Written by Jason Lesnick
Spoon Feed
This review summarizes physiologic changes during pregnancy and recommendations for caring for the pregnant trauma patient. Don’t worry, you can CT pregnant patients (when indicated)!
Two patients for the price of one
This paper nicely reviews caring for the pregnant trauma patient. 4% of pregnant women will have an injury-associated ER visit; thus, trauma is unfortunately common in pregnancy. A horrific stat that I wish wasn’t true – in the U.S., domestic violence is the leading cause of death of pregnant women. Some highlights from the review:
- Ultrasound has only a 53% NPV for placental abruption and uterine rupture
- Levels of fibrinogen < 2 g/L are associated with increased risk of placental abruption (normal during pregnancy is > 4).
- If pregnancy is previable, confirming fetal HR is sufficient. If viable, 4-6 hours of fetal monitoring is recommended and should be initiated after primary and secondary assessments.
- All should receive a Kleihaur Betke (KB) test, fibrinogen, and appropriate imaging (including CT scans as indicated).
Focus on maternal treatment in the setting of physiologic alterations due to pregnancy. Pregnant trauma patients require evaluation for the typical traumatic causes of hemorrhagic shock, but also consider pregnancy-specific causes such as amniotic fluid embolism, uterine rupture, and placental abruption.
How will this change my practice?
The best thing you can do for the fetus is take excellent care of the mother. If the mother needs a CT, you can order the CT; ACOG has a guideline supporting this practice. You can even reference this when discussing the specific risks and benefits with the patient.
Source
Pregnancy and trauma: What you need to know. J Trauma Acute Care Surg. 2025 Feb 1;98(2):190-196. doi: 10.1097/TA.0000000000004478. Epub 2024 Nov 4. PMID: 39496074
