Abdominal trauma during pregnancy

Abstract

In summary, trauma occurs relatively frequently among pregnant patients. Various anatomic and physiologic changes of pregnancy may alter the type of injury experienced by pregnant women. These changes may also alter the manifestations of given injuries and the treatment required to reestablish maternal-fetal hemostasis. Fortunately, most trauma experienced by pregnant individuals is minor and is associated with good prognosis for both the mother and her fetus. Blunt trauma as a result of automobile collision is the most frequent form of serious injury involving pregnant women. However, several cases of penetrating abdominal wounds have also been reported. Both blunt and penetrating trauma may frequently injure the uterus. Fetal intracranial injury and fracture, as well as abruption, often occur as a result of blunt trauma. Multiple direct fetal, placental, and cord injuries have been reported as a result of penetrating trauma. Both blunt and penetrating trauma frequently cause injury to other intraabdominal organs, and blunt trauma is associated with an especially high incidence of pelvic fracture and retroperitoneal hemorrhage. Laparotomy is often required to treat such injuries. At the time of the laparotomy, difficult decisions are required in determining whether the fetus is best delivered or left in utero. Recent technologic advances for assessing fetal status may be helpful in these decisions. Rarely, a mother may expire with her living fetus undelivered, and a rapid postmortem cesarean section may save the fetal life. During the last several years, the prognosis for both trauma victims and gravid women with complicated pregnancies and their fetuses has improved markedly. Hopefully, during the next several years, the knowledge and therapeutic modalities developed to treat each group will be combined to provide optimal care for the pregnant trauma victim and her fetus.