Management of the pregnant trauma patient: A literature study

Abstract

Background Trauma complicates approximately 7 % of pregnancies and is thereby the leading cause of non-obstetric morbidity and mortality during pregnancy [1-10]. The risk of traumatic injury increases with the advancement of pregnancy [4,8,10,11]. Pregnancy as such does not increase morbidity or mortality following trauma but leads to different mechanisms and patterns of injury with an increased vulnerability to abdominal injury [4,6,10,12]. One needs to bear in mind that trauma affects both mother and unborn child, with the latter having a higher mortality rate [4,13]. The spectrum of trauma severity is broad. Severe trauma often leads to fetal loss but minor trauma is responsible for the majority (60-70%) of fetal deaths due to its higher prevalence [2,4,10,12,14]. However, the likelihood of adverse fetal outcome is often unpredictable and does not correlate with the degree of trauma [4,15,16].

Traumatic pelvic ring fracture during pregnancy: a systematic review

“…Subsequently, in the secondary survey, the medical team must evaluate and decide on the most appropriate diagnostic and management strategies for the fracture, while also conducting additional assessments of fetal well-being. Lastly, healthcare professionals need to determine the best course of action for the rest of the pregnancy in conjunction with the fracture management strategy ( 3 , 8 , 11 , 39 , 40 ).…”

“…Advanced Trauma Life Support algorithms (ABCDEF, with airway, breathing, circulation, disability (in the obstetric trauma patient, ‘D’ also stands for ‘displacement’), exposure, and ‘F’ for fetus in obstetric trauma) should guide the initial actions ( 11 , 41 ). Given the potential for significant blood loss in PRFs, especially when accompanied by other injuries like retro- and intraperitoneal injuries, vascular injuries within the pelvis, or fractures of long bones like the femur shaft, maintaining stable hemodynamics through hydration and oxygenation is critical ( 3 , 8 , 9 , 10 , 14 , 32 ). Among the four mothers who had femoral shaft fractures, two did not survive ( 19 ).…”

“…PRFs that lead to hypovolemia can independently escalate patient mortality, irrespective of underlying conditions. This risk is notably exacerbated in pregnant women that potentially elevate the likelihood of fatality ( 1 , 5 , 8 , 9 , 10 , 11 , 12 , 13 ).…”

Trauma and pregnancy

“…It is believed that one in four pregnant women will have at least one fall during pregnancy. (18,19) Most falls occur at home, and falls from one's own height are frequent. About 39% involve stairs.…”

“…It is uncommon during pregnancy (2.3 per 100,000 live births) and associated with low rates of maternal mortality. (1,18) This characteristic is attributed to displacement of the abdominal viscera.…”