A prospective controlled study of outcome after trauma during pregnancy

Article Abstract:

Pregnant women who have suffered trauma (injury) during pregnancy are at risk for spontaneous abortion, early labor, abnormal separation of the placenta (abruptio placentae), mother to fetus blood exchange (fetomaternal transfusion), and stillbirth. The occurrence of these complications depends on the type, location and severity of the injury as well as the age of the fetus. To help predict fetal complications and determine pregnancy management strategies, the outcome of pregnancies suffering trauma was studied; 85 women experiencing an injury during pregnancy (from the 12th through the 41st week of pregnancy) were included. Fetomaternal transfusion occurred in 30.6 percent of the injured women, compared with 8.2 percent of the women who did not sustain an injury (control population). Blood mixing was more likely to occur in women having placentas attached on the anterior aspect of the uterus than in all other positions (47 percent versus 23.5 percent). Injured women were more likely to have immediate adverse outcomes, such as abruptio placentae, premature rupture of the membranes surrounding the fetus, premature labor, or fetal death than non-injured women. The severity of the injury did not influence whether an immediate adverse outcome would be experienced (three women with minor injuries and two women with severe injuries developed an adverse outcome). After immediate adverse outcomes had been excluded, there was no difference in the outcome of the pregnancy with respect to birth weight, fetal age at delivery or fetal well-being at birth (APGAR score) between the injured and control groups. All patients who had completed 20 weeks of pregnancy received fetal heart monitoring and uterine contraction monitoring. All of the women who experienced an adverse outcome experienced contractions every two to five minutes at some time during the four hours of monitoring. Tocolytic agents, which are used to control early labor, are not recommended since any woman with uterine contractions is assumed to be experiencing abruptio placentae until proven otherwise. Since blood mixing occurs in many patients, there is a potential for complications if the mother and fetus have different blood types (blood incompatibilities). Therefore, all pregnant women sustaining an injury after 11 weeks of pregnancy have been completed should be screened for fetomaternal transfusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Maternal-fetal exchange, Causes of, Wound care, Abruptio placentae, Placental abruption, Uterus, Pregnant, Pregnant uterus

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Blunt trauma during pregnancy

Article Abstract:

The treatment of blunt trauma in pregnant women, usually the consequence of motor vehicle accidents, falls, or assaults, requires special skills. A review is presented of the maternal and fetal physiological variables that are likely to be affected by blunt trauma. The effects on the fetus are, of course, related to its gestational age; prior to the 12th week, the uterus is protected by the pelvis from direct impact. If maternal blood pressure falls, so, too, does the pressure of the uterine circulation. The fetal circulation compensates quite well for such fluctuations up to a point, especially when fetuses are older. Fetal death occurs more often after severe maternal injury, but even minor injuries can be fatal if the placenta is forced to detach from the uterus (abruptio placentae). Direct fetal injury from blunt trauma is not common, since maternal tissues protect the fetus. Fetomaternal hemorrhage (the entry of fetal blood into the maternal circulation) may occur, causing immunological reactions in the mother and anemia (low red blood cell density) in the fetus. After trauma, pregnant women should be examined (by an obstetrician, when possible) to evaluate the fetal heart rate and the presence of uterine contractions. This should continue for at least four hours to rule out the possibility of abruptio placentae. The first goal of treatment is maternal resuscitation and stabilization of maternal vital signs. Oxygen and transfusions should be administered, and the patient should be properly positioned so that venous circulation is not compromised. If X-ray studies are needed, they should be performed, regardless of the fetal exposure. Emergency cesarean section in a woman whose vital signs have almost vanished can help in maternal resuscitation. The procedure should be performed if fetal vital signs persist, even in the absence of maternal vital signs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Fetus, Physiological aspects, Blunt trauma, editorial

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Sonographic detection of placenta accreta in the second and third trimesters of pregnancy

Article Abstract:

A study was undertaken to determine whether ultrasonography could detect plancenta accreta reliability in at risk patients. It is found that placenta accreta can be detected as early as 15 to 20 weeks of gestation in most at risk patients by visualization of irregular vascular spaces within the placenta.

United States, Science & research, Research, Methods, Ultrasound imaging, Surveys, Pregnancy diagnosis, Placenta accreta

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