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.