about pregnant women

1. Trauma in Pregnancy
Comprehensive Guide for Medical
Presentation

2. Introduction
• - Trauma is the leading non-obstetric cause of
maternal mortality.
• - Affects about 6–7% of pregnancies.
• - Most common types: blunt trauma (MVCs),
falls, domestic violence, penetrating trauma.
• - Always manage the mother as the primary
patient.

3. Physiological Changes in Pregnancy
• - Cardiovascular: Increased blood volume, HR;
delayed shock response.
• - Respiratory: Increased RR, decreased FRC,
diaphragm elevation.
• - GI: Displacement of stomach and bowels;
increased aspiration risk.
• - MSK: Ligament laxity, postural changes.
• - Uterus becomes abdominal organ after 12–
16 weeks.

4. Mechanisms of Injury
• - Blunt trauma: MVC, falls, assault.
• - Penetrating trauma: Stab, gunshot wounds.
• - Burns, domestic violence, and IPV must be
assessed.

5. Primary Survey – ABCDEF
• - A: Airway with cervical spine control.
• - B: Breathing and oxygenation.
• - C: Circulation with large-bore IVs, blood
products.
• - D: Disability – GCS, pupil check.
• - E: Exposure – Full body exam, prevent
hypothermia.
• - F: Fetal assessment after mother stabilized.

6. Secondary Survey & Obstetric
Evaluation
• - Complete head-to-toe exam.
• - Uterine fundal height, tenderness,
contractions.
• - Check for vaginal bleeding, amniotic fluid
leak.
• - Fetal heart tones and monitoring (CTG if
viable).

7. Investigations
• - FAST scan and focused ultrasound.
• - Kleihauer-Betke test for fetal-maternal
hemorrhage.
• - Blood group and Rh status, give Anti-D if Rh-.
• - X-rays/CT scans are safe if clinically indicated.

8. Common Obstetric Complications
• - Placental abruption.
• - Uterine rupture.
• - Preterm labor.
• - Fetal demise.
• - Amniotic fluid embolism.
• - PROM (Premature rupture of membranes).

9. Fetal Monitoring
• - Viable fetus (>24 weeks): continuous fetal
monitoring.
• - Monitor minimum 4–24 hours post-trauma.
• - Non-viable fetus: prioritize maternal care.

10. Management Principles
• - Stabilize the mother first.
• - Left lateral tilt or manual uterine
displacement (>20 weeks).
• - Tocolytics if labor starts.
• - Corticosteroids for preterm birth risk.
• - Administer Anti-D if Rh-negative.
• - Consider delivery if maternal/fetal distress.

11. Perimortem Cesarean Section
• - Indicated after maternal cardiac arrest (>20
weeks).
• - Perform within 4 minutes to improve
maternal outcome.
• - Aim to deliver fetus by 5 minutes post-arrest.

12. Special Considerations
• - Screen for domestic violence and
psychosocial issues.
• - Psychological impact on the mother.
• - Multidisciplinary care: OB, trauma,
anesthetics, NICU, social services.