Guidelines address blunt abdominal trauma during pregnancy

  • Greco PS & al.
  • Obstet Gynecol
  • 04.11.2019

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • Review and expert guidelines as part of the Clinical Expert Series.
  • Funding: None disclosed.