Trauma in Pregnancy

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 31/05/2015

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Chapter 223 Trauma in Pregnancy

INTRODUCTION

Description: Trauma and violence are the leading causes of death for women of reproductive age and of maternal death from nonobstetric causes. The most common cause of fetal death in automobile accidents is death of the mother. The altered physiologic state of pregnancy and the need to treat two patients simultaneously alters the management of even simple trauma.
Prevalence: One of 12 pregnancies.
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Motor vehicle accidents (most common; two thirds of cases in developed countries), falls, direct assault (battering most common; 60% report two or more episodes of physical assault during pregnancy).
Risk Factors: Failure to use a safety restraint while driving, abusive relationship, low socioeconomic status, drug or alcohol use and abuse.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Varies with type of trauma—blunt trauma, trauma associated with covert internal injuries such as retroperitoneal hemorrhage or splenic rupture with bowel injuries less common, penetrating, fetal injury (two thirds)
• Abruptio placenta (1% to 5% of minor trauma, 40% to 50% of major trauma)—vaginal bleeding, uterine tenderness, tetany, or contractions suggest abruption
• Uterine rupture (0.6%) as the result of substantial force to the abdomen
• Direct fetal injury rare in blunt trauma
• Because of increased blood volume during pregnancy, signs of blood loss may be delayed

DIAGNOSTIC APPROACH

Differential Diagnosis

Based on type of trauma and organs potentially involved.

Associated Conditions: Rh isoimmunization.

Workup and Evaluation

Laboratory: Based on normal management of trauma.
Imaging: As needed for the management of trauma (unchanged by the pregnancy, trauma takes precedence). Ultrasonography for gestational age assessment, placental location, intrauterine death, and others. (Not reliable for assessment of fetal injury.)
Special Tests: Peritoneal lavage under direct vision may be used to evaluate intraperitoneal hemorrhage. Kleihauer-Betke test for fetal–maternal hemorrhage.
Diagnostic Procedures:

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