Laura Joyce 12th January 2016

Trauma in Pregnancy


There are TWO patients. Mum is priority - fetal survival depends on maternal well-being
Every pregnant woman over 18/40 is named Mrs Tilt - LEFT LATERAL POSITION avoids IVC compression
Phone a friend - early: call O+G, plus birthing suite for midwife+CTG machine


Trauma is the most common cause of maternal death - this includes motor vehicle accidents, along with suicide and homicide. The pregnant trauma patient presents a unique challenge because care must be provided for two patients — the mother and the fetus. Anatomic and physiologic changes in pregnancy can mask or mimic injury, making diagnosis of trauma-related problems difficult.

Care of pregnant trauma patients with severe injuries often requires a multidisciplinary approach involving the ED team, obstetrician, neonatologist and midwives.
Never be scared to phone a friend!

Assessment of the Pregnant Trauma Patient


  • Difficult airway
  • Oedematous airways tissues
  • Large boobs in the way
  • Increased aspiration risk
  • May need 0.5 - 1 size smaller ETT
  • Short handled laryngoscope, ramping
  • RSI, consider cricoid (if you believe in it), NGT


  • May be dyspnoeic lying flat
  • Decreased ability for respiratory compensation (increased tidal volume/decreased residual capacity)
  • Ventilation can be difficult (increased abdominal pressure)
  • Diaphragm elevated
  • Positioning - ramped
  • Apply high flow O2
  • Consider two person technique for BVM
  • Insert ICC higher: 3rd or 4th IC space


  • Supine position can compress IVC
  • Relative hypervolaemia (can lose 35% blood volume before becoming tachycardic/hypotensive)
  • Relative anaemia/tachycardia/hypotension
  • Increased cardiac output
  • Fetal HR is a 'C' assessment - use doppler/USS or CTG (Fetal shock can precede signs of maternal shock)

These all mean less reserve in case of major haemorrhage all mean less reserve in case of major haemorrhage

  • Left lateral tilt or manual uterine displacement
  • Large bore iv access + crossmatch
  • May need more fluid/blood than usual
  • Early signs of shock may be subtle: look closely
  • CTG more predictive than USS for abruption


  • Fundus at umbilicus = 20/40
  • Abdo pain/tenderness can indicate placental abruption or ruptured uterus
  • Look for PV blood loss (but leave the PV exam to the obstetric team)
  • Phone a friend. Now.