Chapter 51. Trauma in pregnancy
The approach to the pregnant trauma victim is exactly the same as for the non-pregnant trauma victim, except that there are two patients – mother and fetus – to consider.
The mother is treated directly, the fetus is treated indirectly by optimum resuscitation of the mother. The best chance for the fetus is optimum resuscitation of the mother.
Because the mother has reduced oxygen reserves, the spontaneously breathing pregnant trauma victim must always receive oxygen at as high a concentration as possible, preferably close to 100%, via a reservoir face mask.
Always administer high-flow oxygen
The approach to the pregnant trauma victim
The ‘SAFE’ approach and immediate management of life-threatening injuries is the same for all trauma patients.
Maternal clinical signs of hypovolaemia and haemorrhage present too late to save the fetus in 80% of cases so maintain a high index of suspicion. Treatment precedes formal diagnosis.
If there is ANY possibility of significant trauma immediate evacuation is essential
• High flow oxygen should be applied immediately or early intubation if unconscious
• Position the patient for relief of vena caval compression
• Do not attempt formal examination of the perineum, however do try and check for bleeding or fluid loss from this area
• An attempt should be made to palpate the abdomen, checking for fetal parts, movements and the fetal heart rate if possible. Undue time must not be wasted on this part of the assessment
• Evacuate rapidly to hospital.
Consequences of trauma in pregnancy
• A pregnant woman sustaining any trauma to the abdomen and pelvis, however minor, requires specialist assessment and observation at hospital
• Even small degrees of abdominal trauma can cause the maternal circulation to be contaminated by fetal red blood cells. As a consequence, maternal antibody formation against fetal red cells may result in fetal anaemia and problems with future pregnancies.
Blunt trauma
• Blunt trauma to the abdomen and pelvis is more common than penetrating trauma in UK practice, and in the pregnant woman is most often caused by:
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