Trauma in Pregnancy

Anatomic and physiologic changes in the maternal trauma patient evolve over the course of pregnancy and requires modifications in management based on gestatinal age.
Patient care should be tailored for the anatomic and physiologic changes in gravid trauma patients, but priorities remain the same for the non gravid patient. Relative hypervolemia of pregnancy can mask large volume hemorrhagic losses and requires rapid identification and aggressive resuscitation. Compression of inferior vena cava (IVC) and decreased cardiac output can result from supine positioning, proper positioning and use of wedge is recommended.
A kleihauser - Betke test should be performed in all pregnant trauma patients with greater than 12 weeks of gestation and prophylactic anti-D immune globulin given within 72 hours for high-risk patients. Radiation exposure should be minimized in all pregnant trauma patients.
Ultrasound including (FAST) exposes mother and fetus to no radiation and is reliable. Angiography and embolization may be useful in life threatening hemorrhage. Pregnant women are at increased risk for deep venous thrombosis (DVT) and should be given unfractionated subcutaneous heparin for prophylaxis. Providers should have a low threshold for screening maternal trauma patients for intimate partner violence (IPV) and substance abuse.