Trauma in pregnancy

Background

• Concern for trauma, premature labor, and abruption
• Viable = >23-24wk (~fundus above umbilicus)
• nl FHR = 110-160 beats/min
• The leading cause of death in women during their reproductive years
• The leading non-obstetric cause of death and disability in pregnant women
• Trauma or accidental injury complicates up to 7% of all pregnancies
• For maternal vitals see Maternal Vitals and Labs in Pregnancy

Diagnosis (Abruption)

Symptoms

1. Vag bleed 70% (may be absent if retroplacental)
2. Cramps/contractions
3. Uterine tenderness
4. Hypovolemia
5. Abnl fetal HR

US only 50% accurate

Signs of fetal distress on toco monitor are often the earliest indicator

1. decelerations, tachycardia, bradycardia, and loss of variability

Treatment & Disposition

1. Nonviable fetus (<23-24wks)
   1. Standard treatment for trauma
   2. Consider RhoGAM 50mcg in rh neg
2. Viable fetus (>23-24wks)
   1. Consider RhoGAM 300mcg in rh neg
   2. Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery
   3. Monitor (fetal) all for 4-6hrs -->
   4. Extend Monitoring to 24hrs, if abnormal 6hr monitoring
      1. The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes.

Risk Factors (ATLS)

1. Maternal heart rate > 100
2. Injury Severity Score > 9
3. Evidence of placental abruption
4. Fetal heart rate > 160 or <120
5. Ejection during a motor vehicle crash
6. Motorcycle or pedestrian collisions

Abnormal Monitoring

1. >3 contractions/hr
2. Persistent uterine TTP
3. Worrisome strip
4. Vag bleed
5. PROM
6. Serious maternal injury

Partial abruption w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)

Abruption = risk DIC

External Links

• MDCalc - Pregnancy Due Dates Calculation

See Also

• Fetal Maternal Hemorrhage (RhoGAM)
• Perimortum C-Section
• Abruption
• Maternal Vitals and Labs in Pregnancy