Trauma and the Obstetric Patient: Collaboration in Care (original) (raw)
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.
Trauma in Pregnancy - A Review
Advanced research in gastroenterology & hepatology, 2016
Objective: 1 in 12 pregnant women are affected by major trauma which has an impact on the maternal mortality and morbidity and finally the pregnancy outcome. This requires a multidisciplinary approach for optimum outcome of both mother and the fetus. The aim of this article was to provide the emergency care providers with an evidence based approach which is systematic towards the management of a pregnant trauma patient. Outcomes: Various parameters involved in the management of pregnant females have been considered in this article in the hope to provide adequate information regarding the management of such patients. Evidence: This literature was retrieved through various searches from the Medline, CINAHL, Cochrane library using the following keywords like (trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). The results were restricted to various systematic reviews, RCTs and observational studies.
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC. Disclosure statements have been received from all contributors. Abstract 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 evidence-based systematic approach to the pregnant trauma patient .
Trauma in Pregnancy: The Relationship of Trauma Activation Level and Obstetric Outcomes
The American Surgeon, 2019
Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predic...
Predictors of fetal outcome in pregnant trauma patients: a five-year institutional review
The American surgeon, 2007
Injury Severity Score (ISS) and lactate are controversial in predicting fetal outcome. A retrospective review was conducted to determine whether ISS and lactate are valuable in predicting fetal survival in injured pregnant patients. Injured pregnant women were identified by ICD-9 codes from our Trauma Registry, Emergency Department Registry, and hospital medical records. Records were reviewed for demographic data, mechanism of injury, ISS, Glascow Coma Scale, lactate, vital signs, and maternal/fetal outcome. To determine statistical analysis, chi2 and t test analysis was performed. From 2001 to 2005, 294 women reported injuries. Most patients (51.7%) were discharged from the Emergency Department, yet 18 per cent were admitted to Trauma Surgery. The average maternal and gestational age was 23.4 years and 19.6 weeks, respectively. Seventy-two (33.3%) patients were in the first trimester. The majority of patients (88.1%) were involved in blunt trauma, and 10 (3.9%) had poor fetal outco...
Trauma in Pregnancy: Assessment and Treatment
Scandinavian Journal of Surgery
Women between the ages of 10 and 50 year-old have the potential for pregnancy; therefore this condition must be taken into consideration when a woman is examined in the Emergency Room after sustaining a traumatic event. Pregnancy produces significant physiologic and anatomic changes in every system of the female body. The evaluation of the traumatized pregnant patient, the approach, and the interpretation of the diagnostic tests results must be accompanied by the full knowledge of all changes that take place during pregnancy. In the same context, although the physician treating a pregnant trauma victim must remember that there are two patients, the treatment priorities are the same as for the non-pregnant trauma patient. The best initial treatment for the fetus is the optimum resuscitation of the mother. A thorough exam should take place to discover unique conditions that might be present in any pregnant patient such as blunt or penetrating injury to the uterus, placental abruption,...
