Initial evaluation and management of pregnant women with major trauma
- Sarah J Kilpatrick, MD, PhD
Sarah J Kilpatrick, MD, PhD
- Chair, Department of Obstetrics and Gynecology
- Cedars-Sinai Health Center
- Section Editors
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
Motor vehicle accidents and domestic/intimate partner violence account for most cases of maternal major trauma, while falls, burns, homicide, suicide, penetrating trauma, and toxic exposure account for the majority of the remainder [1-3]. Evaluation of the pregnant patient with major trauma presents unique challenges since the presence of a fetus means two patients are potentially at risk, both of whom require evaluation and management.
In the pregnant woman, compression of the abdomen from a fall, intentional violence, or a low-speed motor vehicle crash can be considered major trauma. Issues specific to the pregnant major trauma patient will be discussed here. Issues related to management of trauma in the nonpregnant population are reviewed separately. (See "Initial management of trauma in adults".)
A 2013 systematic review of studies on trauma in pregnancy reported the following estimates of trauma incidence/prevalence by subtype of trauma :
●Domestic violence: 8307/100,000 live births
●Motor vehicle crash: 207/100,000 live births
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- PREGNANCY-RELATED CHANGES IN PHYSIOLOGY
- INITIAL EVALUATION AND MANAGEMENT OF MAJOR TRAUMA
- General principles
- Airway, breathing, and ventilation
- Cervical spine immobilization
- - Uterine displacement
- - Volume replacement
- - Transfusion
- - Cardiopulmonary resuscitation
- Fetal heart rate
- Neurologic evaluation
- Diagnostic laboratory tests
- Diagnostic imaging
- Diagnostic procedures
- PREGNANCY EVALUATION AND MANAGEMENT AFTER INITIAL MATERNAL STABILIZATION
- Physical examination
- - Determining gestation age
- - Abdominal examination after abdominal trauma
- - Vaginal examination
- Fetal assessment
- - Fetal heart rate monitoring
- - Role of ultrasound examination
- Evaluation and management of obstetric complications
- - Abruptio placentae
- Fetal monitoring
- Maternal management
- - Uterine rupture or penetrating injury
- - Fetomaternal bleeding
- Antenatal corticosteroids for patients at risk for preterm birth
- Management of non-obstetric surgery
- - Anti-D immune globulin
- - Tetanus toxoid
- Overall outcome
- MENTAL HEALTH AND COUNSELING
- SUMMARY AND RECOMMENDATIONS