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Clinical Summary

Guidelines address blunt abdominal trauma during pregnancy

Takeaway

  • Newly published guidance addresses the management of blunt abdominal trauma during pregnancy.

Why this matters

  • Obstetricians should be involved in management to improve outcomes.
  • Trauma is the leading nonobstetrical cause of death among pregnant women.

Key results

  • Physiologic changes during pregnancy can affect care of pregnant trauma victims.
  • Placental abruption is the leading serious event resulting from blunt trauma.
    • Symptoms include: uterine tenderness and contractions, maternal hypotension, or nonreassuring foetal heart tones.
    • Minimum of 2-4 hours of monitoring for contractions and foetal heart tones after blunt abdominal trauma.  
  • Contractions in the setting of trauma are nonspecific, and only 14.3% will have a clinically significant abruption.
  • Management decisions (CPR, imaging, transfusion, surgery) should not be altered because of pregnancy.  
  • Perimortem cesarean delivery within 5 minutes after maternal arrest improves foetal survival and may achieve spontaneous circulation in the pregnant woman.
  • Interdisciplinary policies, checklists, communication are ideal from triage in field to hospital care.
  • Primary survey and maternal stabilisation prior to any foetal assessment.
    • Foetal assessment with secondary survey.
    • The secondary survey is the time for the obstetrician to become actively involved in the patient's care.

Study design

  • Review and expert guidelines as part of the Clinical Expert Series.
  • Funding: None disclosed.

References


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