Trauma in the pregnant patient
Current Opinion in Anaesthesiology, 2004
Accidental lllJUry during pregnancy is both common and unique, not only because two lives are involved but also because of alterations in the nature of and response to injury. Trauma to the gravid patient has become increasingly more common, often presenting the physician with both perplexing medical and potential legal problems. Today's women are more exposed to the rigors and dangers of our society. Because of economic necessity, and by choice, more women are working outside of the home; their jobs are more hazardous and require more traveling in faster but smaller cars, as well as motorcycles. Contemporary women have increased exposure to injury because of greater participation in sports, both conditioning and competitive. Moreover, today's woman does not seclude herself when pregnant. Accidental injury is estimated to occur in 6 to 7 per cent of all pregnancies. Various state and hospital maternal mortality committees continue to report accidents as one of the common nonobstetric causes of death among pregnant women. 2 , 8, 25 Insurance reports continue to list automobile accidents as a leading cause of death due to trauma, followed by violent assault (first guns, then penetrating instruments), followed by suicide. Pregnancy also evokes increased activity within the home; a new room must be added or the nursery refurbished, the walls pain.ted and the curtains hung, and this accomplished on a ladder or chair by the unsteady mother-tobe. Easy fatigability, fainting spells, and hyperventilation commonly occur owing to the ulilpredictable physiologic changes in pregnancy. The protuberant abdomen, loosening of the• pelvic joints, and pelvic pressures that cause pain and neuromuscular dysfunction of the lower extremities cause a general clumsiness. The pregnant woman spends more time on hygiene in the bathroom (and more time in the kitchen) where tile and porcelain surfaces are slippery and hard and there is no soft spot to fall upon. All of these factors set the scenario for accidental injury during pregnancy. .-Major trauma to the pregnant woman is often viewed as a double tragedy by attending medical personnel in the emergency room setting. The lack of familiarity with the physiologic and anatomic changes occuring during gestation, the fear of impending delivery, and the awareness of possible litigation .and legal accountability may lead to relat~ve diagnostic and thera
An Assessment of the Impact of Pregnancy on Trauma Mortality
The Journal of Emergency Medicine, 2011
Background. In the United States, trauma is the leading cause of maternal mortality and an important source of maternal morbidity. Few studies have compared outcomes in injured pregnant women to their nonpregnant counterparts. Some clinical literature regarding hormonal influences on outcomes after trauma suggests a survival advantage in premenopausal women with higher estrogen levels. Given this, as well as possible outcome differences as a result of physiologic changes that occur during pregnancy, we tested the hypothesis that pregnant women have different outcomes after trauma compared with similarly injured nonpregnant women in the same age groups. Methods. We used data derived from 1.46 million patients listed in The National Trauma Data Bank from 2001 to 2005, to query all injured patients between ages 12 and 49 years inclusive, and divided them into 2 comparison groups: nonpregnant and pregnant women. We compared differences in outcome after trauma between pregnant and nonpregnant women. Because the number of pregnant women was small in comparison to the number of nonpregnant women, multivariate analysis after 1:3 (pregnant:nonpregnant) matching was attempted. Results. Crude mortality rate comparisons and unadjusted logistic regression analyses both before and after matching data reveal lower mortality rates in pregnant women. Multivariate logistic regression analyses both before and after matching data also reveal lower mortality rates in pregnant women; but this is statistically significant (P = .01) only after matching data. Conclusion. Among women of similar age groups who are equivalently injured, those who are pregnant exhibit lower mortality. These findings suggest that hormonal and physiologic differences during the gestation period may play a role in outcomes following trauma in pregnant women. (Surgery 2011;149:94-8.)
Trauma in pregnant women: an experience from a level 1 trauma center
Journal of Emergency Practice and Trauma, 2020
Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi. Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019. Analysis was performed using SPSS v. 21. Chi-squared tests were performed for comparison of categorical data. Results: A total of 48 pregnant females with a mean age of 28.80 ± 6.50 years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 pa...
Pregnancy and trauma: analysis of 139 cases
Journal of the Turkish German Gynecological Association, 2012
The aim of this study was to examine the diagnoses and treatment methods and demographical and clinical characteristics of pregnant women who were exposed to trauma and in additon, review of the literature was carried out in this regard. Material and Methods: One hundred thirty-nine pregnant women who presented at the Yüzüncü Yıl University between January 2006 and September 2009 with local or general body trauma complaints were analysed retrospectively. Results: The average age of the cases was 26.72±6.29 years and the age group ranging from 21-34 composed the majority. When they were studied according to their etiologies, falls during daily activities formed 43.9%. When they were analyzed in terms of their gestational weeks, 64.46% were in the 3 rd trimester. Pregnant cases with trauma resulted in maternal (3 cases) and fetal (9 cases) loss. It was found that 19 cases who had imaging techniques involving radiation and whose gestation was continuing had a problem-free gestation period and healthy children. Conclusion: It is mandatory to evaluate both mother and fetus together when trauma exposure is in question, the general well-being of the fetus should be provided and the mother should be informed about the presence of advanced trauma life support.