Skip to Main Content

Trauma remains the leading cause of nonobstetric morbidity and mortality in pregnant women.1 The severity of maternal injuries may be a poor predictor of fetal distress and outcome after a traumatic event (even minor ones). Trauma during pregnancy is associated with an increased risk of preterm labor, placental abruption, fetomaternal hemorrhage, and pregnancy loss. Achieving successful outcomes for both mother and fetus requires a collaborative effort by the prehospital provider, emergency physician, trauma surgeon, obstetrician, and neonatologist.

Trauma during pregnancy is common. One study estimated that 32,810 pregnant women sustain injuries in motor vehicle crashes every year in the United States, a rate of 9 per 1000 live births.2 Motor vehicle crashes are the most common cause of blunt abdominal trauma, accounting for up to 70% of acute injuries. This is followed by falls and direct assault in decreasing order of frequency.3 The incidence of falls appears to increase with the advancement of pregnancy, presumably due to alterations in maternal balance and coordination. Penetrating injuries are less common than blunt trauma during pregnancy.

Physiologic changes in pregnancy are discussed in detail in the chapter titled "Resuscitation in Pregnancy." In addition to normal physiologic changes, conditions such as pregnancy-induced hypertension, placenta previa, pre-eclampsia, and eclampsia may significantly alter the presentation and complicate evaluation and treatment in the setting of trauma (see the chapter titled "Emergencies after 20 Weeks of Pregnancy and the Postpartum Period").

Table 1 in the "Resuscitation in Pregnancy" chapter summarizes important physiologic changes in pregnancy that affect resuscitation. Maternal blood volume expands at approximately week 10 of gestation and peaks at about a 45% increase from baseline at week 28. Because plasma volume increases more than red cell mass, mild physiologic anemia may be evident. Cardiac output increases by 1.0 to 1.5 L/min at week 10 of pregnancy and remains elevated until the end of pregnancy. Heart rate in the mother is generally increased by 10 to 20 beats/min in the second trimester, accompanied by decreases in systolic and diastolic blood pressures of 10 to 15 mm Hg.

Table 1 Checklist for Trauma in Pregnancy

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.