A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?

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11ecbb05_cbe9_cb6a_b433_5959a1942483_MD0009_00 During stabilization of a pregnant client after trauma (eg, motor vehicle collision, fall), uterine displacement is the first step to address supine hypotension (due to aortocaval compression and decreased venous return to the heart) and promote blood circulation to the fetus. The client should be tilted laterally while strapped on the backboard to promote venous return and protect the client from further potential spinal injury (Option D). Manifestations of aortocaval compression (eg, hypotension, pallor, dizziness) may mimic those of other complications of trauma. It is therefore critical to reassess blood pressure after uterine displacement to identify persistent hypotension, which may indicate hemorrhage caused by trauma (eg, placental abruption). (Option A) An IV fluid bolus of isotonic fluids (eg, lactated Ringer solution) to correct hypotension is appropriate if position changes do not relieve symptoms or hemorrhage is suspected. Client positioning should be considered first. (Option B) Assessing medical and obstetric history is important when planning care for a pregnant client, but immediate physical needs are the priority. (Option C) The nurse should first reposition the client to address a potential cause of hypotension (aortocaval compression), which can affect blood flow to the fetus, and then initiate fetal monitoring. Educational objective: During stabilization of a pregnant client after trauma, uterine displacement is the first step to prevent/correct supine hypotension and promote blood circulation to the fetus. A lateral tilt of the backboard can correct aortocaval compression while protecting the client from further spinal injury.

A Pregnant Client at 39 Weeks Gestation Is Brought to the Emergency