Blunt Trauma in the Pregnant Woman

Posted by e-Medical PPT
Trauma occurs in 6-7% of pregnancies in US
Leading nonobstetric cause of  maternal death
Female drivers are more likely to be in a MVA than male drivers

Physiologic Changes in Pregnancy
Pregnant woman can lose 30% (2L) of blood volume before vital signs change
At 30 wks GA the uterus is large enough to compress the great vessels causing
 up to a 30mm Hg drop in systolic BP
 30% drop in stroke volume
A series of 441 pregnant trauma victims with no detectable fetal heart tones showed no fetal survivors.

Results of Large Population Study
Fetal demise prior to 20 weeks gestation not included in this study
Gestational age was the strongest predictor of fetal, neonatal and infant death
What and how severe the trauma was not as strong a predictor as gestational age
Highest risk at <28 weeks gestation
Trauma may cause subclinical, chronic plancenta abruptions
causing insufficient uterine blood supply
Woman involved in a trauma during pregnancy need close monitoring during labor

Fetal Demise
Rate of fetal demise after blunt trauma 3.4-38%
Lead causes
 Placental abruption
 Maternal shock
 Maternal death
1,300-3,900 pregnancies are lost due to trauma each year
Abruption occurs in  40-50% of pregnant woman in severe traumas compared to 1-5% in minor trauma

Uterine Rupture
0.6% of all injuries during pregnancy
Various degrees ranging from seosal hemorrhage to complete avulsion
75% of cases involve the fundus
Fetal mortality approaches 100%
Maternal mortality 10%
 Usually due to other injuries

Preterm Labor
Incidence following trauma is unknow
Estimated to be under 5%
Theory: caused by destabilization of lysosmal enzymes that initiate prostaglandin production
Consider admistering slow-released progesterone for all woman with contracts after trauma

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