A 32-year-old patient at 28 weeks gestation is being transported by air after a motor vehicle collision. She is hemodynamically stable, fully alert, and complaining of moderate (5/10) pain from soft tissue contusions and a closed wrist fracture. Which analgesic is the most appropriate initial choice for pain management during transport?
For mild to moderate pain in pregnancy, acetaminophen is the analgesic of choice due to its established safety profile. Opioids, such as morphine, are reserved for severe pain and carry risks, including neonatal abstinence syndrome and respiratory depression. NSAIDs, including ibuprofen and aspirin, are contraindicated after 20 weeks of gestation and especially in the third trimester (which begins at 28 weeks) because they can cause premature closure of the fetal ductus arteriosus and lead to fetal renal impairment.
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