Trauma During Pregnancy (original) (raw)
Related papers
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,...
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.
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].
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.
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
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
Guidelines for the Management of a Pregnant Trauma Patient
Journal of Obstetrics and Gynaecology Canada, 2015
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.
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.
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.