Management of Trauma in Pregnancy: A Practical Approach to Evidence Based Care

Document Type : Review Article

Authors

1 Instructor, Department of Midwifery, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

2 Professor, Department of Obstetrics and Gynecology, Ovulation Disorders Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant Professor, Department of Emergency Medicine, 9-Day Hospital, School of Medicine, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran

4 College Student of Medical Emergency, School of Paramedicine, Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

Abstract

Introduction: Trauma averagely affects one per 12 pregnancies and is a major non-obstetric cause of mortality among pregnant women, as well as fetal outcomes. Considering the change in therapeutic approaches base on several studies on the management of trauma in pregnancy, it is necessary to update the provided care. Therefore, this review study was performed with aim to collect the optimal care for pregnant patients with trauma using an evidence-based approach based on the most updated articles and guidelines.
Methods: In this review study, all articles and guidelines were searched without time limitation in databases such as Irandoc, Magiran, Scopus, Up-to-date, Science direct, Google Scholar, PubMed, Web of science, Cochrane Library, CINAHL, and Medline using the keywords such as “Trauma” and “pregnancy” and their Persian equivalents by two researchers. After searching, the content of all available articles and guidelines was evaluated to find the most relevant evidence.
Results: Based on the results of the reviewed studies and guidelines, assessment and management of traumatized pregnant women requires a coordinated approach from a team of professionals. Furthermore, in all reviewed articles, the primary objective of treating victims of trauma in pregnancy was to stabilize the mother's condition and then evaluation of the fetus condition. Primary care of pregnant women similar to that of non-pregnant women is based on the principles of Advanced Cardiac Life Sup­port (ACLS). Some of the unique aspects of this procedure include early intubation, resuscitation in the left lateral decubitus position or with manual displacement of uterus, and performing perimortem cesarean section. Routine screening of women for domestic violence, recommending the correct use of a seat belt and not turning off the airbag while driving are from the important strategies to reduce the traumatic effects in pregnancy.
Conclusion: According to the evidence, management of trauma in pregnancy should be done as a team and with regard to specific aspects and changes of this period. The use of strategies to prevent trauma also have a significant role in reducing the effects of this complication in pregnancy.

