Trauma during pregnancy.

Abstract

The appearance of a pregnant trauma patient is rare even in the busiest of trauma centers. Management of these cases can present difficult challenges. A successful outcome for both mother and child is dependent on an immediate team approach and response involving physician, nursing, and ancillary staff. The disciplines of emergency medicine, trauma surgery, obstetrics, and perinatology must be involved primarily in a timely and appropriate fashion. Other consultants required for the optimal treatment of injuries and pregnancy must also play a timely role. An aggressive rather than timid approach to resuscitation, diagnosis, and treatment of these patients must be taken. Knowledge of the normal physiologic changes occurring during pregnancy, special attention to prevention and early recognition of occult maternal hypoxia and hypovolemia, as well as a high index of suspicion for injuries to mother and fetus likely to occur during pregnancy should guide and temper management strategies. Care providers should resist emotional distractions and the urge to focus on the fetus before the mother is properly stabilized and evaluated. They should be cognizant of the fact that an apparently stable mother may be compensating at the expense of the fetus. Finally, the tenet of what benefits the mother will ultimately benefit the fetus should be adhered to. When these points are kept in mind, the potential for successful outcome and satisfying results is greatest for all parties involved.