Obstetrics in trauma

Abstract

Trauma in pregnancy is the leading non-obstetrical cause of maternal death and remains the most common cause of foetal demise. Many diagnostic and management challenges are present when dealing with the injured pregnant patient. Anatomical and physiological variations of pregnancy need to be understood in order to adapt medical management and overcome the numerous challenges which exist for such patients. The relative unfamiliarity of anatomical and physiological changes experienced in pregnancy means great care must be taken when managing such patients, especially in high energy trauma injuries. Review of the available evidence provides an epidemiological understanding for provision of trauma services. Obstetrics in trauma is a relative rare condition in the United Kingdom, however evidence based in the UK regarding the epidemiology is limited. This article also outlines the principle factors for the assessment and treatment of the injured obstetric patients, as well as discussing areas of ongoing uncertainty.

Management of pregnancy and obstetric complications in prehospital trauma care: faculty of prehospital care consensus guidelines

“…60 Also, the wedge should support the length of the spinal immobilisation device in order to be a stable platform and prevent hinging under the weight of the patient. The consensus group undertook a practical demonstration of this method and unanimously agreed on its recommendation in the absence of evidence from the literature [IV].…”

Management of the pregnant trauma patient: A literature study

“…Placental abruption (PA) is a major obstetrical complication following trauma, especially MVA [7,12,26]. The prevalence varies widely but can reach up to 50% [6][7][8][9][10]12,14,15]. It should also be considered following minor trauma, especially later in pregnancy [6,20].…”

“…It should also be considered following minor trauma, especially later in pregnancy [6,20]. It is the most common cause of fetal death with maternal survival following blunt trauma [6,[8][9][10]13,[15][16][17][18]. Fetal mortality rate following PA can reach up to 75%…”

“…The most common causes are Motor Vehicle Accidents (MVA), falls, assaults and burns with the order depending on the world region and the rate of intimate partner violence [1,2,[4][5][6][7][8][9][10]13]. Blunt trauma is more prevalent than penetrating trauma [5,7,9].…”

“…Fetal death following trauma is mostly caused by placental injury or maternal death [1,4,6,[8][9][10]14,17]. Especially in the fi rst trimester, when the uterus is less prone to direct injury, fetal death is often due to fetal hypoperfusion following maternal hypovolemia or hypotension [1].…”