Screening helical CT for evaluation of blunt traumatic injury in the pregnant patient

Pregnant patients who sustain severe blunt trauma are infrequently encountered in most practices. However, detection of internal injuries including those to the gravid uterus is essential since maternal disability or fetal loss are physical and psychologic catastrophes that have long-term effects on the mother and her family. Computed tomography (CT) is commonly used to detect blunt traumatic injuries and can play an important role in the screening of the injured pregnant woman. The normal gravid uterus and physiologic changes of pregnancy can confound CT interpretation. Inhomogeneous enhancement of placental cotyledons, hydronephrosis, and enlarged ovarian veins are normal findings. Avascular regions in the placenta indicate infarction or abruption with impending fetal demise. Although CT can demonstrate uterine rupture and retroperitoneal hemorrhage, direct detection of fetal injuries is rare. Fetal demise is more common when maternal injuries include trauma to the uterus. Although screening ultrasonography can depict fetal distress, use of screening CT allows a concurrent evaluation of multiple areas in the pregnant trauma patient including the uterus. CT is a useful diagnostic tool in the triage of the critically injured pregnant woman.