Algorithm of Morris et al for Management of a Pregnant Woman Including Emergency Cesarean Section

Description

Morris et al proposed an algorithm for the management of the pregnant woman after significant trauma. This can decrease the fetal mortality associated with delays in therapeutic intervention. The authors are from multiple trauma centers from across the United States.

Definition of fetal distress – one or more of the following:

(1) bradycardia

(2) decelerations

(3) lack of fetal heart tones

Definition of maternal distress – one or both of the following:

(1) systolic blood pressure < 90 mm Hg (shock)

(2) acute decompensation

Parameters for decision making in the pregnant woman following trauma:

(1) presence of fetal heart tones

(2) gestational age on ultrasound

(3) maternal status

Fetal Heart Tones on Presentation	Gestational Age	Maternal Distress	Fetal Distress	Management
absent	NA	NA	NA	ATLS resuscitation
present	< 26 weeks	NA	NA	ATLS resuscitation
present	>= 26 weeks	none	none	continue fetal monitoring
present	>= 26 weeks	none	present	C-section
present	>= 26 weeks	present	NA	C –section
present	>= 26 weeks	requiring CPR	NA	perimortem C-section

where:

• Absence of fetal heart tones is one of the criteria for fetal distress. The first situation infers that there has been an absence of fetal heart tones at presentation and presumably for some time. If there was a sudden loss of fetal heart tones, then a C section would be indicated.

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Algorithm of Morris et al for Management of a Pregnant Woman Including Emergency Cesarean Section

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