Trauma in Pregnancy

Epidemiology and Risk Factors

Common causes include:

  • MVA
  • Assault
  • Falls

Pathophysiology

Altered maternal physiology confounds assessment of shock:

  • ↑ Difficult airway
  • ↑ Maternal blood volume
    Up to 50%.
  • ↑ CO
    • ↑ HR
    • ↓ SVR
    • ↓ MAP
  • ↑ VO2, CO2 production, and ↓ FRC
    • ↑ RR
    • ↓ PaCO2
  • Uterus
    • Vulnerable to injury after ~12 weeks when it expands into the peritoneum
    • Displaces bowel contents into upper abdomen, which may be injured in abdominal trauma
  • Hypertrophy of pelvic vasculature
    • Massive retroperitoneal injury
  • ↑ Stomach acid volume
    • ↑ Aspiration risk

Aetiology

Clinical Features

Investigations

Radiation risk to the foetus should be weighted up against risk of missing an injury. In general, life-threatening injures require the same imaging as in the non-pregnant patient.

Bedside:

Laboratory:

  • Blood
    • Kleihauer
      Determine risk of foetal-maternal haemorrhage.

Imaging:

Other:

  • Continuous cardiotocography

Diagnostic Approach and DDx

Management

Resuscitation:

Specific therapy:

  • Pharmacological
    • Anti-D
      For all Rhesus negative pregnant women who suffer trauma.
  • Procedural
  • Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

  • O
    ↑ Risk of:
    • Placental abruption
    • Foetal distress
    • Miscarriage

Prognosis

Key Studies

References

  1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.