Pregnancy Trauma (Injury while Pregnant)

What is Pregnancy Trauma (Injury while Pregnant)?

Injuries during pregnancy can range from minor ones (like a fall from standing height or bumping the belly into an open drawer) to severe ones (such as injuries from a car accident). Over the past 25 years, injuries in pregnancy have become the top non-medical cause of death among expecting mothers in the United States. If a pregnant woman experiences a major injury, there’s a 40% to 50% chance of the baby not surviving. Even minor injuries during the first or second trimester can lead to a premature birth or a child with a low birth weight.

Even though these situations are not common, emergency doctors, trauma surgeons, and obstetricians and gynecologists need to be ready to handle complications linked to injuries during pregnancy. With a good understanding of how a woman’s body works during pregnancy and how injuries can affect it, doctors can provide better care to pregnant trauma victims. This can help reduce harm and deaths.

What Causes Pregnancy Trauma (Injury while Pregnant)?

There are many reasons why pregnant women may suffer injuries. The growing belly can make them lose balance, so they might fall more often, even from low places like standing position or from steps. It’s also important to remember that not all injuries are total accidents; they could be self-inflicted or caused by others. An alarming fact is that domestic violence becomes more common during pregnancy, putting both the mother and her baby in danger. About 4% to 8% of pregnant women experience domestic violence, and this can lead to a 5% risk of the baby dying before birth.

What makes things even more complex is that the normal bodily changes that occur in pregnant women can make it harder for doctors to evaluate and treat injuries. The uterus, where the baby grows, can be especially vulnerable to injuries from sharp or blunt objects. For instance, car accidents are responsible for half of all injuries in pregnant women and 82% of injuries that lead to the baby dying before birth. One reason for this is that seat belts aren’t always used properly. The belt that goes across the lap should be positioned under the belly and across the hips to avoid putting pressure on the uterus in case of a collision. The shoulder belt should be worn across the collarbone and between the breasts.

Risk Factors and Frequency for Pregnancy Trauma (Injury while Pregnant)

Trauma, or injury, happens to about 8% of pregnant individuals. It can bring a serious risk to the life of both the mother and the unborn baby. A quick assessment and treatment are vital, as a maternal shock can lead to a tragic outcome for the baby in 80% of the cases. The pelvic fracture, or a break in the bone of the hip area, is the top cause of injuries leading to the death of the unborn baby. Nearly one-third of unborn babies (35%) do not survive when their mother has a pelvic fracture.

Death can occur due to a direct injury to the baby (20%), placental abruption – a condition when the placenta starts to come away from the inner wall of the womb (32%), or maternal shock (36%).
The physiology in pregnancy introduces some changes in the mother’s body, which makes the blood vessels more stretchable. Any fracture in the pelvic area could lead to a lot of blood loss, and can end fatally in up to 9% of these mothers.
Blunt trauma to the abdomen can cause severe injuries such as placental abruption and the rupturing of the womb. Abruption occurs in 1 to 6% of minor injuries and up to half of all major injuries.
Rupture of the womb occurs rarely, in less than 1% of pregnancy-related trauma cases. It’s most often caused by a hard blunt force to a womb that already had a scar from a previous event.
In comparison, penetrating injuries usually have a more positive outlook for the mother than blunt trauma. This is because the unborn baby absorbs a lot of the impact, protecting the internal organs of the mother. However, this leads to a higher mortality rate in unborn babies from such injury, which could be as high as 73%.

Signs and Symptoms of Pregnancy Trauma (Injury while Pregnant)

Assessing a pregnant patient who has been through trauma follows a certain guideline. This begins with a set of surveys and careful monitoring of the patient’s vital signs, keeping in mind how these can change during a normal pregnancy. The woman should be asked about the possibility of being pregnant, and tests should be done to confirm this, except if she states that pregnancy is not possible. Any history of preterm labor, placental complications should also be noted, and a specialist consultation is recommended, especially if the woman is in her second or third trimester.

If it’s necessary to administer rapid sequence intubation, lower doses of specific medications are required because of changes that happen in the body during pregnancy. It’s crucial to avoid low blood pressure and provide extra oxygen because the unborn baby is very sensitive to lack of oxygen.

A clinical assessment can show signs of potential harm to the uterus or baby. Some alarming signs include:

Penetrating injury to the abdomen
Vaginal bleeding
Ruptured amniotic sac
Bulging perineum (the area between the vagina and the anus)
Presence of contractions
Unusual fetal heart rate or rhythm

Vaginal bleeding before labor can indicate complications like placental issues, early labor, or early dilation of the cervix. Cloudy, white, or green discharge can suggest that the amniotic sac has ruptured, increasing the risk of infection or umbilical cord prolapse, which is an immediate medical emergency requiring a c-section. This calls for a detailed pelvic examination if the woman’s condition allows it.

