Trauma and the Obstetric Patient: Collaboration in Care (original) (raw)
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Management and Outcomes of Trauma During Pregnancy
Anesthesiology Clinics, 2013
The rate of maternal death due to penetrating trauma, suicide, homicide, and motor vehicle accidents (MVAs) is increasing, 1 whereas the rate of maternal death from direct causes is decreasing. This seemingly increased mortality may be the result of KEYWORDS Pregnancy Wounds and injuries Multiple trauma Anesthesia and analgesia Therapeutics Education Outcome and process assessment (health care) Pregnancy outcome
Management of the pregnant trauma patient: A literature study
Open Journal of Trauma, 2020
Background Trauma complicates approximately 7 % of pregnancies and is thereby the leading cause of non-obstetric morbidity and mortality during pregnancy [1-10]. The risk of traumatic injury increases with the advancement of pregnancy [4,8,10,11]. Pregnancy as such does not increase morbidity or mortality following trauma but leads to different mechanisms and patterns of injury with an increased vulnerability to abdominal injury [4,6,10,12]. One needs to bear in mind that trauma affects both mother and unborn child, with the latter having a higher mortality rate [4,13]. The spectrum of trauma severity is broad. Severe trauma often leads to fetal loss but minor trauma is responsible for the majority (60-70%) of fetal deaths due to its higher prevalence [2,4,10,12,14]. However, the likelihood of adverse fetal outcome is often unpredictable and does not correlate with the degree of trauma [4,15,16].
Clinical Obstetrics and Gynecology, 2009
In the United States, trauma is the leading nonobstetric cause of maternal death. The principal causes of trauma in pregnancy include motor vehicle accidents, falls, assaults, homicides, domestic violence, and penetrating wounds. The managing team evaluating and coordinating the care of the pregnant trauma patient should be multidisciplinary so that it is able to understand the physiologic changes in pregnancy. Blunt trauma to the abdomen increases the risk of placental abruption. Evaluation of the pregnant trauma patient requires a primary and secondary survey with emphasis on airway, breathing, circulation, and disability. The use of imaging studies, invasive hemodynamics, critical care medications, and surgery, if necessary, should be individualized and guided by a coordinating team effort to improve maternal and fetal conditions. A clear understanding of gestational age and fetal viability should be documented in the record.
Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population
American Journal of Obstetrics and Gynecology, 2004
Objective: This study was undertaken to determine the occurrence rates, outcomes, risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. Study design: This is a retrospective cohort study of women hospitalized for trauma in California (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999). International Classification of Disease, ninth revision, Clinical Modification codes, and external causation codes for injury were identified. Maternal and fetal/neonatal outcomes were analyzed for women delivering at the trauma hospitalization (group 1), and women sustaining trauma prenatally (group 2), compared with nontrauma controls. Injury severity scores and injury types were used to stratify risk in relation to outcome. Statistical comparisons are expressed as odds ratios (ORs) with 95% CIs. Results: A total of 10,316 deliveries fulfilling study criteria were identified in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains were the most common type of injury. Group 1 was associated with the worst outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 (95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 (95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores increased, outcomes worsened, yet were statistically nonpredictive. The type of injury most commonly leading to maternal death was internal injury. The risk of fetal, neonatal, and infant death was strongly influenced by gestational age at the time of delivery. Conclusion: Women delivering at the trauma hospitalization (group 1) had the worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal injury) had an increased risk of adverse outcomes at delivery, and therefore should be monitored closely during the subsequent course of the pregnancy. This study highlights the need to optimize education in trauma prevention during pregnancy.
