The Surgical clinics of North America
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The management of trauma and hemorrhagic shock in the pregnant patient involves unique considerations owing to extensive alterations in physiology. In the third trimester of pregnancy, emergent delivery by cesarean section should be started within 4 minutes after the initiation of CPR for both maternal and fetal benefits. ⋯ Postpartum hemorrhage is managed by a succession of pharmacologic and surgical maneuvers prior to resorting to hysterectomy, particularly in a woman of low parity. Hepatic rupture and abdominal gestation are unique conditions to pregnancy that require damage control through a close partnership between the obstetrician and the surgeon.
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With the growing understanding of the pathophysiology of exsanguination has come the evolution of extraordinary surgical techniques designed to improve survival. As the success of damage control has grown, so has its acceptance in the traditional surgical community. Our challenge now is to scientifically define patient selection, refine intraoperative techniques, and acquire a greater clinical and basic science understanding of the physiology of exsanguination and reperfusion injury in resuscitation. In these efforts, overall survival should continue to increase and morbidity should continue to decrease.