Trauma in the pregnant patient

Trauma is the leading overall cause of death in the age group under 40 years of age in the United States. Women of reproductive age are considered the population at greatest risk of trauma. A Medline search for recent articles highlighting anesthetic, obstetric and surgical considerations for pregnant trauma victims was performed, and current guidelines (recommendations) are discussed in this review article.

Trauma in pregnancy is currently a leading cause of non-pregnancy-related maternal death, and maternal death remains the most common cause of fetal demise. The most common etiologies of trauma in pregnancy include transportation accidents, falls, violent assaults, and burn injuries. Head and neck injuries and hemorrhagic shock account for most maternal deaths secondary to trauma.

Pregnancy must always be suspected in any female trauma patient of childbearing age. The pregnant trauma victim presents a unique spectrum of challenges to the healthcare team. Expeditious maternal resuscitation is the most effective method of fetal resuscitation. Adequate management of pregnant trauma victims requires the anesthesiologist to consider and understand the unique changes in anatomy and physiology that take place during pregnancy.