- Newly published guidance addresses management of blunt abdominal trauma during pregnancy.
Why this matters
- Obstetricians should be involved in management to improve outcomes.
- Trauma is the leading nonobstetrical cause of death among pregnant women.
- Physiologic changes during pregnancy can affect care of pregnant trauma victims.
- Placental abruption is the leading serious event resulting from blunt trauma.
- Symptoms include: uterine tenderness and contractions, maternal hypotension, or nonreassuring fetal heart tones.
- Minimum of 2-4 hours of monitoring for contractions and fetal heart tones after blunt abdominal trauma.
- Contractions in the setting of trauma are nonspecific, and only 14.3% will have a clinically significant abruption.
- Management decisions (CPR, imaging, transfusion, surgery) should not be altered because of pregnancy.
- Perimortem cesarean delivery within 5 minutes after maternal arrest improves fetal survival and may achieve spontaneous circulation in the pregnant woman.
- Interdisciplinary policies, checklists, communication are ideal from triage in field to hospital care.
- Primary survey and maternal stabilization prior to any fetal assessment.
- Fetal assessment with secondary survey.
- The secondary survey is the time for the obstetrician to become actively involved in the patient's care.
- Review and expert guidelines as part of the Clinical Expert Series.
- Funding: None disclosed.