Management of pregnant trauma patients in emergency department: a narrative review to provide the most recent evidence
Abstract
Evaluation of a pregnant trauma patient (PTP) in the emergency department (ED) is somehow challenging, as two patients should be managed simultaneously. Here, we reviewed recently published articles to provide up-to-date information on the management of PTPs. We examined 35 articles and categorized their topics as follows: trauma severity, management of trauma patients, general approach to pregnant women with trauma, primary evaluation of pregnant women with trauma, breathing and ventilation, airway, circulatory system evaluation simultaneous with bleeding control, uterine replacement, blood transfusion, uterine displacement, cardiovascular resuscitation, defibrillation, pneumatic anti-shock garment, and perimortem cesarean section. Concerning trauma during pregnancy, the basic principle should be successful maternal resuscitation, which is vital for fetus survival.
1. Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health. 2019;11:119.
2. Vieira F, Guimaraes JV, Souza MC, Sousa PM, Santos RF, Cavalcante AM. Scientific evidence on perineal trauma during labor: Integrative review. Eur J Obstet Gynecol Reprod Biol. 2018;223:18-25.
3. Huls CK, Detlefs C, editors. Trauma in pregnancy. Seminars in perinatology; 2018: Elsevier.
4. Watson K, White C, Hall H, Hewitt A. Women’s experiences of birth trauma: A scoping review. Women and Birth. 2020.
5. Bastani P, Hajebrahimi S, Mallah F, Chaichi P, Ghiasi FS. Long-term outcome of synthetic mesh use in Iranian women with genital prolapse. Urol J. 2020;17(1):73-7.
6. Oxford CM, Ludmir J. Trauma in pregnancy. Clin Obstet Gynecol. 2009;52(4):611-29.
7. Raptis CA, Mellnick VM, Raptis DA, Kitchin D, Fowler KJ, Lubner M, et al. Imaging of trauma in the pregnant patient. Radiographics. 2014;34(3):748-63.
8. O'Leary J. The trauma of ultrasound during a pregnancy following perinatal loss. J Loss Trauma. 2005;10(2):183-204.
9. Flik K, Kloen P, Toro JB, Urmey W, Nijhuis JG, Helfet DL. Orthopaedic trauma in the pregnant patient. J Am Acad Orthop Surg. 2006;14(3):175-82.
10. Huth-Bocks AC, Krause K, Ahlfs-Dunn S, Gallagher E, Scott S. Relational trauma and posttraumatic stress symptoms among pregnant women. Psychodyn Psychiatry. 2013;41(2):277-301.
11. Atashkhoei S, Abedini N, Pourfathi H, Znoz AB, Marandi PH. Baricity of bupivacaine on maternal hemodynamics after spinal anesthesia for cesarean section: a randomized controlled trial. Iran J Med Sci. 2017;42(2):136-43.
12. Abedzadeh-Kalahroudi M. Approach to trauma during pregnancy. Arch Trauma Res. 2013;2(2):61-2.
13. Laplante DP, Barr RG, Brunet A, Du Fort GG, Meaney ML, Saucier JF, et al. Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatr Res. 2004;56(3):400-10.
14. Tsuei BJ. Assessment of the pregnant trauma patient. Injury. 2006;37(5):367-73.
15. Van Hook JW. Trauma in pregnancy. Clin Obstet Gynecol. 2002;45(2):414-24.
16. Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117-21.
17. Sakamoto J, Michels C, Eisfelder B, Joshi N. Trauma in pregnancy. Emerg Med Clin. 2019;37(2):317-38.
18. Lavecchia M, Abenhaim HA. Cardiopulmonary resuscitation of pregnant women in the emergency department. Resuscitation. 2015;91:104-7.
19. Cox TR, Crimmins SD, Shannon AM, Atkins KL, Tesoriero R, Malinow AM. Liver lacerations as a complication of CPR during pregnancy. Resuscitation. 2018;122:121-5.
20. Kaplan S, Paschen HR. The Pregnant Trauma Patient. Prehospital Trauma Care. 2001 (pp. 475-494). CRC Press.
21. Sadro CT, Zins AM, Debiec K, Robinson J. Case report: lethal fetal head injury and placental abruption in a pregnant trauma patient. Emerg Radiol. 2012;19(2):175-80.
