Trauma: Trauma in Pregnancy

General Considerations

• Always Mother Before Baby
• Most Common Cause of Death: Intimate Partner Violence
• Blunt Trauma
  • Fetal Injury After Blunt Trauma is Rare (< 1%)
  • Most Common Cause of Fetal Death in Blunt Trauma: Maternal Death
• Penetrating Trauma
  • High Fetal Death Rate – GSW 71% & Stabs 42%
  • Gravid Uterus Provides Protection for Mother with Decreased Mortality

Fetal Maturity

• Fundal Height (Umbilicus = 20 cm = 20 Weeks)
• Signs of Maturity:
  • Lecithin:Sphingomyelin (LS) Ratio > 2:1
  • Phosphatidylcholine in Amniotic Fluid

Radiology

• Do Not Delay or Withhold if Indicated
• No Increased Risk of Fetal Defects/Loss if < 5 Rad
• Fetus Exposed to About 30% of Maternal Radiation Dose
• Approximate Fetal Dose:
  • CXR: < 0.001 Rad
  • Abdominal XR: 0.1 Rad
  • Head CT: < 0.05 Rad
  • Chest CT: < 0.1 Rad
  • Abdominal CT: 2.6 Rad
• Timing:
  • Most Vulnerable During Organogenesis (Weeks 2-8)
  • Generally Safe Past 20 Weeks
• FAST US
  • Any Amount of Free Fluid is Considered Positive
  • Physiologic Free Fluid is Small (7-21 cc) & Not Large Enough to Be Seen on FAST

Managements

• Cardiotrophic Fetal Monitoring for ≥ 6 Hours if Over 20 Weeks Gestation
• Give Supplemental O2 in All Pregnant Patients Regardless of SaO2
  • Physiologic Respiratory Alkalosis with Concern for Hypoxia
• Give Rh Immunoglobulin to All Rh-Negative Patients
  • Give within 72 Hours of Injury
  • Should Also Be Given within 72 Hours of Delivery
• Aortocaval Compression Syndrome (Supine Hypotensive Syndrome)
  • Gravid Uterus Compresses Aorta & IVC When Laying Supine
  • Presentation: Maternal Hypotension
  • Tx: Roll to Left Side (Improves Venous Return)
• If Unable to Adequately Expose Injury Due to Enlarged Uterus: Cesarean Section