Trauma in pregnancy
- 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
- Associate 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
Evaluation of the pregnant trauma patient presents unique challenges since the presence of a fetus means that there are two patients potentially at risk, both of whom require evaluation and management. Knowledge of pregnancy-related anatomic and physiologic changes is also important in the evaluation and management of these women.
Issues specific to the pregnant 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".)
INCIDENCE AND ETIOLOGY OF TRAUMA IN PREGNANT WOMEN
Trauma is a major contributor to maternal mortality, and is the leading cause of pregnancy-associated maternal deaths in the United States [1,2]. In 2002, there were 4.1 injury-related hospitalizations of pregnant women per 1000 deliveries in the United States .
Motor vehicle crashes and domestic/intimate partner violence account for most cases of maternal trauma, while falls, burns, homicide, suicide, penetrating trauma, and toxic exposure account for the majority of the remainder [3-5]. In fact, pregnancy appears to be a risk factor for being assaulted. Between 1993 and 1998, homicide was the leading cause of death among pregnant or recently pregnant women in Maryland and accounted for 20 percent of these deaths, but it was only the fifth leading cause of death among nonpregnant women . In another American series, 5 percent of female homicide victims were murdered while pregnant . An epidemiologic study reported an increased risk of motor vehicle crashes in the second trimester compared with prepregnancy (6.5 versus 4.6 events per 1000 drivers annually; RR 1.42, 95% CI 1.32-1.53), but a causal relationship is unproven . (See "Intimate partner violence: Epidemiology and health consequences", section on 'Pregnancy'.)
Pregnancy appears to increase the risk of falling, possibly because of increased joint laxity, weight gain, a change in the center of gravity, and other anatomical changes. Alterations in sway responses to perturbations have been reported in the third trimester in healthy women with uncomplicated pregnancies .
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- INCIDENCE AND ETIOLOGY OF TRAUMA IN PREGNANT WOMEN
- PREGNANCY-RELATED CONSIDERATIONS
- Changes in major organ systems
- Increased risk of IVC compression
- Cardiopulmonary resuscitation
- Increased vascularity and blood flow
- Changes in the abdomen
- EVALUATION AND MANAGEMENT OF MAJOR TRAUMA
- General principles
- - Assessment/stabilization
- - Fetal monitoring
- - Diagnostic imaging
- - Respiratory support
- - Volume replacement
- - Indications for urgent cesarean delivery
- - Blunt abdominal trauma
- - Burns
- - Obstetrical issues
- Uterine rupture
- Penetrating abdominal trauma
- Abruptio placentae
- Fetomaternal hemorrhage
- Preterm labor and premature rupture of membranes
- Vaginal delivery
- Influence of gestational age
- Influence of trauma severity
- Overall outcome
- MINOR TRAUMA
- SUMMARY AND RECOMMENDATIONS