Trauma in pregnancy

Posted by e-Medical PPT Friday, October 26, 2012
Trauma in Pregnancy remains the leading cause of non O. morbidity & Mort. accounting for 46 % of fatalities in pregnant women.
Since women remains active during preg it is reported that 6-7 % of them will have trauma.
The major cause of maternal death are the same as those in non pregnant; head injuries and hypovolemia.
Injury in pregnant women may be intentional or unintentional.
MVC & falls are most common cause of injury.
However, homicide and suicide accounts for 1/3 of cases.
In one study domestic violence occurred in at least 8-17 % of cases during pregnancy. Single kick to abdomen in late preg. is associated with abruption placentae and fetal loss.
In one series, 57% of the maternal deaths were due to homicides and 7% due to suicides.
Causes of traumatic injury roughly parallel those seen in the general population, blunt being more common.
10% of maternal deaths from trauma are due to head injury, like the general population.
Maternal death rate is not statistically different from the general matched population.
Trauma, however, does seem to raise the rate of fetal loss and placental abruption over baseline rates in pregnant population.

Physiological Changes During Pregnancy
Each system of the mother undergoes changes to compensate for the growing metabolic demand and load
of the new fetus.
The cardiovascular and hematopoetic changes include those noted above.
Additionally, there are increased amounts of thrombolytic factors present in the placenta, although systemic measurements of coagulation are normal.
The placental vascular system is exquisitely sensitive to circulating catacholamines which may result in intense vasoconstriction.
Maternal shock may result in 85% fetal mortality.

Total blood volume increases by 50%
Shock-like changes
Up to 20% acute and 30-35% gradual blood loss may show no sign of instability
Normal baseline heart rate is increased up by 10-15 bpm
Diastolic BP is decreased by 5-15 mmHg...

Injuries unique to pregnancy
Premature Contractions
Rarely progress to preterm delivery
Tocolysis is not proven in trauma.(1)

Abruptio Placentae
Different elastic properties in uterus & placenta “shearing”
3 % of minor trauma and upto 50 % in severe trauma

Uterine Rupture
Rare, 0.6 % of severe abdominal trauma (1)
Direct trauma after 12 wks of gestation
Prior Surgery (C/S or Myomec.) the risk

Maternal-Fetal Hemorrhage
Trimesters:T1 3%, T2 12%, T3 45%
4-5 X more common in injured pregnant women
Causes isoimmunization & fetal death
Kleihauer-Betke test - volume of fetal blood
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