26 Sept 2023 • Not one but two lives are at stake

Approximately 8% of all pregnancies are complicated by trauma, which is the leading non- obstetric cause of death among pregnant women.🤰🏻

While more than 90% of the trauma are minor following which the patient usually does not report pain, vaginal bleeding, loss of fluid, or decreased fetal movement, in major trauma, there is a 40-50% risk of fetal death.🚨

Nevertheless, even minor trauma can result in fetal demise, therefore continuous monitoring for a viable fetus is recommended for at least 4 hours.👩🏻‍⚕

Dr. Ashima Sharma in the session 'The Primary Evaluation of Obstetric Trauma' explains that maternal body undergoes a lot of physiological changes as part of pregnancy (hematological, cardiovascular, respiratory) making her and her baby more susceptible to the detrimental effects of trauma.😕

Traumatic injuries to pregnant women may be unintentional (a fall, motor vehicle accident, poisoning) or intentional (assault/domestic violence, suicide, homicide) with pelvic fracture being the most common maternal injury resulting in fetal death.🚑

Hence obstetric trauma calls for timely and swift management to save both lives, and if you have attended any session with Dr. Ashima previously, her mantra for analysing any injury is MIST.

M - Mechanism of Injury I - Type of Injury S - Signs and Symptoms T - Treatment given prior to reaching ED

And the way to proceed? ABC

Dr. Sharma advises us to be mindful of the supine hypotension syndrome in trauma cases, which can be managed by turning the patient to the left side relieving pressure on the IVC.

In the worst case scenario, like a maternal cardiac arrest, resuscitative hysterotomy should be performed which involves continuous CPR on the mother, along with caesarean section to take the baby out, followed by neonatal resuscitation.

It is imperative to understand that management of the pregnant trauma patient involves evaluation and resuscitation of two individuals, the mother and fetus, with the primary focus being prompt and sustained resuscitation of the mother to optimize outcomes for both lives.✅

Want to learn more?🤗

Click here to catch more on the Primary Evaluation of Obstetric Trauma by Dr. Ashima Sharma right here on Medflix 💛