Trauma in pregnancy

In the assessment and management of the pregnant trauma patient, all efforts should be directed toward stabilizing the mother first, according to Advanced Trauma Life Support protocols, with airway, breathing, and circulation being priorities. Subsequent to this, attention can be turned to evaluation of the fetus. Standard laboratory values must be seen in the context of changes in maternal physiology. Volume resuscitation generally is the mainstay of therapy for shock. Vasoactive drugs should be avoided, unless absolutely indicated, because of their propensity to cause shunting of blood away from the uterus. In assessing maternal injury, consideration has to be given to the variety of injuries that can occur to the uterus, including abruptio placentae and uterine rupture. Evaluation of the fetus requires a multidisciplinary approach, involving both obstetricians and pediatricians, along with the surgical team in an attempt to provide an optimal solution for management.