EM · Trauma in pregnancy
Trauma in pregnancy
Pregnant trauma is two patients resuscitated as one. ANZCOR: mother first, manual uterine displacement from 20 weeks, perimortem caesarean in the second half of pregnancy without a mandated start minute. SOGC: electronic fetal monitoring at least 4 hours from 23 weeks, anti-D for every Rh-negative patient, and perimortem caesarean by 4 minutes when possible. ACEM-primary, globally tagged.
Checked against its sources on 2 Sept 2026
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Target exams
Red flags
- Best fetal resuscitation is maternal resuscitation (ANZCOR). Do not invert the order.
- From 20 weeks, or once the uterus is palpable above the umbilicus, displace the uterus left — manual displacement preferred during CPR (ANZCOR).
- SOGC: perimortem caesarean for viable pregnancies (≥23 weeks) no later than 4 minutes when possible. ANZCOR 2024 does not define a start interval.
- Indicated maternal CT is not deferred for fetal radiation (SOGC/ACOG). Abdominal CT fetal dose 1.3–35 mGy; harm not reported below 50 mGy.
- Anti-D for every Rh-negative pregnant trauma patient; Kleihauer (or equivalent) to guide extra doses (SOGC).
Meet the patient
A 32-year-old woman, G2P1 at 32 weeks, arrives an hour after a restrained moderate-speed motor-vehicle collision. BP 100/65, HR 108, abdominal pain and tightenings; CTG shows a baseline of 160 with late decelerations. Two questions: is maternal perfusion adequate, and is there abruption? The late decelerations are a maternal-flow problem first. Manual left uterine displacement, oxygen to saturation greater than 95%, two large-bore upper-limb cannulae, bloods including fibrinogen and Kleihauer, obstetric and neonatal teams now — not a fetal-first caesarean while she is under-resuscitated.[2]
References11ShowHide
- [1]Murphy NJ, Quinlan JD. Trauma in pregnancy: assessment, management, and prevention Am Fam Physician, 2014.PMID 25403036
- [2]Jain V, Chari R, Maslovitz S, et al. Guidelines for the Management of a Pregnant Trauma Patient J Obstet Gynaecol Can, 2015.PMID 26334607
- [3]El-Kady D, Gilbert WM, Anderson J, et al. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population Am J Obstet Gynecol, 2004.PMID 15284764
- [4]El Kady D. Perinatal outcomes of traumatic injuries during pregnancy Clin Obstet Gynecol, 2007.PMID 17762411
- [5]Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26443610
- [6]Zelop CM, Einav S, Mhyre JM, et al. Characteristics and outcomes of maternal cardiac arrest: A descriptive analysis of Get with the guidelines data Resuscitation, 2018.PMID 30170022
- [7]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319
- [8]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
- [9]Klinich KD, Flannagan CA, Rupp JD, et al. Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint Am J Obstet Gynecol, 2008.PMID 18395036
- [10]Owattanapanich N, Lewis MR, Benjamin ER, et al. Motor vehicle crashes in pregnancy: Maternal and fetal outcomes J Trauma Acute Care Surg, 2021.PMID 33496550
- [11]American College of Obstetricians and Gynecologists Committee on Obstetric Practice Committee Opinion No. 723: Guidelines for Diagnostic Imaging During Pregnancy and Lactation Obstet Gynecol, 2017.PMID 28937575