Changes affecting the initial evaluation and care of the pregnant trauma victim

Pregnant women in American society today are at significant risk of injury during a period when physiologic responses to trauma, as well as expected findings of physical examination and laboratory evaluation are altered by the on-going pregnancy. Changes in anatomy, hemodynamics, respiratory function, gastrointestinal function, and hematologic and hemostatic parameters impact upon the approach to the evaluation and management of injured pregnant women. Maternal outcome is dependent on the nature and extent of injury and on the delivery of appropriate care. Fetal outcome relates to the magnitude of direct injury and the maternal physiologic response. It is imperative that all physicians involved in clinical evaluation and management of injured pregnant women understand the changes engendered by pregnancy and their effects upon the mother, the fetus, and the decision-making process. The best way to secure a favorable outcome for both mother and fetus is a standardized planned approach to care provided by a team cognizant of these changes.