Common

complication
and significant
fraction
Radiologic
exam can be No Level 1
used Evidence
Key
Points

Initial maternal
Multidisciplinary
approach stabilization >
Fetal Assesment
Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017
• Trauma includes both intentional harm and
accident
• Intentional harm >> encompasses assault, blunt
force trauma and penetrating trauma.
• Accidents include predominantly, motor vehicle
crashes and fails

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

 Etiology/basic Pathophysiology

80% 73%
70%

60%

50%
Etiology/basic
40% Pathophysiology

30%

20% 12% 9%

10% 2% 1% 3%
0%
MVA Assault Fall bicycle Suicide Other

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

 Seatbelt
GCS Use

Lactat >2 Severe Head

mmol/L Injury

Injury to
Prognostic
ISS score > 9 thorax,
Factors abdomen,

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

 • 0.1-1.4%associated with
Maternal trauma
• Fatality rate is 2-4 %
Death • 27 % are injury related

• Maternal death = fetal

Fetal death
• >80 % are associated with
Death MVA

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

 Airway
Breathing
Maternal Circulation
stabilization First
Disability
Exposure

focused abdominal sonogram for trauma (FAST) is

commonly undertaken as part of an initial assessment
in the ER
Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017
CT Recommended if haemodinamically
stable

Blunt abdominal Trauma

• FAST ultrasound
• Exploratory laparotomy for positive DPL

Penetrating abdominal wound

• Single Pre-op Broad spectrum Antibiotics

• Laparotomy if hypotension is present

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

Open Fractures

• Prophylactic Antibiotics + gram coverage

Traumatic Brain Injury

• Head CT generally required

• Prophylactic AB if penetrating

Spine Trauma suspected

• Immobilization and imaging, generally CT

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

• Teratogenic effects are of no concern until after 5 to 10 mGy.

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017

 PMCD
• No different in • Not every pregnant
pregnant patients • No return of spontaneous women
• Left Uterine circulation • 4-5 mins after arrest
displacement • Survival rate 64%
CPR Unsuccsessfull

Maternal Fetal evidence based guidelines, Vincenzo Berghella, Philadelphia, 2017