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Håndtering af gravide med mindre traumer. Anette Olesen Jakob Dinesen Lone Nørgaard

Håndtering af gravide med mindre traumer. Anette Olesen Jakob Dinesen Lone Nørgaard Forskningstræning modul 2 2008. Klinisk problemstilling. Er der evidens for gængs praksis med 24 timers indlæggelse/observation af gravide med mindre traumer ?

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Håndtering af gravide med mindre traumer. Anette Olesen Jakob Dinesen Lone Nørgaard

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  1. Håndtering af gravide med mindre traumer. Anette Olesen Jakob Dinesen Lone Nørgaard Forskningstræning modul 2 2008

  2. Klinisk problemstilling • Er der evidens for gængs praksis med 24 timers indlæggelse/observation af gravide med mindre traumer ? • Findes der undersøgelser, som kan identificere risikopatienter ?

  3. PICO • P: pregnancy, minor trauma • I: Ultrasound, CTG, FMH • C: Observation • O: Abruptio

  4. Litteratursøgning • TRIP: Trauma AND pregnancy: 114 • Cochrane: Trauma AND pregnancy:0 • Pubmed: -Trauma AND pregnancy : 16.700 -Trauma AND pregnancy AND abruptio : 188 -Trauma AND pregnancy AND abruptio AND (ultrasound OR observation): 14 -Trauma AND pregnancy AND minor AND abdominal: 24 +.........related articles

  5. Kriterier for udvælgelse • Minor trauma • Full text access (ældre artikler fx 1990)‏ • 3 artikler udvalgt

  6. A. Cahill: Minor trauma in pregnancy-Is the evaluation unwarranted?AJOG: feb 2008 • 3-års prospektivt cohorte studie • 317 gravide • Traume mekanismer, fødselsudfald(80,8%)‏ • Observation: obj. undersøgelse, ultralyd, 4 timers CTG, koagulationsstatus, KB • Indlæggelse i 24 timer: >4 kontraktioner /time og neg KB

  7. Statements • Kontinuerlig CTG i 4 timer: >4 kontraktioner/time: 24 timers kontinuerlig overvågning • Ingen prædiktiv værdi af KB eller koag. Status Evidensgrad: IIb

  8. Chames MC: Trauma during pregnancy: Outcomes and clinical Magement. ReviewClin Obs Gyn 2008 Evidensgrad IV

  9. Chames MC:Trauma during pregnancy: Outcomes and clinical Magement. Review Clin Obs Gyn 2008

  10. El Kady D:Perinatal outcomes of traumatic injuries During Pregnancy. Review.Clin Obs Gyn sept 2007 ”The prediction of placental abruption after an MVA isdifficult and optimal length of time of maternal and fetal observation has not yet been determined, and the discussion is beyond the scope of this chapter, however, a minimum of 4 hours of monitoringis recommended >20 weeks gestation.With evidence of preterm labor or > 6 contractions per hour, this monitoring may be extended to 24 hours observation ”. Evidensgrad IV

  11. Rekommandation(D): • Objektiv undersøgelse evt. UL • Kontinuerlig CTG 4 timer > 4 kontraktioner/time < 4 kontraktioner time Udskrives Henv. ved smerte, veer, blødning, vandafgang eller mindre liv Indlæggelse 24 timer til observation. Monitorering med kontinuerlig CTG eller ud fra symptomer • Ingen prædiktiv værdi af KB eller koag.status

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