Trauma in pregnancy - Revision history

Danbot: Strip excess bold

2026-03-22T09:27:41Z

Strip excess bold

← Older revision		Revision as of 09:27, 22 March 2026
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	*Radiographic imaging as directed by [[ATLS]] assesment<ref>Edmonton V, Edmonton R, Maslovitz S, et al. Guidelines for the Management of Pregnant Trauma Patient. J Obset Gynaecol Can 2015. 37(6):553-571</ref>		*Radiographic imaging as directed by [[ATLS]] assesment<ref>Edmonton V, Edmonton R, Maslovitz S, et al. Guidelines for the Management of Pregnant Trauma Patient. J Obset Gynaecol Can 2015. 37(6):553-571</ref>
	**Radiographic imaging should not be delayed or deferred due to concern for fetal radiation exposure in the trauma setting		**Radiographic imaging should not be delayed or deferred due to concern for fetal radiation exposure in the trauma setting
	*Tocographic and fetal monitoring - ~~'''~~VEAL CHOP~~'''~~		*Tocographic and fetal monitoring - VEAL CHOP
	**~~'''V'''ariable~~ - ~~'''C'''ord~~ compression		**Variable - Cord compression
	**~~'''E'''arly~~ - ~~'''H'''ead~~ compression		**Early - Head compression
	**~~'''A'''ccelerations~~ - ~~'''O'''kay~~		**Accelerations - Okay
	**~~'''L'''ate~~ - ~~'''P'''lacental~~ insufficiency		**Late - Placental insufficiency

	==Treatment & Disposition==		==Treatment & Disposition==

Rossdonaldson1: /* Treatment & Disposition */

2025-04-16T15:50:43Z

Treatment & Disposition

← Older revision		Revision as of 15:50, 16 April 2025
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	**Consider [[RhoGAM]] 50mcg in Rh negative patients		**Consider [[RhoGAM]] 50mcg in Rh negative patients
	*Viable fetus (>23-24wks)		*Viable fetus (>23-24wks)
	**Consider RhoGAM 300mcg in Rh negative patients		**Consider [[RhoGAM]] 300mcg in Rh negative patients
	**Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery		**Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery
	**Fetal monitoring (continuous cardiotocographic monitoring)		**Fetal monitoring (continuous cardiotocographic monitoring)

Spenceemmett: /* Complications */

2022-05-02T23:54:34Z

Complications

← Older revision		Revision as of 23:54, 2 May 2022
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	==Complications==		==Complications==
	*[[Uterine rupture]]		*[[Uterine rupture]]
	**~~more~~ common with direct abdominal trauma in second half of pregnancy		**More common with direct abdominal trauma in second half of pregnancy
	**Occurs in severe MVAs resulting in pelvic fractures, penetrating trauma		**Occurs in severe MVAs resulting in pelvic fractures, penetrating trauma
	**Signs and Sx		**Signs and Sx
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	***palpable fetal parts		***palpable fetal parts
	***sudden abnormal FHR pattern		***sudden abnormal FHR pattern
	***~~Ascent~~ of fetal presenting part		***ascent of fetal presenting part

	*[[Placental Abruption]]		*[[Placental Abruption]]
	**Most common cause of fetal demise in blunt trauma		**Most common cause of fetal demise in blunt trauma
	**US on not sensitive → do not delay treatment for [[ultrasound]] if abruption suspected		**US alone not sensitive → do not delay treatment for [[ultrasound]] if abruption suspected
	**Signs and Sx		**Signs and Sx
	***abdominal pain		***abdominal pain
	***uterine tenderness		***uterine tenderness
	***vaginal bleeding (70%, may be absent if retroplacental)		***vaginal bleeding (70%, may be absent if retroplacental)
	***~~Uterine~~ contractions or hypertonicity		***uterine contractions or hypertonicity
	***~~Signs~~ of fetal distress on toco monitor are often the earliest indicator		***signs of fetal distress on toco monitor are often the earliest indicator
	****decelerations, tachycardia, bradycardia, and loss of variability		****decelerations, tachycardia, bradycardia, and loss of variability

Elcatracho: /* Complications */

2021-03-06T23:57:01Z

Complications

← Older revision		Revision as of 23:57, 6 March 2021
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	*[[Placental Abruption]]		*[[Placental Abruption]]
	**Most common cause of fetal demise in blunt trauma		**Most common cause of fetal demise in blunt trauma
	**US on not sensitive → do not delay treatment for [[ultrasound]] if ~~abrpution~~ suspected		**US on not sensitive → do not delay treatment for [[ultrasound]] if abruption suspected
	**Signs and Sx		**Signs and Sx
	***abdominal pain		***abdominal pain

Elcatracho: /* See Also */

2021-03-06T23:56:18Z

Kxl328: /* Evaluation */

2018-10-22T17:55:38Z

Evaluation

← Older revision		Revision as of 17:55, 22 October 2018
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	*Radiographic imaging as directed by [[ATLS]] assesment<ref>Edmonton V, Edmonton R, Maslovitz S, et al. Guidelines for the Management of Pregnant Trauma Patient. J Obset Gynaecol Can 2015. 37(6):553-571</ref>		*Radiographic imaging as directed by [[ATLS]] assesment<ref>Edmonton V, Edmonton R, Maslovitz S, et al. Guidelines for the Management of Pregnant Trauma Patient. J Obset Gynaecol Can 2015. 37(6):553-571</ref>
	**Radiographic imaging should not be delayed or deferred due to concern for fetal radiation exposure in the trauma setting		**Radiographic imaging should not be delayed or deferred due to concern for fetal radiation exposure in the trauma setting
			*Tocographic and fetal monitoring - '''VEAL CHOP'''
			**'''V'''ariable - '''C'''ord compression
			**'''E'''arly - '''H'''ead compression
			**'''A'''ccelerations - '''O'''kay
			**'''L'''ate - '''P'''lacental insufficiency

