Trauma, most often from car crashes, falls and intimate partner violence, is a leading cause of non-obstetric death in pregnancy. The best care for the fetus is fast, standard resuscitation of the mother, adjusted for the changes of pregnancy.
Key symptoms
- Abdominal pain, contractions or back pain
- Vaginal bleeding or fluid leak
- Less fetal movement
- Injuries that do not match the story (possible violence)
What you find on exam
- Primary survey: airway, breathing, circulation
- Left uterine displacement or tilt after 20 weeks to prevent low blood pressure
- Abdomen: uterine tenderness, fundal height, seat belt marks
- Fetal heart rate; speculum exam for bleeding or fluid
Tests
- Continuous fetal monitoring for at least 4 hours after 20 weeks
- FAST ultrasound; do not withhold needed CT scans
- Blood count, type and screen, coagulation tests
- Kleihauer-Betke test in Rh-negative patients
Treatment basics
- Resuscitate the mother first: oxygen, IV fluids, blood
- Rh immune globulin if Rh negative
- Tetanus update and treatment of injuries
- Perimortem cesarean within 4 to 5 minutes of cardiac arrest if the uterus reaches the umbilicus
- Screen for intimate partner violence before discharge
Red flags
- Signs of placental abruption: pain, bleeding, tense uterus
- Abnormal fetal heart rate or frequent contractions
- Maternal shock or cardiac arrest
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.