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Penetrating injuries to the gravid uterus date back to antiquity, when wounding instruments included spears, sticks, and animal horns. Ambroise Paré, famous for his skills as a military surgeon, was also an obstetrician and was among the first to describe the treatment of gunshot wounds to the uterus. Paré wrote, “When the womb is wounded, the blood cometh out at the privites, and all other accidents appeared … ”1 Maternal deaths resulting directly from pregnancy or the complications of labor and delivery have declined sharply in recent years. In the United States, the absolute risk of pregnancy-related death is estimated currently at 11.8 deaths per 100,000 live births, a reduction in death rate by 99% since 1900.2,3 In contrast, trauma has emerged as the leading cause of death during pregnancy, accounting for nearly 50% of maternal deaths in the United States and over 1 million deaths annually worldwide.3,4 An estimated 6–7% of pregnancies are complicated by trauma with 0.4% of all pregnant patients requiring hospitalization for the treatment of injuries.5 Interestingly, the incidence of trauma increases with each pregnancy trimester, with only 8% of injuries occurring during the first trimester and over 50% during the third trimester.6 The true number of injured gravid women is grossly underestimated by these figures, however, as many injuries are unreported, especially those resulting from domestic violence. Thus, it is essential that all trauma care professionals recognize the anatomic and physiologic changes unique to pregnancy and appreciate how these changes impact the evaluation and treatment of the injured gravid patient. Complete evaluation of these patients includes an assessment of the fetus, and the treating physician must not only be cognizant of the signs of fetal distress, but must also be able to make rapid interventions in the interest of saving both mother and baby.

Weiss et al.7 examined data from the Pennsylvania state trauma registry and found that, among a total of 16,722 women of childbearing age who required hospitalization for injuries over a 1-year period, 761 were pregnant (4.6%). The leading causes of injury among pregnant women in this series were transportation-related (33.6%), falls, and assaults. Younger women (mean age 25) appeared to be at higher risk for injuries when compared to older gravid women. In a recent study from the state of Utah, pregnant women with an injury-related visit to an emergency department (ED) were more likely than noninjured women to experience preterm labor, placental abruption, and cesarean delivery, and infants born to women who were injured were more likely to be born preterm.8 In a related study that included data from 16 states, 240 trauma-related fetal deaths were identified (3.7 fetal deaths per 100,000 live births).9 Motor vehicle crashes were again the leading mechanism resulting in fetal death (82% of cases), followed by firearms (6%) and falls (3%). Placental injury was mentioned in 100 cases, and maternal death was the cause of fetal death ...

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