Trauma is the largest cause of non-obstetric morbidity and mortality in pregnant women. Significant trauma complicates 6-7% of pregnancies.
Assessment[edit | edit source]
The Primary Survey ABCDE priorities of trauma management in pregnant patients, are the same as those in non-pregnant patients.
Primary Survey: Specific Considerations in Pregnant Patients[edit | edit source]
Specific considerations in the pregnant patient include:
- Resuscitation involves both mother and baby
- Resuscitation of the mother is the priority
- Intubation may be more difficult and risk of aspiration of gastric contents is higher
- Hypotension in the pregnant woman is a late sign in hypovolaemia
- Monitoring of the foetus is important
- Early involvement of the obstetrician is essential
Anatomical and Physiological Changes[edit | edit source]
Anatomical and physiological changes occur in pregnancy. These are extremely important in the assessment of the pregnant trauma patient.
Anatomical Changes[edit | edit source]
The size of the uterus gradually increases and becomes more vulnerable to damage both by blunt and penetrating injury.
The position of the fundus:
- At 12 weeks of gestation the fundus is at the symphysis pubis
- At 20 weeks it is at the umbilicus
- At 36 weeks it is at the xiphoid
Physiological Changes[edit | edit source]
- Increased respiratory rate and oxygen utilisation
- Increased heart rate
- 30% increased cardiac output
- Blood pressure is usually 15 mmHg lower
- Aortocaval compression in the third trimester can cause the “supine hypotension syndrome”
Assessment and Management: Specific Considerations in Pregnant Patients[edit | edit source]
Specific considerations during assessment and management in traumatically injured pregnant patients, include:
- Resuscitation with displacement of the uterus to the left to avoid aortocaval compression
- This can be by pushing the uterus over to the left or by rotation of the whole body, to avoid worsening spinal trauma
- Vaginal examination (speculum) for vaginal bleeding and cervical dilatation
- Involvement of obstetric staff, if available
Blunt trauma may lead to:
- Premature labour
- Partial or complete rupture of the uterus
- Partial or complete placental separation (up to 48 hours after trauma)
- Severe blood loss with pelvic fracture
Intercostal drains may be placed 1 or 2 interspaces higher than in non-pregnant patients.
Anti D may be necessary if the mother is Rhesus negative.