Trauma in Pregnancy

Mom is Scared. You are Scared. Don’t Be Scared.











General Principles











* Evaluate for intimate partner violence in all poorly explained traumas during pregnancy* Get the scans you would order in a non-pregnant patient, even CTs!* Shield the uterus if necessary











Basic Approach to Trauma in Pregnancy











* Step 1: Place mother in left lateral decubitus position* This removes the weight of the uterus OFF the inferior vena cava (IVC)* Can significantly improve patient’s hemodynamics* Step 2: Palpate the fundus* If fundus is palpable at umbilicus, fetus is approximately 20 weeks* Add 1 week of pregnancy for every 1cm above umbilicus* Step 3: Pelvic ultrasound* Primary utility is to reassure mother that baby is OK* Calculate fetal heart rate* Also identifies SOME placental abruptions and pelvic free fluid* Step 4: Obtain type and screen* If mother is Rh NEGATIVE…* Give RhoGAM* Prevents Rh isoimmunization in mothers with Rh positive babies* Step 5: Consult OBGYN for fetal heart monitoring (tocodynamometry)* Best test to rule out placental abruption and uterine irritability* Only necessary if patient is >20 weeks gestational age











Additional Reading











* Trauma Basics (EM Clerkship)* Trauma in Pregnancy (AAFP)