Pregnant trauma patients - NYSORA

Explore NYSORA knowledge base for free:

Pregnant trauma patients

Learning objectives

  • Discuss the potential for obstetric complications after trauma
  • Outline the complex management challenges of trauma during pregnancy

Definition and mechanisms

  • Trauma is the leading cause of nonobstetric mortality and affects 7% of all pregnancies
  • The most common traumatic injuries are motor vehicle crashes, assaults, falls, or partner violence
  • Major trauma has been associated with 7 percent of maternal and 80 percent of fetal mortality
  • Placental abruption is the most common cause of fetal death:
    • First trimester: the thick-walled uterus is protected from trauma by the pelvic girdle
    • Second trimester: the fetus is protected by relatively abundant amniotic fluid volume
    • Third trimester: the thin-walled uterus is exposed to blunt and penetrating abdominal trauma
  • Pregnant trauma patients should be approached and managed like any other trauma patient using a standard ABCD approach
  • Clinical decision-making is complicated by:
    • The needs of both mother and fetus must be considered
    • Anatomical and physiological changes in pregnancy can mask or mimic injury
    • Life-threatening obstetric complications can occur even after seemingly minor trauma and may require urgent delivery of the fetus
    • Fetal injury can predominate of that the mother
  • Establishing maternal stability may not be possible without obstetric intervention


Injury severity score

Physiological changes of pregnancy

Pulmonary system

↑ Tidal volume
The respiratory rate is unchanged
↑ Oxygen consumption
↑ Minute ventilation
↓ Arterial CO2 tension
↓ Thoracic compliance
Elevated diaphragm
Apply supplementary oxygen to avoid hypoxia
Consider desaturation
Bag mask ventilation may be difficult
Place chest drains higher (3rd or 4th intercostal space)
Airway↑ Airway edema
↑ Vascular engorgement
↑ Tissue friability
↑ Breast size and neck adiposity
↑ Aspiration risk
Difficult intubation
Consider cricoid pressure
insert early NGT
Cardiovascular system↑ Plasma volume (40-50%)
↑ Heart rate (15-25%)
↑ Cardiac output (50%)
↓ SVR (20%)
Increased blood volume may initially mask the shock
Supine hypotension due to IVC compression may reduce CO
Hematological changesHypercoagulability
↑ Factors VII, VIII, IX, X, XII, von Willebrand, and fibrinogen
↓ aPTT, PT, and INR
All Rhesus-negative mothers should receive anti-D within 72 hours of injury
Consider rhesus status when initiating blood product transfusion
Renal system↑ Renal blood flow
↑ Glomerular filtration rate (60%)
↓ Serum creatinine and bicarbonate
Gastrointestinal system↓ Esophageal sphincter tone
Cephalad displacement of the stomach
↑ Intra-gastric pressure
Delayed gastric emptying
Perform early gastric decompression with NGT
The bladder becomes an intra-abdominal organ after 1st trimester
Other abdominal organs are displaced by the uterus

See also physiological changes during pregnancy


Advanced cardiac life support, maternal status

Airway and spinal immobilization, breathing, circulation

Catastrophic hemorrhage, maternal cardiac arrest, neurological disability

Discharge criteria:

  • Resolution of contractions
  • A reassuring fetal heart tracing
  • Intact membranes
  • No vaginal bleeding
  • No uterine tenderness
  • Administer Rh immune globulin therapy to all Rh-negative patients unless the injury is remote from the uterus

Anesthetic management

Suggested reading

  • Irving, T., Menon, R., Ciantar, E., 2021. Trauma during pregnancy. BJA Education 21, 10–19.
  • Huls CK, Detlefs C. Trauma in pregnancy. Semin Perinatol. 2018;42(1):13-20.
  • Jain V, Chari R, Maslovitz S, et al. Guidelines for the Management of a Pregnant Trauma Patient. J Obstet Gynaecol Can. 2015;37(6):553-574.

We would love to hear from you. If you should detect any errors, email us at