Pregnancy outcome and fetomaternal hemorrhage after noncatastrophic trauma

Trauma in pregnancy

“…Despite this recommendation, literature on the appropriate level of care in injured pregnant patients is very limited. Goodwin and Breen [15] proved in a landmark contribution in 1990 that, in addition to the accepted ATLS guidelines for transferal of patients to level I trauma centers (like Glasgow Coma Score less than 14, respiratory rate less than 10 or greater than 29, systolic blood pressure less than 90, Revised Trauma Score (RTS) less than 11, anatomy or mechanism of injury) that in pregnant trauma victims a pulse rate faster than 110, chest pain, loss of consciousness, and third trimester gestation are independently correlated with need for trauma center. These criteria are particularly useful in mass casualty triage of patients in adjunction to prehospital trauma scoring systems in order to identify those patients who would beneWt most from rapid transfer to trauma centers.…”

“…It represents the second most common cause of fetal mortality in trauma patients, and its incidence has been reported to vary between 20 and 50% or higher in mothers who survive major trauma [15,26]. Minor trauma carries a risk of placental abruption estimated as high as 1-5% [7,15,26].…”

“…It represents the second most common cause of fetal mortality in trauma patients, and its incidence has been reported to vary between 20 and 50% or higher in mothers who survive major trauma [15,26]. Minor trauma carries a risk of placental abruption estimated as high as 1-5% [7,15,26]. Understanding the causative mechanism of placental abruption will remind the treating physician about the risk of delayed presentation of this condition: The sudden increase in intra-abdominal pressure in blunt trauma leads to acute compression and deformation of the elastic myometrium.…”

“…With more than eight registered contractions per hour and in the absence of reassuring fetal monitoring, there is a 25% chance of Wnding placental abruption in a pregnant women after blunt abdominal trauma [49]. Only 35% of clinically signiWcant placental abruptions had vaginal bleeding [15]. Although placental abruption is frequently found in association with fetomaternal hemorrhage, screening for fetal blood cells in the maternal circulation with Kleihauer-Betke tests has a low speciWcity and is currently for this purpose not recommended [1,30].…”

Conseqüências da violência familiar na saúde da criança e do adolescente: contribuições para a elaboração de propostas de ação

“…As pesquisas que estudam as conseqüências na saúde do feto sugerem a possibilidade de associação do abuso fí-sico na gestação com várias conseqüências deletérias, como o aborto espontâneo ou hemorragias intracranianas com conseqüente morte fetal. Também são citados o descolamento prematuro de placenta, que aumentaria o risco de prematuridade e outras complicações maternas e fetais (Pugh, 1978;Goodwin & Breen, 1990;Berenson et al, 1994).…”