Trauma in pregnancy clinical practice guidelines: systematic review

Area of Science:

• Obstetrics and Gynecology
• Trauma Care
• Clinical Guidelines

Background:

• Clinical practice guidelines (CPGs) for managing trauma in pregnancy lack standardized methodologies and exhibit significant clinical heterogeneity.
• Objective evaluation of existing CPGs is crucial for improving patient care and outcomes.

Approach:

• A systematic review of CPGs for trauma in pregnancy was conducted using databases like PubMed, Google Scholar, UpToDate, and Scopus.
• The Appraisal Of Guidelines for Research and Evaluation (AGREE II) tool assessed methodological quality and risk of bias.
• Key management aspects evaluated included evidence assessment, recommendations, causes of trauma, seat belt use, diagnostic methods, physiological changes, survey approaches, fetal viability, imaging, fetal monitoring, RhD-immunoglobulin use, tetanus vaccination, and perimortem Cesarean section timing.

Key Points:

• Significant variability exists in CPGs regarding quality of evidence (16.7%), classification of recommendations (50%), fetal viability definitions (20-24 weeks), fetal monitoring duration, RhD-immunoglobulin administration (33.3%-50%), tetanus vaccination (33.3%), and perimortem Cesarean section timing (4-5 minutes).
• Motor vehicle crashes are consistently identified as the primary cause of trauma in pregnancy, yet seat belt importance is only mentioned in 50% of CPGs.
• The AGREE II assessment yielded a mean overall score of 69%, with only three CPGs exceeding 60%.

Conclusions:

• The current CPGs for trauma in pregnancy demonstrate considerable clinical heterogeneity across critical management areas.
• There is an urgent need for updated, consensus-driven guidelines from major medical societies to standardize the care of pregnant patients with trauma.