Trauma in pregnancy

Background

Viable = >20-24wk (~fundus above umbilicus)

nl FHR = 120-160 beats/min

For maternal vitals see OB/GYN: Vitals

Concern for trauma and abruption

Diagnosis (Abruption)

Symptoms

1. Vag bleed
2. Cramps/contractions
3. Uterine tenderness
4. Hypovolemia
5. Abnl fetal HR

US only 50% acurate

Treatment & Disposition

1. Nonviable fetus (<20-24wks)
   1. Standard treatment for trauma
   2. Consider RhoGAM
2. Viable fetus (>20-24wks)
   1. Consider RhoGAM
   2. Monitor (fetal) all for 4-6hrs -->
   3. Extend Monitoring to 24hrs, if risk factor or abnormal 6hr monitoring

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. Persistant uterine TTP
3. Worisome strip
4. Vag bleed
5. PROM
6. Serious maternal injury

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

Abrupion = risk DIC

See Also

See OB/GYN: Fetal Maternal Hemorrhage (RhoGAM)

See Procedures: Perimortum C-Section

See OB/GYN: Abruption

See OB/GYN: Vitals

Source

3/29/06 DONALDSON (adapted from Rosen)