Trauma resuscitation in pregnancy

Order. SOGC: assessment, stabilization and care of the pregnant woman is the first priority; then, if the fetus is viable (≥23 weeks), fetal heart rate and obstetric consultation. ANZCOR: effective maternal resuscitation is the best fetal resuscitation.^[2]

Primary survey modifications. From 20 weeks (or uterus above the umbilicus) manual left uterine displacement; if a tilt is used, 15–30 degrees must still allow compressions (ANZCOR). Murphy’s CPR figure is a 25–30 degree whole-body tilt. Oxygen to keep maternal saturation greater than 95% (SOGC). Two large-bore upper-limb cannulae. Coagulation panel including fibrinogen. O-negative blood until crossmatch in the Rh-negative. A systolic of 90 is not reassuring — do not invent a 1500 mL threshold this paper does not carry.^[1][2]

Fetal assessment. Viable fetus (≥23 weeks): electronic fetal monitoring for at least 4 hours (SOGC). 24-hour observation if tenderness, significant pain, bleeding, sustained contractions, ruptured membranes, abnormal CTG, high-risk mechanism, or fibrinogen less than 200 mg/dL. Ultrasound is low sensitivity, high specificity for abruption (Murphy).^[1][2]

Key complications. Abruption (pain, tenderness, contractions, bleeding that may be concealed, fetal distress). Uterine rupture is the catastrophic major-trauma complication (El-Kady group-1 rupture OR 43 among women delivering at the trauma admission).^[3] Fetomaternal haemorrhage: anti-D for every Rh-negative; Kleihauer to size extra doses. Ask about intimate partner violence.^[1][2]

TXA. If traumatic bleeding is significant, CRASH-2 dosing is 1 g over 10 min then 1 g over 8 h. WOMAN is a PPH trial, not this mechanism.^[4]