Trauma in pregnancy

Background

• Concern for trauma, premature labor, and abruption
• Viable = >23-24wk (~fundus above umbilicus)
• nl FHR = 110-160 beats/min
• The leading cause of death in women during their reproductive years
• The leading non-obstetric cause of death and disability in pregnant women
• Trauma or accidental injury complicates up to 7% of all pregnancies
• For maternal vitals see Maternal Vitals and Labs in Pregnancy

Diagnosis (Abruption)

Symptoms

• Vag bleed 70% (may be absent if retroplacental)
• Cramps/contractions
• Uterine tenderness
• Hypovolemia
• Abnl fetal HR

US only 50% accurate

Signs of fetal distress on toco monitor are often the earliest indicator

• decelerations, tachycardia, bradycardia, and loss of variability

Treatment & Disposition

• Nonviable fetus (<23-24wks)
  • Standard treatment for trauma
  • Consider RhoGAM 50mcg in rh neg
• Viable fetus (>23-24wks)
  • Consider RhoGAM 300mcg in rh neg
  • Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery
  • Monitor (fetal) all for 4-6hrs -->
  • Extend Monitoring to 24hrs, if abnormal 6hr monitoring
    • The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes.

Abnormal Monitoring

• >3 contractions/hr
• Persistent uterine TTP
• Worrisome strip
• Vag bleed
• PROM
• Serious maternal injury

Partial abruption w/ stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)

Abruption = risk DIC

External Links

• MDCalc - Pregnancy Due Dates Calculation

See Also

• Fetal Maternal Hemorrhage (RhoGAM)
• Perimortum C-Section
• Abruption
• Maternal Vitals and Labs in Pregnancy