Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-24T15:19:00.125Z Has data issue: false hasContentIssue false

26 - Trauma in Pregnancy

Published online by Cambridge University Press:  18 January 2010

By
John R. Fisgus ,
Kalpana Tyagaraj  and
Sohail Kamran Mahboobi
Edited by
Charles E. Smith
John R. Fisgus
Affiliation:
Department of Anesthesia, Maimonides Medical Center, New York
Kalpana Tyagaraj
Affiliation:
Department of Anesthesiology, Maimonides Medical Center, New York
Sohail Kamran Mahboobi
Affiliation:
Department of Anesthesia, Maimonides Medical Center, New York
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
Get access

Summary

Objectives

  1. Review the etiology of trauma in pregnant patients.

  2. Discuss the physiologic changes of pregnancy and their impact on anesthetic management of a pregnant trauma patient.

  3. List the various causes of maternal and fetal morbidity and mortality associated with different types of trauma.

  4. Be able to triage a pregnant trauma patient and know the impact of gestational age on resuscitation.

  5. Review the principles of cardiorespiratory resuscitation in a pregnant patient, including perimortem cesarean delivery.

Trauma complicates approximately 7 percent of all pregnancies and is responsible for 0.3 percent to 0.4 percent of maternal hospital admissions [2]. Trauma is the most common cause of maternal death in the United States [1]. Mechanisms of trauma during pregnancy include motor vehicle accidents, domestic violence [3], falls [4], and penetrating injuries [5]. Pregnancy has its own unique injuries due to the expanding uterus and developing fetus that must be taken into consideration in the pregnant trauma patient.

Many providers are involved in the care of the pregnant patient from the trauma scene, to the emergency department, and to the operating room. The anesthesiologist can play a key role in the care and management of the pregnant trauma victim. All anesthesiologists have training in obstetric anesthesia during their residency and frequently cover obstetric units in hospitals where pregnant patients are cared for. On the other hand, most nonobstetric physicians have little obstetric exposure and may be uncomfortable caring for the pregnant patient because of unfamiliarity with the physiologic changes of pregnancy or the evaluation of fetal well-being.