22. Atta E, Gardner M. Cardiopulmonary resuscitation in pregnancy. Obstet Gynecol Clin North Am. 2007;34(3):585-97.
23. Nedeff N, Hakala P. Anesthetic management of the pregnant trauma patient. Essentials of Trauma Anesthesia. 2012:288.
24. Hull SB, Bennett S. The pregnant trauma patient: Assessment and anesthetic management. Int Anesthesiol Clin. 2007;45(3):1-18.
25. McAuley DJ. Trauma in pregnancy: anatomical and physiological considerations. Trauma. 2004;6(4):293-300.
26. Stone IK. Trauma in the obstetric patient. Obstet Gynecol Clin North Am. 1999;26(3):459-67.
27. Greco PS, Day LJ, Pearlman MD. Guidance for evaluation and management of blunt abdominal trauma in pregnancy. Obstet Gynecol. 2019;134(6):1343-57.
28. Madden A, Meng M. Cardiopulmonary resuscitation in the pregnant patient. BJA Educ. 2020;20(8):252-8.
29. Reddy SV, Shaik NA, Gunakala K. Trauma during pregnancy. J Obstet Anaesth Crit Care. 2012;2(1):3-9.
30. Hill CC, Pickinpaugh J. Trauma and surgical emergencies in the obstetric patient. Surg Clin North Am. 2008;88(2):421-40.
31. Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 2015;37(6):553-71.
32. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81(10):1400-33.
33. Morris Jr JA, Rosenbower TJ, Jurkovich GJ, Hoyt DB, Harviel JD, Knudson MM, et al. Infant survival after cesarean section for trauma. Ann Surg. 1996;223(5):481.
34. Aghamohamadi D, Gol MK. An Investigation Into the Effects of Magnesium Sulfate on the Complications of Succinylcholine Administration in Nulliparous Women Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial. Int J Womens Health Reprod Sci. 2019;7(4):1123-32.
35. Alvandfar D, Alizadeh M, Khanbabayi Gol M. Prevalence of pregnancy varicose and its effective factors in women referred to gynecology hospitals in Tabriz. Iran J Obstet Gynecol Infertil. 2019;22(9):1-7.
36. Hasanzadeh M, Rastin Z, Babapour N. Term Natural Delivery without Complications in a Pregnant Woman with Bladder Exstrophy: A Case Report. Iran J Obstet Gynecol Infertil. 2018;21(3):103-8.
37. Sadrzadeh SM, Mousavi SM, Rezvani Kakhki B, Deldar K, Rahmani S. Trauma in Pregnancy: A Case Series and Literature Review. Iran J Obstet Gynecol Infertil. 2018;21(6):92-9.
38. Schreiner L, Crivelatti I, de Oliveira JM, Nygaard CC, Dos Santos TG. Systematic review of pelvic floor interventions during pregnancy. Int J Gynecol Obstet. 2018;143(1):10-8.
39. Bilehjani E, Fakhari S, Farzin H, Yaghoubi A, Mirinazhad M, Shadvar K, et al. The correlation between preoperative erythrocyte sedimentation rate and postoperative outcome in adult cardiac surgery. Int J Gen Med. 2017;10:15-21.
40. Nazari B, Amani L, Ghaderi L, Khanbabayi Gol M. Effects of probiotics on prevalence of ventilator-associated pneumonia in multitrauma patients hospitalized in neurosurgical intensive care unit: a randomized clinical trial. Trauma Mon. 2020;25(6):262-8.
41. Pooransari P, Ebrahimi A. Evaluation of Mother and Fetus after a Traumatic Event: An Overview. Front Emerg Med. 2021;5(1):e14.
42. Azmoude E, Ashrafizaveh A, Tara F, Dinpanah H, Azmoude H. Management of Trauma in Pregnancy: A Practical Approach to Evidence Based Care. Iran J Obstet Gynecol Infertil. 2018;21(9):101-17.
43. Hashemzadeh K, Dehdilani M, Gol MK. Study of the effects of simple exercise with or without physiotherapy on prevention of deep vein thrombosis among postmenopausal women requiring coronary artery bypass graft surgery. Int J Womens Health Reprod Sci. 2021;9(1):69-74.
