A pregnant trauma patient must be evaluated for the full range of injuries. This evaluation proceeds in a systematic manner identical to a non-pregnant patient evaluation. There are diagnoses unique to pregnancy that must be considered including placental abruption, preterm labor, and uterine rupture.

The placenta is a fixed structure relative to the uterus and is vulnerable to injury following abdominal trauma. The clinical presentation of placental abruption can be dramatic with marked fetal distress, or it can be subtle and difficult to diagnose. Abruption can occur following minor abdominal trauma. After trauma, complaints of abdominal pain are common but vaginal bleeding is not. Ultrasound may demonstrate a placental abruption but is notoriously insensitive and cannot be used to rule out the diagnosis.¹⁰ A recent retrospective cohort study found 24% sensitivity, 96% specificity, and 88% positive and 53% negative predictive value of ultrasound to detect abruption.¹¹ Other studies have similar findings, and while an ultrasound suggestive of abruption is very useful, a negative ultrasound will potentially miss an abruption.¹² Signs of fetal distress on cardiac toco monitors are often the earliest indicators for placental abruption. These signs include decelerations, tachycardia, bradycardia, and loss of heart rate variability.

Frank rupture of the uterus is a potentially devastating complication of severe trauma and is almost always associated with death of the fetus.¹⁰ A patient with uterine rupture presents with complaints of severe abdominal pain. Fetal parts may be palpable on physical examination. Preterm labor, defined as “uterine contractions accompanied by cervical dilatation,” may occur following even a minor injury. Any pregnant trauma patient with abdominal pain should be evaluated for signs of preterm labor.

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