Type
Chapter
Information
Trauma Anesthesia , pp. 402 - 416
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Colburn, V.Trauma in pregnancy. J Perinat Neonat Nurs 1999;13(3):21–32.CrossRefGoogle ScholarPubMed
Lavin, JP, Polsky, SS. Abdominal trauma during pregnancy. Clin Perinatol 1983;10: 423–38.CrossRefGoogle ScholarPubMed
Mighty, H.Trauma in pregnancy. Crit Care Clin 1994;10: 623–34.CrossRefGoogle ScholarPubMed
Petrone, P, Asensio, JA. Trauma in pregnancy: Assessment and treatment. Scand J Surg 2006;95: 4–10.CrossRefGoogle ScholarPubMed
Kaunitz, AM, Hughes, JM, Grimes, DA. Causes of maternal mortality in the United States. Obstet Gynecol 1985;65: 605.Google ScholarPubMed
George, ER, Vanderwaak, T, Scholten, DJ. Factors influencing pregnancy outcome after trauma. Am Surg 1992;58: 595–8.Google ScholarPubMed
Scorpio, RJ, Esposito, TJ, Smith, LG, et al. Blunt trauma during pregnancy: Factors affecting fetal outcome. J Trauma 1992;32: 213–6.CrossRefGoogle ScholarPubMed
Moise, KJ Jr, Belfort, MA. Damage control for the obstetric patient. Surg Clin N Am 1997;77: 835–52.CrossRefGoogle ScholarPubMed
Hill, DA, Lense, JJ. Abdominal trauma in the pregnant patient. Am Family Physician 1996;53: 1269–74.Google ScholarPubMed
Esposito, TJ. Trauma during pregnancy. Emerg Med Clin N Am 1994;12: 167–99.Google ScholarPubMed
Shah, KH, Simons, RK, Holbrook, T, et al. Trauma in pregnancy: Maternal and fetal outcomes. J Trauma Inj Infec Crit Car 1998;45(1):83–6.CrossRefGoogle ScholarPubMed
Capless, EL, Clapp, JF. Cardiovascular changes in early phase of pregnancy. Am J Obstet Gynecol 1988;168(6):1449–53.Google Scholar
Clapp, JF, Seawad, BL, Sleamaker, RH, Hiser, J. Maternal physiological adaptations to early human pregnancy. Am J Obstet Gynecol 1988;159: 1456–60.CrossRefGoogle ScholarPubMed
Ueland, K, Hansen, JM. Maternal cardiovascular hemodynamics. III. Labor and delivery under local and caudal analgesia. Am J Obstet Gynecol 1969;103: 8–17.CrossRefGoogle Scholar
Ueland, K, Akamatsu, TJ, Eng, M, et al. Maternal cardiovascular hemodynamics. VI. Cesarean section under epidural anesthesia without epinephrine. Am J Obstet Gynecol 1972;114: 775–80.CrossRefGoogle ScholarPubMed
Howard, BK, Goodson, JH, Mengert, WF. Supine hypotension syndrome in late pregnancy. Obstet Gynecol 1953;1: 371–7.Google ScholarPubMed
Gamann WR, Ostheimer GW. Understanding the mother. In Ostheimer, GW, ed. Manual of Obstetric Anesthesia. New York: Churchill and Livingstone, 1992, pp 1–11.Google Scholar
Weinberger, SE, Weiss, ST, Cohen, WR, et al. Pregnancy and the lung. Am Rev Respir Dis 1980;121: 559–81.CrossRefGoogle ScholarPubMed
Campbell, , Klocke, RA. Implications for the pregnant patient. Am J Respir Crit Care Med 2001;163(5):1051–4.CrossRefGoogle ScholarPubMed
Shah, AJ, Kilcline, BA. Trauma in pregnancy. Emerg Med Clin N Am 2003;21: 615–29.CrossRefGoogle ScholarPubMed
Maull, KI. Maternal-fetal trauma. Semin Pediatr Surg 2001; 10(1):32–4.CrossRefGoogle ScholarPubMed
Varela, YB, Zietlow, SP, Bannon, MP, et al. Trauma in pregnancy. Mayo Clin Proc 2000;75: 1243–8.
ACOG Technical Bulletin: Trauma in pregnancy. 1991a;161: 1.
Weiss, H, Songer, T, Fabio, A. Fetal deaths related to maternal injury. JAMA 2001;286(15):1863–8.CrossRefGoogle ScholarPubMed
Crosby, WM, Costiloe, JP. Safety of lap-belt restraint for pregnant victims of automobile collisions. N Engl J Med 1971;284: 632–6.CrossRefGoogle ScholarPubMed
Wolf, ME, Alexander, BH, Rivera, FP, Hickok, , Marier, RV, Starzyk, PM. A retrospective cohort study of seatbelt use and pregnancy outcome after a motor vehicle crash. J Trauma 1993;34: 116–9.CrossRefGoogle ScholarPubMed
Hyde, LK, Cook, LJ, Olson, LM, Weiss, HB, Dean, JM. Effect of motor vehicle crashes on adverse fetal outcome. Obstet Gynecol 2003;102: 279–86.Google Scholar
