Management of the Pregnant Trauma Patient: A Systematic Literature Review

Liggett, Marjorie R.; Amro, Ali; Son, Moeun; Schwulst, Steven J.

doi:10.1016/j.jss.2022.11.075

Cited by 3 publications

(2 citation statements)

References 49 publications

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“…Tranexamic acid (intravenous or topical) does cross the placenta, and observational studies have not shown any increased risk to the fetus with episodic use. 2,24,25 If necessary, blood transfusions may be performed safely in pregnant patients. 26 In the rare case of life-threatening epistaxis, operative intervention or delivery of the fetus may be indicated depending on gestational age, as epistaxis usually resolves post partum.…”

Section: Epistaxismentioning

confidence: 99%

“…When epistaxis is refractory to pressure or packing, the treatment of choice is endoscopic cautery under local anesthesia, with bipolar cautery being preferable and silver nitrate use described, though the risk profile is unknown. Tranexamic acid (intravenous or topical) does cross the placenta, and observational studies have not shown any increased risk to the fetus with episodic use . If necessary, blood transfusions may be performed safely in pregnant patients .…”

Section: Otolaryngologic Manifestations In the Pregnant Patientmentioning

confidence: 99%

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Otolaryngology and the Pregnant Patient

Lawlor,

Graham,

Owen

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportancePregnancy may result in physiologic and pathologic changes in the head and neck. Otolaryngologists may need to intervene medically or surgically with pregnant patients. Careful consideration of risks to both the gravid patient and the developing fetus is vital.ObservationsPatients may present with otolaryngologic complaints exacerbated by or simply occurring during their pregnancy. Symptoms of hearing loss, vertigo, rhinitis or rhinosinusitis, epistaxis, obstructive sleep apnea, sialorrhea, voice changes, reflux, subglottic stenosis, and benign and malignant tumors of the head and neck may prompt evaluation. While conservative measures are often best, there are medications that are safe for use during pregnancy. When required, surgery for the gravid patient requires a multidisciplinary approach.Conclusions and RelevanceOtolaryngologic manifestations in pregnant patients may be managed safely with conservative treatment, medication, and surgery when necessary. Treatment should include consideration of both the pregnant patient and the developing fetus.

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Section: Epistaxismentioning

confidence: 99%

Section: Otolaryngologic Manifestations In the Pregnant Patientmentioning

confidence: 99%

Otolaryngology and the Pregnant Patient

Lawlor,

Graham,

Owen

et al. 2023

JAMA Otolaryngol Head Neck Surg

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Reanimación de la mujer embarazada

Muller,

Chamaraux-Tran,

Pottecher

2024

EMC - Ginecología-Obstetricia

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Management of spinal trauma in pregnant patients: A systematic review of the literature

Rajkovic,

Kiss,

Lee

et al. 2024

J Trauma Acute Care Surg

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BACKGROUND Despite the high incidence of spine trauma globally, traumatic spinal cord injury (tSCI) during pregnancy is considered a rare medical emergency. The literature on acute management of these patients is sparse compared with that of mothers with preexisting tSCI. This systematic review aims to evaluate management strategies for tSCI during pregnancy in improving neurologic, obstetric, and neonatal outcomes. METHODS A systematic review of PubMed/MEDLINE was performed without language restriction from inception until November 2, 2023 for patients who acquired tSCI during pregnancy. Excluded articles described postpartum trauma, trauma before pregnancy, or SCI of nontraumatic etiology such as neoplastic, vascular, hemorrhagic, or ischemic origin. Primary outcomes investigated were maternal American Spinal Injury Association (ASIA) grade, pregnancy termination, cesarean delivery, prematurity, and neonatal adverse events. RESULTS Data from 73 patients were extracted from 43 articles from 1955 to 2023. The mothers' median age was 24 years (interquartile range, 23–30 years), and the average gestational age at the time of injury was 21.1 ± 7.7 weeks. The thoracic spine was the most common segment affected (41.1%) and had the greatest proportion of complete tSCI (46.6%). Furthermore, ASIA score improvement was observed in 17 patients with 3 patients experiencing a 2-score improvement and 1 patient experiencing a 3-score improvement. Among these patients, 86% of ASIA B and 100% of ASIA C patients showed neurologic improvement, compared to only 17% of ASIA A patients. Surgically managed patients had a lower rate of neonatal adverse events than conservatively managed patients (11% vs. 34%). CONCLUSION Acute tSCI requires a coordinated effort between a multidisciplinary team with careful consideration. While maternal neurologic improvement was observed more often following a better ASIA grade on presentation, the presence of neonatal adverse events was less common in patients treated with surgery than in patients who were managed conservatively. LEVEL OF EVIDENCE Systematic review/Meta-analysis; Level IV.

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Management of the Pregnant Trauma Patient: A Systematic Literature Review

Cited by 3 publications

References 49 publications

Otolaryngology and the Pregnant Patient

Otolaryngology and the Pregnant Patient

Reanimación de la mujer embarazada

Management of spinal trauma in pregnant patients: A systematic review of the literature

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