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KEY POINTS

KEY POINTS

  • Motor vehicle crashes account for 50% of trauma injuries during pregnancy and 82% of trauma-related fetal deaths, many of which are related to improper seat belt use.

  • The disproportionate increase in plasma volume compared to red blood cell volume during pregnancy allows 35% of maternal blood to be lost before the mother exhibits clinical signs of shock.

  • When supine, the gravid uterus compresses the inferior vena cava and causes a decrease in venous return to the heart and a drop in cardiac output. Placing the mother in the left lateral decubitus position restores venous flow and improves cardiac output.

  • Imaging in the pregnant patient should be similar to the nonpregnant patient if life-threatening injuries are suspected.

  • Pelvic fractures are the most common maternal injury that results in fetal death.

  • Consider emergency cesarean delivery within 5 minutes in women who are beyond 20 weeks and have cardiopulmonary collapse because the gravid uterus may interfere with maternal hemodynamics.

  • Intimate partner violence is the most common form of intentional trauma in pregnancy.

INTRODUCTION

Pregnancy imparts unique considerations in the evaluation and management of trauma patients. These include the following: epidemiologic distinctions from the general population; changes in anatomy and physiology that can alter injury presentation; concerns for fetal and placental injury; ramifications of trauma on the natural course of gestation; and poorly defined implications for the fetus from cumulative ionizing radiation employed in diagnostic imaging. Trauma during pregnancy has increased dramatically over the past 25 years.1 Injury is now the leading cause of nonobstetrical maternal death in the United States,2 and adverse fetal outcomes that have been correlated with trauma during pregnancy include preterm delivery, low birth weight, and fetal demise.3

Major trauma is associated with a 40% to 50% risk of fetal death, but the severity of trauma does not always predict the severity of injury to mother and fetus. Minor trauma occurs much more frequently but can still pose a significant risk to the fetus. A study of 5352 expectant mothers classified their injuries as major if hospital admission was required or minor if only emergency department evaluation occurred. They found that women in their first or second trimester with minor injury were 20% more likely to have a child with prematurity or low birth weight.4

EPIDEMIOLOGY

Trauma complicates an estimated 1 in 12 pregnancies, and 0.4% of pregnant women require hospitalization for their injuries.5 Motor vehicle crashes account for 50% of all traumatic injuries during pregnancy and 82% of trauma-related fetal deaths.6

A major risk factor for injury is the improper use of a seat belt.7 Over 40% of pregnant women involved in motor vehicle crashes did not receive counseling on appropriate seat belt use in one study.8 Correct placement has the lap belt underneath the abdominal dome, with the belt ...

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