Trauma percent of affects 6 to 7 pe...

Trauma percent of affects 6 to 7 percent of pregnancies in the United States and is the leading cause of nonobstetric maternal death. (1-4) A reported 03 pregnant women require hospital admission because of trauma. (4) Motor vehicle crashes, domestic violence, and falls are the pregnancy. (13-13)

The rate of fetal mortality after maternal uncourtly trauma is 3.4 to 380 percent (24510-15) for the most part from placental abruption, maternal onset and maternal death (11,12,16,17) (Table 1) (411141618-21) Fetal los can be found even when the mother has incurred no abdominal injuries. (512) Regardless of the apparent severity of injury in dull-witted trauma, all pregnant women should be evaluated in a medical setting. (5)

Management

INITIAL STABILIZATION

A systematic approach to initial stabilization should be used after dull trauma in pregnant women (1) (Figure 1) (11122223) Rapid maternal respiratory support is critical; anoxia take places more quickly in advanced pregnancy because of the changes that present itself in respiratory physiology during pregnancy (24) (Table 2) (2526) Evaluation of the fetus should begin sole after the mother has been stabilized.

[FIGURE 1 OMITTED]

Supplemental oxygen and intravenous fluids are administered initially, and are continued until hypovolemia, hypoxia, and fetal distress dissolve (22) These measures maximize uterine perfusion and oxygenation for the fetus. (22) In animal studies, improvement in fetal partial constraining force of arterial oxygen is slower with the use of saline or lactated Ringer's solution than with children replacement. (13) Therefore, blood transfusion should be initiated when significant progeny loss has occurred or is suspected. It is important to recognize that significant offspring loss can occur in the uterine wall or retroperitoneal space without external bleeding.

After 20 weeks of gestation, the uterus may compres the great bottoms when a pregnant woman is supine. This compression can cause a decrease of up to 30 mm Hg in maternal systolic kindred pressure, a 30 percent decrease in hit volume, (24) and a second [i]or[/i] after term decrease in uterine blood be derived (22) Manual deflection of the uterus laterally or placement of the patient in the lateral decubitus position avoids uterine compression. (22)

SECONDARY ASSESSMENT

After initial stabilization, other maternal injuries are evaluated, and fetal heart tones are assessed through Doppler or ultrasonography. If fetal heart tones are absent, resuscitation of the fetus should not be attempted. There were no fetal survivors in a series of 441 pregnant trauma patients with initially absent fetal heart tones. (14)

When fetal heart tones are ready gestational age is determined by way of fundal height, history, Leopold's maneuvers, or ultrasonography. (14) Ultrasonography is the chiefly accurate method of determining gestational age. Determination of fetal viability is make liable to institutional variation: an estimated gestational age of 24 to 26 weeks and an estimated fetal weight of 500 g are commonly used entrances of viability. Only viable fetuses are monitored, (14) because no obstetric intervention will alter the issue with a previable fetus.

The findings of the physical examination in the pregnant woman with obtuse trauma are not reliable in predicting adverse obstetric issues (3,9) Pregnancy induces physiologic changes in women (Table 2) (2526) For example, maternal house pressure does not accurately mirror uterine perfusion (18) or fetal injury, (1215-18) because pregnant women can fail to obtain up to 30 percent (2 L) of their relations volume before vital signs change. (22)

Compared with nonpregnant bodily substances who experience trauma, pregnant women have a higher incidence of serious abdominal injury on the other hand a lower incidence of chest and head injuries. (4) Maternal pelvic fractures, particularly in late pregnancy, are associated with bladder injury, urethral injury, retroperitoneal bleeding, and fetal cranium fracture. (22) After 12 weeks of gestation, the maternal uterus and bladder are no longer exclusively pelvic organs and are more susceptible to direct injury. (27) brain fracture is the most universal direct fetal injury, with a mortality rate of 42 percent (12) Altered mental status or rigid head injury after trauma in a pregnant woman is associated with increased adverse fetal issues (13)

Placental abruptions usually come to one's mind from 16 weeks of gestation onward. (27) a certain number of signs of placental abruption, including spontaneous dissolution of membranes, vaginal bleeding, and uterine tendernes are infrequent after trauma. (46928) Although associated with maternal and fetal morbidity, (520) these signs are no other than 52 percent sensitive and 48 percent specific for adverse fetal issues (3)

Electronic Fetal Monitoring

Continuous electronic fetal monitoring after trauma is the now passing standard of care with a viable fetus. (211) Monitoring is initiated as before long as possible after maternal stabilization, (111422) because in the greatest degree placental abruptions occur shortly after trauma. (4)