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Chapter 74 - Trauma in Pregnancy

from Section 13 - Miscellaneous Conditions

Published online by Cambridge University Press:  23 February 2023

By
Marwa Salman
Edited by
Amira El-Messidi  and
Alan D. Cameron
Amira El-Messidi
Affiliation:
McGill University, Montréal
Alan D. Cameron
Affiliation:
University of Glasgow
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Summary

A 29-year-old G1P0 at 32 weeks’ gestation is brought in by ambulance to the A&E (E.R.) department in your tertiary trauma center following a road traffic accident. She was the restrained driver of a vehicle driving on an icy road at around 50 mph (80 km/h), when she lost control and had a frontal impact collision with another vehicle. She is healthy and has had an unremarkable pregnancy to date. On arrival, she is alert but appears anxious and uncomfortable. Her cervical spine is immobilized with a cervical collar and blocks, and she is on a spinal board. She complains of pains in her chest and lower abdomen. There is a bruise across her right forehead. Her vital signs show a sinus tachycardia of 115 bpm, blood pressure 87/62 mmHg, pulse oximetry 94% on room air, respiratory rate 28/min, and core temperature of 34.6°C. You are covering the birthing center and have been called urgently to the A&E department to assist in the management of this patient.

Keywords

Blunt trauma, pregnancyPhysical examinationPrimary survey assessment, patient stabilizationHemothoraxDisseminated intravascular coagulation in traumaMaternal cardiac arrestAdvanced life supportFetal supportPerimortem Cesarean section
Type
Chapter
Information
OSCEs in Obstetrics and Maternal-Fetal Medicine
An Evidence-Based Approach
 , pp. 939 - 945
Publisher: Cambridge University Press
Print publication year: 2023

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References

Suggested Readings

American College of Surgeons, Committee on Trauma. Advanced Trauma Life Support® Student Course Manual, 10th ed. Chicago, IL: American College of Surgeons; 2018.Google Scholar
Chu, J, Johnston, TA, Geoghegan, J. Maternal collapse in pregnancy and the puerperium. BJOG 2020; 127:e14–e52.Google Scholar
Galvagno, SM Jr, Nahmias, JT, Young, DA. Advanced trauma life support update 2019: management and support for adults and special populations. Anesthesiol Clin 2019; 37: 13–32.CrossRefGoogle ScholarPubMed
Greco, PS, Day, LJ, Pearlman, MD. Guidance for evaluation and management of blunt abdominal trauma in pregnancy. Obstet Gynecol 2019; 134:1343–1357.Google Scholar
Huls, CK, Detlefs, C. Trauma in pregnancy. Semin Perinatol 2018;42:13–20.CrossRefGoogle ScholarPubMed
Jain, V, Chari, R, Maslovitz, S. Guidelines for the management of a pregnant trauma patient. SOGC 2015. J Obstet Gynaecol Can. 2015;37:553–571.Google Scholar
Lipman, S, Cohen, S, Einav, S, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg. 2014 May;118(5):1003–1016.CrossRefGoogle Scholar
MacArthur, B, Foley, M, Gendra, K, et al. Trauma in pregnancy: a comprehensive approach to the mother and fetus. Am J Obstet Gynecol 2019; 220: 465–468.CrossRefGoogle Scholar
Monteiro, R, Salman, M, Malhotra, S, et al. Trauma in pregnancy. In Anaesthesia, Analgesia and Pregnancy, 4th ed. Cambridge: Cambridge University Press; 2019.CrossRefGoogle Scholar
Sakamoto, J, Michels, C, Eisfelder, B. Trauma in pregnancy. Em Med Clin N Am 2019; 37: 317–338.CrossRefGoogle ScholarPubMed

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