Midwifery triage and management of trauma and second/third trimester bleeding

Trauma affects approximately 8% of all pregnancies, and bleeding affects nearly 5% of gestations. These two conditions are potentially life-threatening and require immediate management by the midwife. Trauma in pregnancy is commonly caused by motor vehicle accidents, falls, and assault. Although abruption resulting from trauma is a rare occurrence, injury caused by domestic violence, is associated with the greatest risk of obstetric complications. Bleeding in pregnancy has a number of etiologies. Midwives are well-prepared to safely and competently make a differential diagnosis of bleeding in the second and third trimesters. A sequence for midwifery triage of clients who present to the emergency room/triage area for trauma and bleeding is presented. Considerations for stabilization, history, physical examinations, diagnostic testing, initial management, and follow-up are described. Practical considerations for midwifery services incorporating provisions for triage into their caseloads are also provided.