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Trauma in pregnancy

Accident and Emergency Department, King’s College Hospital, London, UK

Serious trauma in pregnancy is an uncommon event but is particularly challenging to the physician, due to the presence of a potential second patient. Responding to the challenge requires a knowledge of the physiological changes which may alter the maternal response to injury, as well as an understanding of the maternal-fetal relationship. Fetal outcome is dependent on maternal well-being, and thus timely and appropriate resuscitation of the mother is the first priority. Initial management of the pregnant trauma patient includes attention to the airway-breathing-circulation (ABC). Certain injuries are more common in pregnancy and are influenced by the presence of the gravid uterus. The physician needs an awareness of the common complications of pregnancy and additional skills may be required to diagnose and assess fetal viability. The principles of the perimortem section should be understood, as well as the social implications of domestic violence towards pregnant women.

Key Words: physiology • resuscitation priorities • fetal viability • complications

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