Trauma In Pregnancy

Clinical description

Trauma is a leading cause of morbidity and mortality in reproductive-age women; pregnant women are not excluded.

Signs and symptoms

History/Exam/Investigations If trauma is reported, regardless of visible signs of injury,the patient and her fetus should be thoroughly evaluated.

Treatment

• Ensure safety of the woman first
• Check airway, breathing, circulation (ABC)
• If airway is blocked, then foreign body removal
• If upper airway is inflamed and cannot be relieved, then tracheotomy
• If airway is patent, then check breathing
• If breathing is compromised, then look for cause and treat accordingly
• Involve general surgeons if operative management may be needed (i.e., ICD)
• If breathing is compromised due to weakness of respiratory muscles,then intubation
• Once breathing addressed, check circulation via BP and pulse rate(quality and rate)
• Insert 2 large bore cannulae (i.e. 16G) for possible resuscitation
• If shock, then give IV fluids to keep BP ≥100/60 while waiting for bloodproducts
• Take blood for Hb and X-match for whole blood
• Catheterise a patient in haemorrhagic shock to monitor urine output
• Start fluid chart (strict ins and outs)
• Raised foot of bed to ensure adequate circulation to vital organs
• Look for other deformities and treat accordingly
• Confirm viability of fetus with US
• Monitor for signs of abruption
• Give Rhogam if available for Rh negative women

Safety for the mother is the main focus in an emergency situation, with general ABC-procedures, then the baby.