Furthermore, the abdomen should be examined to measure the height of the uterus. This measurement can give an estimate of the gestational age, particularly when the patient can’t communicate. From 8 to 12 weeks, the uterus grows and begins to move into the abdominal cavity. By 20 weeks, it’s around the belly button level, growing approximately the width of a finger until 40 weeks. By 36 weeks, it reaches the breastbone level and then lowers as the baby’s head descends into the pelvic region. If there’s a mismatch between the measured size of the uterus and the estimated gestational age, this can point to a concern such as previous uterine trauma, multiple pregnancies, or stunted growth of the baby in the womb.

Testing for Pregnancy Trauma (Injury while Pregnant)

If a pregnant woman is in a traumatic incident, it is essential to maintain standard protocols to assess her status and the health of her unborn child. One of the main methods to check the baby’s condition is by listening to the fetal heart sounds using a stethoscope or Doppler device. The baby’s heart can be heard as early as 12 weeks into the pregnancy, usually beating between 110 and 160 times per minute. Changes in the heart rate, like a sustainably slower rate below 120 beats per minute, could signal the baby is in distress, suggesting potential blood loss from the mother. It is common practice to monitor the baby’s heartbeat in women who are 24 weeks pregnant or further along, usually for a period of 4 to 6 hours initially.

Additionally, imaging techniques like X-ray or CT scans can help doctors diagnose any potential problems or injuries after a traumatic event. While there is a risk of radiation from these tests affecting the baby, it is essential to note that failing to diagnose and treat the mother’s injuries poses a more significant risk. The effects of radiation on an unborn child would depend on the stage of their development and how much radiation they are exposed to. More radiation can potentially disrupt their growth or cause other issues, especially when the exposure is early in the pregnancy. However, when done correctly, these scans should not exceed the accepted levels of radiation exposure during pregnancy.

The American College of Obstetricians and Gynecologists advises that a single diagnostic procedure involving X-rays does not result in harmful effects to the baby if radiation exposure is less than 5 rads. Furthermore, concerns about radiation should not prevent necessary diagnostic procedures from being carried out. Alternatives with no radiation – such as ultrasounds and MRI scans – should be considered when suitable during pregnancy. It’s worth noting that these methods are not associated with any known adverse effects on the fetus.

Specialists can help determine the fetus’s estimated radiation dose when multiple diagnostic X-rays are needed. Usage of radioactive iodine isotopes is not highly recommended during pregnancy. Even though contrast agents used in scans are unlikely to cause harm, their usage should be justified by the potential benefits to the pregnant woman.

In addition to X-rays and CT scans, other imaging methods like ultrasound or MRI scans could also be useful. Ultrasound scans can quickly identify indications of traumatic conditions and are generally helpful during trauma assessments. MRI scans provide specific results without radiation exposure; however, these scans might not be practical in emergency situations owing to their limited availability and longer duration.

Treatment Options for Pregnancy Trauma (Injury while Pregnant)

The same trauma treatment principles apply whether an individual is pregnant or not. The mother’s wellbeing is crucial, and when she is properly cared for, the fetus is as well. Checking whether a woman is pregnant is very important, especially for the women between 10 and 55 years of age. Moving pregnant patients to a specialized trauma care hospital can greatly improve the mother and baby’s health after being injured.

If a patient is pregnant, she might need to lie on her side with support behind her back to alleviate a condition called aortocaval compression syndrome, which can restrict blood flow. This position helps to increase the flow of blood from the body back to the heart.

Finding out the patient’s Rh blood type is important too. If the mother’s Rh type is negative, she might need a medication called Rh Immunoglobulin to prevent any future pregnancies from being compromised. The amount needed depends on her pregnancy stage and how severe her abdominal injury is.

If the patient’s blood pressure drops, immediate action is needed. This is because the mother’s body will reduce the blood flow to the fetus in times of shock. Fluid replacement and keeping the patient’s blood pressure under control are crucial. Existing treatment protocols should be followed while considering the potential impacts on the fetus.

About a quarter of trauma patients with viable fetuses might go into preterm labor, and nearly 40% might experience contractions. Issues that warrant an immediate cesarean section include non-reassuring fetal heart tones, alarming signs for placental abruption, severe pelvic or spine fractures, premature labor with fetal malposition, and a pregnant uterus that prevents trauma exposure during an abdominal operation. The cesarean section should be carried out as normally as possible, taking extra care with the uterus to prevent any vascular complications.

It’s safe to give the tetanus shot during pregnancy, and standard antibiotics can be used. However, certain antibiotics should be avoided due to their potential harm to the fetus. Blood thinning medications can be used safely as they can’t cross the placenta. After a mother’s death, if the fetus is at least 25 weeks old and can be delivered within 15 minutes, a cesarean section can be performed, and immediate neonatal support should be provided.

Here are some medical scenarios and procedures that necessitate quick attention:

Abdominal injury caused by a sudden, forceful hit
Emergency management of a condition where the placenta prematurely separates from the uterus during pregnancy, called abruptio placentae
Abdominal injury due to a sharp, penetrating object

These conditions are serious and require prompt medical intervention to prevent complications or save lives.