2. Vieira F, Guimaraes JV, Souza MC, Sousa PM, Santos RF, Cavalcante AM. Scientific evidence on perineal trauma during labor: Integrative review. Eur J Obstet Gynecol Reprod Biol. 2018;223:18-25.
3. Huls CK, Detlefs C, editors. Trauma in pregnancy. Seminars in perinatology; 2018: Elsevier.
4. Watson K, White C, Hall H, Hewitt A. Women’s experiences of birth trauma: A scoping review. Women and Birth. 2020.
5. Bastani P, Hajebrahimi S, Mallah F, Chaichi P, Ghiasi FS. Long-term outcome of synthetic mesh use in Iranian women with genital prolapse. Urol J. 2020;17(1):73-7.
6. Oxford CM, Ludmir J. Trauma in pregnancy. Clin Obstet Gynecol. 2009;52(4):611-29.
7. Raptis CA, Mellnick VM, Raptis DA, Kitchin D, Fowler KJ, Lubner M, et al. Imaging of trauma in the pregnant patient. Radiographics. 2014;34(3):748-63.
8. O'Leary J. The trauma of ultrasound during a pregnancy following perinatal loss. J Loss Trauma. 2005;10(2):183-204.
9. Flik K, Kloen P, Toro JB, Urmey W, Nijhuis JG, Helfet DL. Orthopaedic trauma in the pregnant patient. J Am Acad Orthop Surg. 2006;14(3):175-82.
10. Huth-Bocks AC, Krause K, Ahlfs-Dunn S, Gallagher E, Scott S. Relational trauma and posttraumatic stress symptoms among pregnant women. Psychodyn Psychiatry. 2013;41(2):277-301.
11. Atashkhoei S, Abedini N, Pourfathi H, Znoz AB, Marandi PH. Baricity of bupivacaine on maternal hemodynamics after spinal anesthesia for cesarean section: a randomized controlled trial. Iran J Med Sci. 2017;42(2):136-43.
12. Abedzadeh-Kalahroudi M. Approach to trauma during pregnancy. Arch Trauma Res. 2013;2(2):61-2.
13. Laplante DP, Barr RG, Brunet A, Du Fort GG, Meaney ML, Saucier JF, et al. Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatr Res. 2004;56(3):400-10.
14. Tsuei BJ. Assessment of the pregnant trauma patient. Injury. 2006;37(5):367-73.
15. Van Hook JW. Trauma in pregnancy. Clin Obstet Gynecol. 2002;45(2):414-24.
16. Thim T, Krarup NHV, Grove EL, Rohde CV, Løfgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117-21.
17. Sakamoto J, Michels C, Eisfelder B, Joshi N. Trauma in pregnancy. Emerg Med Clin. 2019;37(2):317-38.
18. Lavecchia M, Abenhaim HA. Cardiopulmonary resuscitation of pregnant women in the emergency department. Resuscitation. 2015;91:104-7.
19. Cox TR, Crimmins SD, Shannon AM, Atkins KL, Tesoriero R, Malinow AM. Liver lacerations as a complication of CPR during pregnancy. Resuscitation. 2018;122:121-5.
20. Kaplan S, Paschen HR. The Pregnant Trauma Patient. Prehospital Trauma Care. 2001 (pp. 475-494). CRC Press.
21. Sadro CT, Zins AM, Debiec K, Robinson J. Case report: lethal fetal head injury and placental abruption in a pregnant trauma patient. Emerg Radiol. 2012;19(2):175-80.
22. Atta E, Gardner M. Cardiopulmonary resuscitation in pregnancy. Obstet Gynecol Clin North Am. 2007;34(3):585-97.
23. Nedeff N, Hakala P. Anesthetic management of the pregnant trauma patient. Essentials of Trauma Anesthesia. 2012:288.
24. Hull SB, Bennett S. The pregnant trauma patient: Assessment and anesthetic management. Int Anesthesiol Clin. 2007;45(3):1-18.
