, days, weeks, or months after the accident:
- vaginal bleeding or spotting
- swelling in your face or fingers
- a leakage of fluid or increased vaginal discharge
- severe or unrelenting and constant headaches
- pain in your abdomen or shoulder areas
- persistent vomiting that is not connected to morning sickness
- chills or a fever
- a noticeable change in the frequency or strength of your baby’s
- painful or urgent urination
- faintness or dizziness
Assessment and treatment of a pregnant trauma patient in the emergency room (ER) may require the involvement of a multidisciplinary team that may include an emergency physician or trauma specialist (or the designated emergency care provider), an obstetrician (or obstetrical care provider), a neonatologist, an anaesthetist, and skilled nursing staff. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. Transfer to a maternity facility (triage of a labour and delivery unit) is advocated when injuries are neither life nor limb-threatening and the fetus is viable (≥ 23 weeks), and to the emergency room when the fetus is under 23 weeks gestational age or considered to be non-viable. When the injury is major, the patient is transferred to the trauma unit or emergency room, regardless of gestational age.
Evaluation of a pregnant trauma patient in the ER; assessment, stabilization, and care of the pregnant women is the first priority; then, if the fetus is viable (≥ 23 weeks), fetal heart rate auscultation and
Fetal monitoring can be initiated and an obstetrical consultation obtained as soon as feasible. In pregnant women with a viable fetus (≥ 23 weeks) and suspected uterine contractions, placental abruption, or traumatic uterine rupture, urgent obstetrical consultation is recommended. The obstetrician (or other obstetric care provider) plays a major role in determining gestational age, optimizing uteroplacental perfusion, assessing fetal well-being, providing information about the risks of radiation exposure and use of medications, and deciding upon and executing an emergency Caesarean section. As with non-pregnant women, the initial treatment of an acutely injured pregnant woman includes securing her airway, ensuring breathing and maintaining adequate circulation. The most important lifesaving primary interventions might include, for example, intubation and controlling severe external hemorrhage.
Traumatic injuries managed by physiotherapist includes the following
- pelvic fractures
- Pubis symphysis dysfunction
- Incontinence following incomplete spinal cord injury
- Neuro-musculoskeletal and Head injuries
- Breathing, chest complications and so on.
Pelvic fractures (especially high-impact) most commonly result from major incidents such as a motor vehicle accidents, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency room care, surgery, and extensive physical therapy rehabilitation. Pelvic fracture recovery often involves a long periods of bed rest. In the case of pregnancy, avoidance of activities is recommended until pain and other complications has resolved. During these periods of rest, which are usually weeks to months, a person often loses strength, flexibility, endurance, and balance abilities. This can be corrected through physiotherapy.
A symphysis pubis dysfunction is a common and debilitating condition affecting woman. It’s painful and it can have a significant impact on quality of life, which can lead to complications as depression Pregnancy leads to an altered pelvic load, lax ligaments and weaker musculature. This leads to spino-pelvic instability, which manifest itself as symphysis pubic dysfunction.
Spinal Cord Injury is damage to the spinal cord that results in a loss of function such as mobility or feeling, its frequent cause of damage are trauma and disease. Urinary incontinence (UI) is defined by the International Continence Society as involuntary urinary leakage; the various types of incontinence resulting from SCI are dependent on the level of injury sustained. Impairment/Injury to the S4-S5 nerve root affects the urinary bladder. Physiotherapy management of bladder can minimize the suffering to a great extend. It has been recommended that treatment strategies start with the simplest and least invasive, and only if they are not effective, then progress to more complex and invasive techniques. Treatment of UI involves physiotherapy intervention behavioral techniques, pharmacological strategies, or surgical intervention.