Beck, LF, Gilbert, BC, Shults, RA. Prevalence of seat belt use among reproductive-aged women and prenatal counseling to wear seat belts. Am J Obstet Gynecol 2005;192: 580–5.CrossRefGoogle ScholarPubMed
Kettel, LM, Branch, DW, Scott, JR. Occult placental abruption after maternal trauma. Obstet Gynecol 1988;223: 481–8.Google Scholar
Ikossi, DG, Lazar, AA, Morabito, D, Fildes, J, Knudson, MM. Profile of mothers at risk: An analysis of injury and pregnancy loss in 1,195 trauma patients. J Am Coll Surg 2005;200(1):49–56.CrossRefGoogle ScholarPubMed
Pearlman, MD, Tintinelli, JE, Lorenz, RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162: 1502–10.CrossRefGoogle ScholarPubMed
Pearlman, M. Management of trauma during pregnancy. The Female Patient 1996;21: 79–98.Google Scholar
Poole, GV, Martin, JN, Perry, KG, et al. Trauma in pregnancy: Role of interpersonal violence. Am J Obstet Gynecol 1996;174: 1873–5.CrossRefGoogle ScholarPubMed
Amy, B, McManus, W, Goodwin, C, et al. Thermal injury in the pregnant patient. Surg Gynecol Obstet 1985;161: 209–12.Google ScholarPubMed
Lavery, J. Staten-McCormik, M. Management of moderate to severe trauma in pregnancy. Obstet Gynecol Clin N Am 1995; 22(1):69–90.Google ScholarPubMed
Polko, L, McMohan, M. Burns in pregnancy. Obstet Gynecol Surv 1997;53(1):50–6.CrossRefGoogle Scholar
Schmitz, J. Pregnant patients with burns. Am J Obstet Gynecol 1971;110: 57.CrossRefGoogle ScholarPubMed
Kuhlmann, R, Cruikshank, D. Maternal trauma during pregnancy. Clin Obstet Gynecol 1994;37(2):274–93.CrossRefGoogle ScholarPubMed
Longo, LD, Hill, EP. Carbon monoxide uptake and elimination in fetal and maternal sheep. Am J Physiol 1997;232(3): H324–30.Google Scholar
Longo, LD. Carbon monoxide in the pregnant mother and fetus and its exchange across the placenta. Ann N Y Acad Sci 1970;174(1):312–41.CrossRefGoogle ScholarPubMed
Caravati, EM, Adams, CJ, Joyce, SM, et al. Fetal toxicity associated with maternal carbon monoxide poisoning. Ann Emerg Med 1988;17(7):714–7.CrossRefGoogle ScholarPubMed
Cramer, CR. Fetal death due to accidental carbon monoxide poisoning. J Toxicol Clin Toxicol 1982;19(3):297–301.CrossRefGoogle Scholar
Clark, SL, Cotton, DB, Privarnik, JM, et al. Positional changes and central hemodynamic profile during normal third trimester pregnancy and post partum. Am J Obstet Gynecol 1991;164: 883–7.CrossRefGoogle Scholar
Connoly, AM, Katz, VL, et al. Trauma in pregnancy. Am J Perinatol 1997;14: 331–6.CrossRefGoogle Scholar
National Safety Council. Accidents facts. Nail Safety Counc Bull Chicago 1997.
Pak, LL, Reece, EA, Chen, L. Is adverse pregnancy outcome predictable after blunt abdominal trauma?Am J Obstet Gynecol 1998;179: 1140–4.CrossRefGoogle ScholarPubMed
Knudson MM, Rozycki GS, Pacquin MM. Reproductive system trauma. In Moore, EE, Feliciano, DV, Mattox, KL, ed. Trauma, 5th edition. New York: McGraw-Hill, 2004, p 851.Google Scholar
Davis, BH, Olsen, S, Bigelow, NC, et al. Detection of fetal red cells in fetomaternal hemorrhage using a fetal hemoglobin monoclonal antibody by flow cytometry. Transfusion 1998;38: 749–56.CrossRefGoogle ScholarPubMed
Holland, JG, Hume, AS, Martin, JN Jr.Drug use and physical trauma: Risk factors for preterm delivery. J Miss State Med Assoc 1997;38: 301–5.Google ScholarPubMed
Huzel, PS, Remsberurg-Bell, EA. Fetal complication related to minor maternal trauma. J Obstet Gynecol Neonatal Nurs 1996;25: 121–4.Google Scholar
Goodwin, H, Holmes, J, Wisner, D. Abdominal ultrasound examination in pregnant blunt trauma patients. J Trauma ICC 2001; 50(4):689–94.CrossRefGoogle ScholarPubMed
Ingeman, J, Plewa, M, Okasinski, R, et al. Emergency physician use of ultrasonography in blunt abdominal trauma. Acad Emerg Med 1996;3(10):931–7.CrossRefGoogle ScholarPubMed
Ma, O, Mateer, J, DeBehnke, D. Use of ultrasonography for the evaluation of pregnant trauma patients. J Trauma ICC 1996; 40(4):665–8.Google ScholarPubMed
