Trauma During Pregnancy — A Review of Management

Abstract

The assessment and management of 22 pregnant patients who were admitted after trauma to Westmead Hospital between July, 1987 and October, 1988 was reviewed. Thirteen of the 22 patients were victims of motor vehicle accidents. Despite the fact that an injury research unit, responsible for the clerking and review of all trauma patients, is well established at our institution, only 6 patients in this series had been assessed in this fashion. Although a number of important obstetric investigations (albeit uncommon in the accident and emergency room situation) are well described in the literature, these were not performed in a number of patients. A protocol for the management of such patients is recommended so that more standardized and appropriate care might be given to the injured pregnant patient.

The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes

“…Although there have been many studies that focus on trauma during pregnancy (Aitokallio-Tallberg and Halmesmäki, 1997;Baerga-Varela et al, 2000;Bowman et al, 1989;Drost et al, 1990;El-Kady et al, 2004;Galle and Anderson, 1997;Greenblatt et al, 1997;Hartl and Ko, 1996;Kingston et al, 2003;Kissinger et al, 1991;Klinich et al, 2000;Kuo et al, 2007;Legros et al, 2000;LeSher and O'Connor, 1992;Metz and Abbott, 2006;Occelli et al, 1998;Rainio and Penttila, 2003;Sandy and Koerner, 1989;Schiff et al, 2001;Schiff and Holt, 2005;Sherer et al, 1993;Weiss, 1999;Williams et al, 1990), our study is the first to describe on a population basis the epidemiology of emergency department treated injured pregnant women. Most emergency department treated injured women are not hospitalized, thus studies that only include inpatient records are not looking at the whole picture.…”

Radiation fear

“…For the pregnant trauma patient, the US additionally allows for confirmation of fetal viability and placental position. In their study of 22 pregnant patients, Bowman et al 25 focused on compliance with specific obstetrics investigations such as US, cardiotocography, Kleihauer count, 26 did not assess the use of chest x-ray, as adherence to imaging guidelines was not a primary focus of their study. 16 To our knowledge, the current literature does not support the use of MRI in the setting of trauma.…”