	==Treatment & Disposition==		==Treatment & Disposition==

Jglee3 at 17:58, 15 March 2018

2018-03-15T17:58:04Z

← Older revision		Revision as of 17:58, 15 March 2018
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	*Motorcycle or pedestrian collisions		*Motorcycle or pedestrian collisions

	==~~Clinical Features~~==		==Assessment==
	*Airway		*Airway
	**Prepare for potentially difficult airway		**Prepare for potentially difficult airway
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	*[[Uterine rupture]]		*[[Uterine rupture]]
	**more common with direct abdominal trauma in second half of pregnancy		**more common with direct abdominal trauma in second half of pregnancy
			**Occurs in severe MVAs resulting in pelvic fractures, penetrating trauma
	**Signs and Sx		**Signs and Sx
	***maternal [[shock]]		***maternal [[shock]]
	***abdominal distension		***abdominal distension
	***abnormal uterine contour		***abnormal uterine contour
			***abnormal fetal lie (oblique or transverse)
	***palpable fetal parts		***palpable fetal parts
	***sudden abnormal FHR pattern		***sudden abnormal FHR pattern

Jglee3 at 17:55, 15 March 2018

2018-03-15T17:55:11Z

← Older revision		Revision as of 17:55, 15 March 2018
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	**Fetal risks from defibrillation of mother are small		**Fetal risks from defibrillation of mother are small

			==Complications==
	*[[Uterine rupture]]		*[[Uterine rupture]]
	**more common with direct abdominal trauma in second half of pregnancy		**more common with direct abdominal trauma in second half of pregnancy
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	*Nonviable fetus (<23-24wks)		*Nonviable fetus (<23-24wks)
	**Standard treatment for trauma		**Standard treatment for trauma
			***No obstetric intervention will alter the outcome of a pre-viable fetus
	**Consider [[RhoGAM]] 50mcg in Rh negative patients		**Consider [[RhoGAM]] 50mcg in Rh negative patients
	*Viable fetus (>23-24wks)		*Viable fetus (>23-24wks)

Jglee3 at 17:49, 15 March 2018

2018-03-15T17:49:45Z

← Older revision		Revision as of 17:49, 15 March 2018
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	==Clinical Features==		==Clinical Features==
	*Airway		*Airway
	**Pregnant women at increased risk of aspiration		**Prepare for potentially difficult airway
			***Increased soft tissue edema, breast enlargement, weight gain
			**Pregnant women at increased risk of aspiration due to delayed gastric emptying
	**Failed intubations 8 times more likely in pregnant trauma patients		**Failed intubations 8 times more likely in pregnant trauma patients
	***Increased respiratory mucosal edema, weight gain, delayed gastric emptying

	*Breathing		*Breathing

Jglee3 at 17:46, 15 March 2018

2018-03-15T17:46:03Z

← Older revision		Revision as of 17:46, 15 March 2018
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	**Consider [[RhoGAM]] 50mcg in Rh negative patients		**Consider [[RhoGAM]] 50mcg in Rh negative patients
	*Viable fetus (>23-24wks)		*Viable fetus (>23-24wks)
	**Consider RhoGAM 300mcg in ~~rh neg~~		**Consider RhoGAM 300mcg in Rh negative patients
	**Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery		**Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery
	**~~Monitor~~ (~~fetal~~) ~~all~~ for 4-~~6hrs →~~		**Fetal monitoring (continuous cardiotocographic monitoring)
	**~~Extend Monitoring to 24hrs~~, ~~if abnormal 6hr monitoring~~		***If no risk factors for fetal loss, minimum 4-6 hours
	***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. <ref>Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–10.</ref>		***If risk factors for fetal loss/abruption, monitor for 24 hours
			****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. <ref>Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–10.</ref>

	*Allow patient to roll onto left side to unload uterine compression of IVC → increases venous return to heart		*Allow patient to roll onto left side to unload uterine compression of IVC → increases venous return to heart
			*In the setting of maternal cardiac arrest, consider [[Perimortem cesarean delivery\|Perimortem Cesarean delivery]] if no ROSC within 4 minutes
	*~~Abdominal CT imaging should be delayed or deferred due to concern for fetal radiation exposure in~~ the setting of ~~trauma.~~

	[[Perimortem cesarean delivery\|Perimortem Cesarean delivery]]

	===Abnormal Monitoring===		===Abnormal Monitoring===

← Older revision		Revision as of 23:56, 6 March 2021
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	*[[Maternal Vitals and Labs in Pregnancy]]		*[[Maternal Vitals and Labs in Pregnancy]]
	*[[Trauma (main)]]		*[[Trauma (main)]]
			*[[Pregnancy (main)]]

	==References==		==References==