25. McAuley DJ. Trauma in pregnancy: anatomical and physiological considerations. Trauma. 2004;6(4):293-300.
26. Stone IK. Trauma in the obstetric patient. Obstet Gynecol Clin North Am. 1999;26(3):459-67.
27. Greco PS, Day LJ, Pearlman MD. Guidance for evaluation and management of blunt abdominal trauma in pregnancy. Obstet Gynecol. 2019;134(6):1343-57.
28. Madden A, Meng M. Cardiopulmonary resuscitation in the pregnant patient. BJA Educ. 2020;20(8):252-8.
29. Reddy SV, Shaik NA, Gunakala K. Trauma during pregnancy. J Obstet Anaesth Crit Care. 2012;2(1):3-9.
30. Hill CC, Pickinpaugh J. Trauma and surgical emergencies in the obstetric patient. Surg Clin North Am. 2008;88(2):421-40.
31. Jain V, Chari R, Maslovitz S, Farine D, Bujold E, Gagnon R, et al. Guidelines for the management of a pregnant trauma patient. J Obstet Gynaecol Can. 2015;37(6):553-71.
32. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81(10):1400-33.
33. Morris Jr JA, Rosenbower TJ, Jurkovich GJ, Hoyt DB, Harviel JD, Knudson MM, et al. Infant survival after cesarean section for trauma. Ann Surg. 1996;223(5):481.
34. Aghamohamadi D, Gol MK. An Investigation Into the Effects of Magnesium Sulfate on the Complications of Succinylcholine Administration in Nulliparous Women Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial. Int J Womens Health Reprod Sci. 2019;7(4):1123-32.
35. Alvandfar D, Alizadeh M, Khanbabayi Gol M. Prevalence of pregnancy varicose and its effective factors in women referred to gynecology hospitals in Tabriz. Iran J Obstet Gynecol Infertil. 2019;22(9):1-7.
36. Hasanzadeh M, Rastin Z, Babapour N. Term Natural Delivery without Complications in a Pregnant Woman with Bladder Exstrophy: A Case Report. Iran J Obstet Gynecol Infertil. 2018;21(3):103-8.
37. Sadrzadeh SM, Mousavi SM, Rezvani Kakhki B, Deldar K, Rahmani S. Trauma in Pregnancy: A Case Series and Literature Review. Iran J Obstet Gynecol Infertil. 2018;21(6):92-9.
38. Schreiner L, Crivelatti I, de Oliveira JM, Nygaard CC, Dos Santos TG. Systematic review of pelvic floor interventions during pregnancy. Int J Gynecol Obstet. 2018;143(1):10-8.
39. Bilehjani E, Fakhari S, Farzin H, Yaghoubi A, Mirinazhad M, Shadvar K, et al. The correlation between preoperative erythrocyte sedimentation rate and postoperative outcome in adult cardiac surgery. Int J Gen Med. 2017;10:15-21.
40. Nazari B, Amani L, Ghaderi L, Khanbabayi Gol M. Effects of probiotics on prevalence of ventilator-associated pneumonia in multitrauma patients hospitalized in neurosurgical intensive care unit: a randomized clinical trial. Trauma Mon. 2020;25(6):262-8.
41. Pooransari P, Ebrahimi A. Evaluation of Mother and Fetus after a Traumatic Event: An Overview. Front Emerg Med. 2021;5(1):e14.
42. Azmoude E, Ashrafizaveh A, Tara F, Dinpanah H, Azmoude H. Management of Trauma in Pregnancy: A Practical Approach to Evidence Based Care. Iran J Obstet Gynecol Infertil. 2018;21(9):101-17.
43. Hashemzadeh K, Dehdilani M, Gol MK. Study of the effects of simple exercise with or without physiotherapy on prevention of deep vein thrombosis among postmenopausal women requiring coronary artery bypass graft surgery. Int J Womens Health Reprod Sci. 2021;9(1):69-74.
| Files | ||
| Issue | Vol 6 No 4 (2022): Autumn (October) | |
| Section | Review article | |
| DOI | 10.18502/fem.v6i4.10442 | |
| Keywords | ||
| Emergency Medical Services Evidence-Based Medicine Multiple Trauma Pregnancy Wounds and Injuries | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mousazadeh R, Dehdilani M. Management of pregnant trauma patients in emergency department: a narrative review to provide the most recent evidence. Front Emerg Med. 2022;6(4):e55.
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