Trauma in pregnancy: a systematic approach.
Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Potential complications include maternal injury or death, shock, internal hemorrhage, intrauterine fetal demise, direct fetal injury, abruptio placentae, and uterine rupture. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma. Many of the assessment and management aspects of obstetric trauma are unique to pregnancy, although initial evaluation and resuscitation should always be maternally directed. Once maternal stability is established, vigilant evaluation of fetal well-being becomes warranted. Continuous fetal heart monitoring, ultrasonography, computed tomography, open peritoneal lavage, and/or exploratory laparotomy may be indicated in a case of obstetric trauma. In view of the significant impact of trauma on the pregnant woman and her fetus, preventive strategies are paramount.
Mirza
Fadi G
FG
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York 10032, USA. fgm2107@columbia.edu
Devine
Patricia C
PC
Gaddipati
Sreedhar
S
D000007:Abdominal Injuries / Q000628:therapy; D000037:Abruptio Placentae / Q000209:etiology; D004556:Electric Injuries; D005260:Female; D005323:Fetal Monitoring; D050723:Fractures, Bone / Q000628:therapy; D006340:Heart Rate, Fetal; D006801:Humans; D007813:Laparotomy; D010384:Pelvic Bones / Q000293:injuries; D010533:Peritoneal Lavage; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016216:Ultrasonography, Prenatal; D014597:Uterine Rupture / Q000628:therapy; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000628:therapy; D014950:Wounds, Penetrating