SOGC ClINICAl PRACTICE GUIDElINE Guidelines for the Management of a Pregnant Trauma Patient MATERNAl FETAl MEDICINE COMMITTEE (original) (raw)
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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].
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.
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 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 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 pregnancy: an updated systematic review
American Journal of Obstetrics and Gynecology, 2013
We reviewed recent data on the prevalence, risk factors, complications, and management of trauma during pregnancy. Using the terms "trauma" and "pregnancy" along with specified mechanisms of injury, we queried the PubMed database for studies reported from Jan. 1, 1990, through May 1, 2012. Studies with the largest number of patients for a given injury type and that were population-based and/or prospective were included. Case reports and case series were used only when more robust studies were lacking. A total of 1164 abstracts were reviewed and 225 met criteria for inclusion. Domestic violence/intimate partner violence and motor vehicle crashes are the predominant causes of reported trauma during pregnancy. Management of trauma during pregnancy is dictated by its severity and should be initially geared toward maternal stabilization. Minor trauma can often be safely evaluated with simple diagnostic modalities. Pregnancy should not lead to underdiagnosis or undertreatment of trauma due to unfounded fears of fetal effects. More studies are required to elucidate the safest and most cost-effective strategies for the management of trauma in pregnancy.
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.
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.
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.