Possible Complications When Diagnosed with Pregnancy Trauma (Injury while Pregnant)

Here are some potential complications that can happen:

Exsanguination (severe loss of blood)
Uterine rupture (tearing of the uterus)
Retroperitoneal hemorrhage (bleeding in the space at the back of the abdomen)
Rupture of amniotic membrane (breaking of the bag of water)
Amniotic fluid embolism (a rare childbirth emergency where amniotic fluid or other debris enters the mother’s blood stream)
Placental abruption (when the placenta separates from the inner wall of the womb before birth)

Frequently asked questions

Pregnancy trauma refers to injuries that occur during pregnancy, ranging from minor incidents to severe accidents. Injuries during pregnancy have become the leading non-medical cause of death among expecting mothers in the United States. Even minor injuries can have serious consequences, such as premature birth or low birth weight.

Pregnancy trauma (injury while pregnant) happens to about 8% of pregnant individuals.

Signs and symptoms of pregnancy trauma (injury while pregnant) include: - Penetrating injury to the abdomen - Vaginal bleeding - Ruptured amniotic sac - Bulging perineum (the area between the vagina and the anus) - Presence of contractions - Unusual fetal heart rate or rhythm These signs and symptoms indicate potential harm to the uterus or baby and should be taken seriously. Vaginal bleeding before labor can suggest complications such as placental issues, early labor, or early dilation of the cervix. Cloudy, white, or green discharge may indicate a ruptured amniotic sac, which increases the risk of infection or umbilical cord prolapse. In such cases, immediate medical attention, including a c-section, may be necessary. Additionally, a mismatch between the measured size of the uterus and the estimated gestational age could indicate concerns such as previous uterine trauma, multiple pregnancies, or stunted growth of the baby in the womb.

Pregnancy trauma or injury can occur due to various reasons such as falls, domestic violence, car accidents, and blunt or penetrating force to the abdomen.

The doctor needs to rule out the following conditions when diagnosing Pregnancy Trauma (Injury while Pregnant): 1. Injury to the abdomen due to a blunt force 2. Urgent treatment of the premature separation of the placenta from the uterus 3. Injury to the abdomen due to a puncture or sharp impact

The types of tests that may be needed for pregnancy trauma (injury while pregnant) include: 1. Listening for the baby's heartbeat using a stethoscope or a Doppler device. 2. Toconometry, which is a method to assess the baby's welfare and detect signs of distress. 3. Radiographic imaging, such as X-rays or CT scans, to evaluate potential injuries. However, the use of radiation should be minimized and the dosage should be carefully considered. 4. Ultrasound and magnetic resonance imaging (MRI) can also provide more information without the use of ionizing radiation. 5. Blood tests to assess the mother's blood type and determine if Rh Immunoglobulin is needed. 6. Other tests may be ordered based on the specific circumstances and potential injuries, such as tests to evaluate blood pressure, blood loss, or clotting disorders.

Pregnancy trauma, or injury while pregnant, is treated by following the principles of Advanced Trauma Life Support (ATLS) guidelines. These guidelines apply to both non-pregnant and full-term pregnant patients. The first step is to properly treat the mother, as early treatment of the unborn child starts with treating the mother. Pregnant patients should undergo tests to determine if they are pregnant, and injured pregnant patients should be moved to a trauma center that provides specialized prenatal care. Avoiding or relieving aortocaval compression syndrome, which impacts blood flow, is crucial. Stabilizing the mother is key, and immediate action is necessary if she shows signs of low blood pressure. Special care should be taken when inserting tubes or intravenous lines, and decisions to perform abdominal surgery should follow the same guidelines as for non-pregnant trauma victims. Regular obstetric care should be given in cases of preterm labor or contractions. In some cases, immediate cesarean section may be warranted due to complications or potential injuries during surgery. Some medications can be safely administered during pregnancy, while others should be avoided.

The potential complications that can occur when treating pregnancy trauma (injury while pregnant) include: - Exsanguination (severe loss of blood) - Uterine rupture (tearing of the uterus) - Retroperitoneal hemorrhage (bleeding in the space at the back of the abdomen) - Rupture of amniotic membrane (breaking of the bag of water) - Amniotic fluid embolism (a rare childbirth emergency where amniotic fluid or other debris enters the mother's bloodstream) - Placental abruption (when the placenta separates from the inner wall of the womb before birth)

The prognosis for pregnancy trauma (injury while pregnant) can vary depending on the severity of the injury. Here are some key points: - Major injuries during pregnancy have a 40% to 50% chance of the baby not surviving. - Minor injuries during the first or second trimester can lead to a premature birth or a child with a low birth weight. - Death can occur due to direct injury to the baby, placental abruption, or maternal shock.

Emergency doctors, trauma surgeons, and obstetricians and gynecologists.