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Trauma During Pregnancy

Trauma is the leading cause of nonobstetric death in women of reproductive age. Six percent of all pregnancies are complicated by some type of trauma.

Blunt Abdominal Trauma

Blunt abdominal trauma secondary to motor vehicle accidents is the leading cause of nonobstetric-related fetal death during pregnancy, followed by falls and assaults.

Uterine rupture or laceration, retroperitoneal hemorrhage, renal injury and upper abdominal injuries are possible.

Abruptio placentae occurs in 40-50% of patients with major traumatic injuries and in up to 5% of patients with minor injuries.

Clinical Findings in Blunt Abdominal Trauma. Vaginal bleeding, uterine tenderness, uterine contractions, fetal tachycardia, late decelerations, fetal acidosis, and fetal death.

Detection of Abruptio Placentae. Beyond 20 weeks of gestation, external electronic monitoring can detect uterine contractile activity. The presence of vaginal bleeding and tetanic or hypertonic contractions is presumptive evidence of abruptio placentae.

Uterine Rupture Pregnancy Trauma

Uterine rupture is an infrequent but life-threatening complication. It usually occurs after a direct abdominal impact.

Findings of uterine rupture range from subtle (uterine tenderness, nonreassuring fetal heart rate pattern) to severe, with rapid onset of maternal hypovolemic shock and death.

Direct Fetal Injury is an infrequent complication of blunt trauma.

The fetus is more frequently injured as a result of hypoxia from blood loss or abruption.

In the first trimester the uterus is not an abdominal organ; therefore, minor trauma usually does not cause miscarriage in the first trimester.

Penetrating Trauma

Penetrating abdominal trauma from gunshot and stab wounds during pregnancy has a poor prognosis.

Perinatal mortality is 41-71%. Maternal mortality is less than 5%.

Minor Trauma in Pregnancy

Pregnant patients who sustain seemingly minimal trauma require an evaluation to exclude significant injuries. Common "minor" trauma includes falls, especially in the third trimester, blows to the abdomen, or "fender benders" motor vehicle accidents.

The patient should be questioned about seat belt use, loss of consciousness, pain, vaginal bleeding, rupture of membranes, and fetal movement.

Physical Exam

Physical examination should focus on upper abdominal tenderness (liver or spleen damage), flank pain (renal trauma), uterine pain (placental abruption, uterine rupture), and pain over the symphysis pubis (pelvic fracture, bladder laceration, fetal skull fracture).

A search for orthopedic injuries is completed.

Treatment

The patient with a fetus that is less than 20 weeks gestation (not yet viable), with no significant