Keywords

References

  1. Lucia A, Dantoni SE. Trauma management of the pregnant patient. Crit Care Clin 2016; 32(1):109-17.
  2. Desjardins G. Management of the injured pregnant patient. Florida: Related Resuscitation University of Miami; 2012.
  3. Murphy NJ, Quinlan JD. Trauma in pregnancy: assessment, management, and prevention. Am Fam Physician 2014; 90(10):717-22.
  4. Trauma during pregnancy. ACOG technical bulletin number 161-November 1991. Int J Gynecol Obstet 1993; 40(2):165-70.
  5. Huls CK, Detlefs C. Trauma in pregnancy. Semin Perinatol 2018; 42(1):13-20.
  6. Rudloff U. Trauma in pregnancy. Arch Gynecol Obstet 2007; 276(2):101-17.
  7. Rothenberger D, Quattlebaum FW, Perry Jr JF, Zabel J, Fischer RP. Blunt maternal trauma: a review of 103 cases. J Trauma 1978; 18(3):173-9.
  8. Goldman SM, Wagner LK. Radiologic management of abdominal trauma in pregnancy. AJR Am J Roentgenol 1996; 166(4):763-7.
  9. Hill D, Lense J. Abdominal trauma in the pregnant patient. Am Fam Physician 1996; 53(4):1269-74.
  10. Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol 2013; 209(1):1-10.
  11. Kilpatrick SJ, Manaker S, Moreira ME. Initial evaluation and management of pregnant women with major trauma. New York: UpToDate, Inc; 2016.
  12. Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the management of a pregnant trauma patient. J Obste Gynaecol Can 2015; 37(6):553-74.
  13. Queensland Clinical Guideline. Trauma in pregnancy. Brisbane, Australia: Maternity and Neonatal Clinical Guideline; 2014. P. 1-31.
  14. Bochicchio GV, Napolitano LM, Haan J, Champion H, Scalea T. Incidental pregnancy in trauma patients. Obstetrical & gynecological survey. J Am Coll Surg 2001; 192(5):566-9.
  15. Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, et al. Part 12: cardiac arrest in special situations. Circulation 2010; 122(18 suppl 3):S829-61.
  16. Barraco RD, Chiu WC, Clancy TV, Como JJ, Ebert JB, Hess LW, et al. Practice management guidelines for the diagnosis and management of injury in the pregnant patient: the EAST Practice Management Guidelines Work Group. J Trauma 2010; 69(1):211-4.
  17. Pearlman MD, Viano D. Automobile crash simulation with the first pregnant crash test dummy. Am J Obstet Gynecol 1996; 175(4):977-81.
  18. Moise KJ, Belfort MA. Damage control for the obstetric patient. Surg Clin North Am 1997; 77(4):835-52.
  19. Ministry of Health and Medical Education. National guidelines for obstetric and perinatal care. 3rd ed. Tehran: Ministry of Health and Medical Education; 2017.
  20. Torkestani F, Abedini MD, Radpuyan L, Rahimi Qasabeh S, Hadipour Jahromi L, Bakhshandeh M, et al. Country guide for midwifery and maternal services. 4th ed. Tehran: The Ministry of Health and Medical Education; 2017.
  21. Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol 1990; 162(6):1502-7.
  22. Shah AJ, Kilcline BA. Trauma in pregnancy. Emerg Med Clin North Am 2003; 21(3):615-29.
  23. American College of Surgeons. Committee on Trauma. Subcommittee on advanced trauma life support: ATLS student course manual. 9th ed. Chicago: American College of Surgeons; 2012.
  24. Dahmus MA, Sibai BM. Blunt abdominal trauma: are there any predictive factors for abruptio placentae or maternal-fetal distress? Am J Obstet Gynecol 1993; 169(4):1054-9.
  25. Lipitz S, Achiron R, Horoshovski D, Rotstein Z, Sherman D, Schiff E. Fetomaternal haemorrhage discovered after trauma and treated by fetal intravascular transfusion. Eur J Obstet Gynecol Reprod Biol 1997; 71(1):21-2.
  26. Pearlman M, Tintinalli J. Evaluation and treatment of the gravida and fetus following trauma during pregnancy. Obstet Gynecol Clin North Am 1991; 18(2):371-81.
  27. Maghsoudi H, Samnia R, Garadaghi A, Kianvar H. Burns in pregnancy. Burns 2006; 32(2):246-50.
  28. Parikh P, Sunesara I, Lutz E, Kolb J, Sawardecker S, Martin Jr JN. Burns during pregnancy: implications for maternal-perinatal providers and guidelines for practice. Obstet Gynecol Surv 2015; 70(10):633-43.
  29. Sure M. Trauma during pregnancy. Obstet Gynecol 2004; 40:24-8.
  30. Gilles MT, Blair E, Watson L, Badawi N, Alessandri L, Dawes V, et al. Trauma in pregnancy and cerebral palsy: is there a link? Med J Aust 1996; 164(8):500-1.
  31. Leggon RE, Wood GC, Indeck MC. Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes. J Trauma 2002; 53(4):796-804.
  32. Mcgoldrick NP, Green C, Burke N, Quinlan C, Mccormack D. Pregnancy and the orthopaedic patient. Orthopaed Trauma 2012; 26(3):212-9.
  33. Baumgartner R, Libuit K, Ren D, Bakr O, Singh N, Kandemir U, et al. Reduction of radiation exposure from C-arm fluoroscopy during orthopaedic trauma operations with introduction of real-time dosimetry. J Orthop Trauma 2016; 30(2):e53-8.
  34. Giordano BD, Baumhauer JF, Morgan TL, Rechtine GR 2nd. Patient and surgeon radiation exposure: comparison of standard and mini-C-arm fluoroscopy. J Bone Joint Surg Am 2009; 91(2):297-304.
  35. American College of Obstetricians Gynecologists' Committeeon Obstetric Practice. Committee Opinion No. 656: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol 2016; 127(2):e75-80.
  36. Vallier HA, Cureton BA, Schubeck D. Pregnancy outcomes after pelvic ring injury. J Orthop Trauma 2012; 26(5):302-7.
  37. Crosby WM, Costiloe JP. Safety of lap-belt restraint for pregnant victims of automobile collisions. N Engl J Med 1971; 284(12):632-6.
  38. American College of Obstetricians and Gynecologists. Car safety for you and your baby. New York: ACOG Education Pamphlet AP018; 2009.
  39. Golmakani N, Azmoude E. Domestic violence in pregnancy, outcomes and strategies: a review article. Iran J Obstet Gynecol Infertil 2013; 15(42):13-22. (Persian).

The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 21, Issue 9
November 2018
Pages 101-117

Files

Share

How to cite

Statistics