Trauma complicates one in 12 pregnancies, and is the leading nonobstetric cause of death among pregnant women. The most common traumatic injuries are motor vehicle crashes, assaults, falls, and intimate partner violence. Nine out of 10 traumatic injuries during pregnancy are classified as minor, yet 60% to 70% of fetal losses after trauma are a result of minor injuries. In minor trauma, four to 24 hours of tocodynamometric monitoring is recommended. Ultrasonography has low sensitivity, but high specificity, for placental abruption. The Kleihauer-Betke test should be performed after major trauma to determine the degree of fetomaternal hemorrhage, regardless of Rh status. To improve the effectiveness of cardiopulmonary resuscitation, clinicians should perform left lateral uterine displacement by tilting the whole maternal body 25 to 30 degrees. Unique aspects of advanced cardiac life support include early intubation, removal of all uterine and fetal monitors, and performance of perimortem cesarean delivery. Proper seat belt use reduces the risk of maternal and fetal injuries in motor vehicle crashes. The lap belt should be placed as low as possible under the protuberant portion of the abdomen and the shoulder belt positioned off to the side of the uterus, between the breasts and over the midportion of the clavicle. All women of childbearing age should be routinely screened for intimate partner violence.
Journal of Orthopaedics, Traumatology and Rehabilitation⋅ Vol-6 ⋅ Issue-1 ⋅ Jan-Apr 2013
Trauma during pregnancy is an important cause of nonobstetrical cause of maternal mortality & morbidity. Apart from type of injury affecting the maternal & fetal outcome there are several life threatening complications unique to pregnancy like abruption placentae, uterine rupture, amniotic fluid embolism, & direct fetal trauma which needs immediate interventions. Maternal assessment & management during pregnancy needs special consideration to physiological changes during pregnancy as well as fetal surveillance to improve the maternal & fetal outcome. All pregnant trauma patient needs multi disciplinary approach involving obstetrician, neonatologist, obstetric anaesthetist & trauma surgeons
Perimortem caesarean section is an ethically difficult decision for emergency medicine resuscitation teams. A 34-years-old woman was attacked by her husband with a gunshot. At the time arrival to the emergency room, there was no pulse, no spontaneous breath and blood pressure was unobtainable. Although extensive advanced cardiopulmonary resuscita-tion was performed for 7 minutes, no cardiac activity was regained. During the cardiopulmonary resuscitation efforts, an abdominal ultrasonography was performed and revealed a fetal heart rate with bradycardia. Low segment caesarean section was performed by the obstetrician in the resuscitation room and a female newborn was delivered within less than one minute of the skin incision. Decision on terminating the CPR efforts should not be made in maternal cardiac arrests older than 28 weeks' gestational age, unless the viability of the fetus had been evaluated.
Traumatismo materno grave y cirugía múltiple con resultado perinatal exitoso
Jorge Hasbun H, Susana Benitez S, Rodrigo Cornejo R, Ramón Asencio C, José Luis Navarro A, Stefan Danilla E.
REV CHIL OBSTET GINECOL 2011; 76(5): 354 - 358
El traumatismo mayor de la embarazada es frecuente, tiene riesgo de muerte y agrega a sus complicaciones propias, las generadas por el embarazo como prematurez, desprendimiento placentario y daño perinatal. Presentamos el caso de una embarazada de 27 semanas, con traumatismo grave por atropello, fracturas óseas y desforramiento extenso de extremidad inferior derecha, que fue sometida a tratamiento quirúrgico con reducción y corrección de luxofracturas, aseo e injertos cutáneos. Se complica con infección grave de foco cutáneo, persistente, permaneciendo 24 días en Unidad de Cuidad Intensivo (UCI) en tratamiento antibiótico, 10 drenajes quirúrgicos, nutrición enteral y manejo continuo del dolor, antes del parto. Inicia síndrome de respuesta inflamatoria sistémica y se efectúa operación cesárea. El recién nacido prematuro pesó 1500 gramos y evolucionó favorablemente. En su puerperio permanece 60 días hospitalizada en UCI con 14 cirugías de reparación y mejoría completa. Se analiza las características singulares de morbilidad materna del caso, discutiendo los aspectos obstétricos, quirúrgicos y de cuidado intensivo, la evolución materna, el manejo de la infección y el rol de la cirugía en la prolongación del embarazo y su influencia en el resultado perinatal exitoso. Se concluye la importancia de la integración multidisciplinaria en la toma de decisiones médicas y quirúrgicas en el manejo del trauma materno grave. PALABRAS CLAVE: Embarazo, trauma, desforramiento, infección, cuidado intensivo
Guidelines for the Management of a Pregnant Trauma Patient
Venu Jain, MD, Edmonton AB Radha Chari, MD, Edmonton AB Sharon Maslovitz, MD, Tel Aviv, Israel Dan Farine, MD, Toronto ON
J Obstet Gynaecol Can 2015;37(6):553-571
Objective: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidencebased systematic approach to the pregnant trauma patient. Outcomes: Significant health and economic outcomes considered in comparing alternative practices. Evidence: Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/ controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014.