Review Article, 2022
Evaluation of a pregnant trauma patient (PTP) in the emergency department (ED) is somehow challenging, as two patients should be managed simultaneously. Here, we reviewed recently published articles to provide up-todate information on the management of PTPs. We examined 35 articles and categorized their topics as follows: trauma severity, management of trauma patients, general approach to pregnant women with trauma, primary evaluation of pregnant women with trauma, breathing and ventilation, airway, circulatory system evaluation simultaneous with bleeding control, uterine replacement, blood transfusion, uterine displacement, cardiovascular resuscitation, defibrillation, pneumatic anti-shock garment, and perimortem cesarean section. Concerning trauma during pregnancy, the basic principle should be successful maternal resuscitation, which is vital for fetus survival.
Initial Trauma Management in Advanced Pregnancy
Anesthesiology Clinics, 2007
The pregnant trauma patient presents unique challenges to the anesthesiologist. Initial assessment and treatment must take into account the normal physiologic adaptations to pregnancy of the mother and the fetus, the typical patterns of injury seen in pregnancy, and the maternal and fetal response to trauma. Because trauma management typically involves a broad range of physicians, including emergency physicians, surgeons, anesthesiologists, obstetricians, neonatologists, and intensivists, a multidisciplinary approach is required. Existing knowledge of trauma management in pregnancy is based mostly on animal studies, retrospective clinical reports, and consensus statements, but infrequently is based on solid evidence. In this article, the authors aim to present practical recommendations for initial trauma resuscitation in pregnancy. They focus on the last trimester, specifically beyond 24 weeks, when the physiologic changes become most significant and the fetus is considered viable, and when, occasionally, the treating physician has to reconcile the conflicting demands of both the mother and the fetus. The reader is referred to several excellent articles on the management of the traumatized pregnant patient [1-5] for a more detailed review of the physiologic changes in pregnancy, mechanisms of injury, effects on pregnancy, and management stratagems past initial care, all of which are beyond the scope of this article.
Trauma in pregnancy – A brief review
Trauma and Emergency Care, 2017
Pregnancy ensues a different normal physiology. This changed physiology adds to the vulnerability of mother to trauma. Treating two lives in one patient adds to the responsibility of the treating physician and increases the anxiety of both the patient and the physician. Incidence of trauma in pregnancy amounts to 6 to 7 % with leading cause being motor vehicle accident. The incidence increases with increasing gestation. This article reviews the incidence of maternal trauma, impact of trauma on altered maternal physiology, resuscitation, principles of management, prevention and diagnostic considerations in pregnant trauma patients.
Australian Journal of Rural Health, 1999
Injury to the pregnant woman evokes a certain amount of anxiety because of its infrequent occurrence and the complex implications. By definition, it constitutes a multitrauma and, throughout the resuscitation and assessment of the woman, it is important to remember that there are two patients. Of particular importance is that one of these patients must be resuscitated aggressively to save the other and, very occasionally, the baby has to be delivered to save the mother. Early transfer to an urban environment should be considered. The aim of the present paper is to provide an overview of the current management and issues in relation to trauma in pregnancy.
Management of trauma during pregnancy
ANZ Journal of Surgery, 2004
Background: Pregnancy may confuse the management of a trauma patient. The present retrospective review was conducted in order to develop guidelines for the management of such a patient. Methods: A retrospective review of case notes was undertaken using a trauma database to evaluate the management of pregnant trauma patients. A review of the English language literature was also carried out. Results: Between July of 1994 and July of 2002, 34/25 206 (0.13%) of patients on the database were pregnant at the time of injury. The vast majority (27/34; 79%) suffered no obstetric complication. Obstetric complications included four pregnancies complicated by preterm labour but not preterm delivery, one placental abruption and one second trimester pregnancy loss. There was one maternal death with an 8 week gestation fetus viable at time of maternal death and one fetal death with maternal survival. Conclusion: The findings are in keeping with those of other published series. Priority in the management of a pregnant patient who has sustained major trauma must always be maternal stabilization. After stabilization, an assessment of obstetric complications should be a part of the secondary survey. Fetal heart rate monitoring should be used to assess the fetus in pregnancies ≥ 22 weeks gestation. Active intervention, such as Caesarian section, can be considered if fetal compromise is found.