American journal of perinatology
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Trauma and/or accidental injury complicates 6-7% of all pregnancies. The management protocols for trauma in pregnancy are based largely on case reports and small series. The purposes of this study were to: describe the demographics of pregnant trauma patients at a tertiary care center and a large community hospital; identify variables predictive of fetal outcome including an examination of Kleihauer-Betke and nonstress testing; and recommend an evaluation and management protocol after trauma based on empirical data rather than anecdotal reports. ⋯ Given our findings that prolonged monitoring was not helpful in management of pregnant trauma patients, we support the recommendation that initial external fetal monitoring be performed for 4 hr, and, if reassuring, the patient may be sent home with precautions. We also recommend an Rh-immunoglobulin work-up for all Rh-negative pregnant trauma patients, but do not recommend Kleihauer-Betke testing for Rh-positive women. Given the frequency with which trauma affects pregnancy and the difficulty encountered with identifying variables predictive of pregnancy outcome, there may be great benefits of incorporating trauma prevention into routine prenatal care.
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Laerdal Infant Resuscitators (Laerdal Medical Co., NY) are commonly used as free-flow oxygen delivery devices during neonatal resuscitation in situations where oxygen but not mechanical ventilation is desired. This study evaluates the performance of these resuscitators as free-flow oxygen devices. Efficiency was measured by comparing oxygen flow entering the resuscitator to oxygen flow delivered by the resuscitator. ⋯ Simulated fiO2 ranged from 0.23 to 0.68 at 5 lpm oxygen flow. We conclude that use of the Laerdal Infant Resuscitator for the delivery of free-flow oxygen, even with the valve assembly removed, generates highly variable patient fiO2. The use of self-inflating bags for delivery of oxygen without manual ventilation should be reconsidered.