Rothenberger, D, Quattlebaum, F, Zabel, J, et al. Diagnostic peritoneal lavage for blunt trauma in pregnant women. Am J Obstet Gynecol 1977;129(5):479–81.CrossRefGoogle ScholarPubMed
Ma, O, Mateer, J, Ogata, M, et al. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma ICC 1995;38(6):879–85.Google ScholarPubMed
Lazebnik, N, Laebnik, RS. The role of ultrasound in pregnancy related emergencies. Radiol Clin N Am 2004;42: 315–27.CrossRefGoogle ScholarPubMed
Eliot G, Rao D: Pregnancy and radiographic examination. In: Trauma and Pregnancy. Haycock, CE (Ed). PSG Publishing, p 69. Littleton, MA. 1985Google Scholar
Selden, BS, Burke, TJ. Complete maternal and fetal recovery after prolonged cardiac arrest. Ann Emerg Med 1988;17: 346–9.CrossRefGoogle ScholarPubMed
Runnebaum, IB, Holeberg, G, Katz, M. Pregnancy outcome after repeated blunt abdominal trauma. Eur J Obstet Gynecol Reprod Biol 1998;80: 85–6.CrossRefGoogle ScholarPubMed
Drost, TF, Rosemurgy, AS, Sherman, HF, et al. Major trauma in pregnant women: Maternal/fetal outcome. J Trauma 1990;30: 574–8.CrossRefGoogle ScholarPubMed
Knupple, RA, Drucker, JE. High Risk Pregnancy: A Team Approach, 2nd edition. Philadelphia: WB Saunders, 1993, p 241.Google Scholar
Ducey, JP, Knape, KG. Maternal esmolol administration resulting in fetal distress and cesarean section in a term pregnancy. Anesthesiology 1992;77(4):829–32.CrossRefGoogle Scholar
Karsli, B, Kaya, T, Cetin, A. Effects of intravenous anesthetic agents on pregnant myometrium. Pol J Pharmacol 1999;51(6): 505–10.Google ScholarPubMed
Carnini, A, Eckenhoff, MF, Eckenhoff, RG. Interactions of volatile anesthetics with neurodegenerative-disease-associated proteins. Anesth Clin N Am 2006;24: 381–405.CrossRefGoogle ScholarPubMed
Ostheimer, GW. Manual of Obstetric Anesthesia. New York: Churchill and Livingstone, 1992, 147 pp.Google Scholar
Murphy N, Reed S. Maternal resuscitation and trauma. In Damos, JR, Eisinger, SH, ed. Advanced Life Support in Obstetrics (ALSO) Provider Course Syllabus. Leawood, KS: American Academy of Family Physicians, 2000, pp 1–25.Google Scholar
Tweddale, CJ. Trauma during pregnancy. Crit Care Nurs Q 2006;29(1):53–67.CrossRefGoogle ScholarPubMed
Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 1992;268: 2199–241.
Katz, V, Dotters, D, Droegemueller, W: Perimortum cesarean delivery. Obstet Gynecol 1986;68: 571–6.Google Scholar
Oats, S, Williams, GL, Rees, GA. Cardiopulmonary resuscitation in late pregnancy. BMJ 1988;297: 404–5.CrossRefGoogle Scholar
Lindsay, SL, Hanson, GC. Cardiac arrest in near term pregnancy. Anesthesia 1987;42: 1074–7.CrossRefGoogle ScholarPubMed
Connor, O' RL, Sevarino, FB. Cardiopulmonary arrest in the pregnant patient: A report of a successful resuscitation. J Clin Anesth 1994;6: 66–8.CrossRefGoogle Scholar
DePase, NL, Betesh, JS, Kotler, MN. Postmortem cesarean section with recovery of both mother and offspring. JAMA 1982; 248: 971–3.CrossRefGoogle Scholar
Lee, R, Rodgers, B, White, L, Harvey, R. Cardiopulmonary resuscitation of pregnant women. Am J Med 1986;81: 311–8.CrossRefGoogle ScholarPubMed
Zakowski, MI, Ramanathan, S. CPR in pregnancy. Curr Rev Clin Anesth 1989;10: 106–11.Google Scholar
Mallampalli, A, Powner, DJ, Gardner, MO. Cardiopulmonary resuscitation and somatic support of the pregnant patient. Crit Care Clin 2004;20: 747–61.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Trauma in Pregnancy
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.029
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Trauma in Pregnancy
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.029
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Trauma in Pregnancy
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.029
Available formats
×