Trauma in Pregnancy

Sunday, January 24, 2021 20:44

• Introduction
• Common cause of non obstetric maternal death.
• Risk of fetal death, pre mature delivery, low birth
weight

• Mechanisms?
• Motor vehicle accidents are the commonest
• Falls
• Intentional trauma - self inflicted, Intimate partner
violence(IPV)
•
• Motor vehicle - Improper use of seat belt/shoulder
harness
• Correct method - seat bet should be placed below the
abdomen - to prevent direct compression
• Suspicious history, recurrent admissions, depression,
disproportionate injuries should alert possibility of IPV.

• Physiological changes in pregnancy and implications?

• Principals of managing trauma in pregnancy

• Primary survey
• ABC
• First priority is the mother as early directed
resuscitation improves both maternal and fetal
outcomes
• Breathing - 100% Oxygen supplementation.
• Circulation - SBP below 100 mmHg is taken as
hypotension, IV cannulation should be done in upper
limbs (due to caval compression by fetus).

• Adjuncts to primary survey

• Radiological evaluation
• Choice of imaging modality should be as same as a non
pregnant woman when life threatening injuries are
suspected.
• MRI and Ultrasound are considered harmless.

• What's the risk of radiation to the fetus?

• Risk is maximum at 8 - 15 gestational weeks
(Organogenesis, neural development)
• Risk is minimum below 5 weeks and 15 weeks above.
• Potential risks are
○ Developmental delay
○ Defective organogenesis
○ Childhood cancer
○ Fetus demise
• Exposure to less than 5rad (50mGy) is not associated
with fetal loss.
• CT remains the best imaging modality and should be
used if necessary.
• Radio-opaque and paramagnetic contrast material are
unlikely to cause fetal harm.
• Use should be limited - only if benefits overweighs the
potential risks.

• Whats the use of FAST scan in pregnancy?

•
• Sensitivity in detecting free fluid in the abdomen is as
same as for a non pregnant woman following
abdominal injury.
• Can assess the mother as well as the fetus.
• Has its limitations.

• Management of specific trauma

• Thoracic trauma
• IC tube insertion should be about 2 ribs above the
normal 5th intercostal space(Late gestation) -
diaphragmatic elevation from gravid uterus.

• Blunt abdominal injury

• Priority is the mother.
• Treated as same for a non pregnant woman.
• Fetal death is associated with
○ Placental abruption
○ Uterine rupture

• Pelvic trauma
• Common reason for fetal issues in pregnancy.
• Bleeding is more profound - dilated pelvic veins.
• Most can deliver vaginally following pelvic fractures.
• Contraindications are
○ Pubic rami fracture adjacent to urethra or
bladder.
○ Significant lateral compression.
○ Acute fracture with marked displacement.

• What are the criteria to discharge a pregnant patient

following minor trauma?
• Contractions no more than every 10 minutes
• No vaginal bleeding
• No abdominal pain
• Normal fetal heart tracing