Trauma in pregnancy

A 26-week pregnant woman is brought in by ambulance after a high-speed motor vehicle crash. She is tachycardic at 118, blood pressure 104/68 with a narrowed pulse pressure, and the paramedics have her flat on a spinal board. In the next five minutes you will make the decisions that decide whether mother and fetus survive: tilt her, oxygenate her, intubate early, give blood, and resuscitate her as a pregnant woman — not as a small adult. This topic is those five minutes.^[2][10]

Overview and definition

Trauma is a leading non-obstetric cause of maternal death and a leading cause of non-obstetric fetal loss. Pregnancy distorts every step of trauma care — physiology, primary survey, secondary survey, imaging choices, drug doses, and the worst-case scenario of perimortem caesarean. The principle that orders all of it is simple and unbreakable: resuscitate the mother first, definitively and aggressively, because maternal stabilisation is fetal resuscitation.^[2][9]

Classify trauma in pregnancy by mechanism (blunt, penetrating, thermal, electrical) and by source. Two sources dominate the epidemiology: motor vehicle crashes and intimate partner violence (IPV). The systematic review evidence is unambiguous — these are the predominant mechanisms reported, and IPV is the one most often missed.^[2]

Pregnancy itself is defined here by the gestational thresholds that change management: aortocaval compression becomes relevant from 20 weeks, the fetus is considered potentially viable from about 23-24 weeks (when CTG monitoring begins), and perimortem caesarean is indicated at a uterine height consistent with 20 weeks and above.^[1][4]

References13ShowHide

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2. [2]Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ Trauma in pregnancy: an updated systematic review Am J Obstet Gynecol, 2013.PMID 23333541
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12. [12]Curry SJ, Krist AH, Owens DK, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement JAMA, 2018.PMID 30357305
13. [13]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 518: Intimate partner violence Obstet Gynecol, 2012.PMID 22270317