Standard prehospital protocols for trauma patients also apply to pregnant patients, with a few important considerations. In the last half of pregnancy, the enlarged uterus may compress the inferior vena cava when the patient is lying flat, reducing cardiac output by 30%. Placing the woman in the left lateral decubitus position or manually displacing the uterus to the left can alleviate this phenomenon, which is known as “supine hypotension.”⁷ If the patient is on a backboard, alleviate hypotension by tilting the backboard using sheets or other materials beneath it. Early intravenous fluids should be given, especially following a severe mechanism of injury or if there are any signs of hemodynamic compromise.

All pregnant trauma patients should receive supplemental oxygen since the changes in pulmonary function during pregnancy can cause the patient to desaturate quickly, and a developing fetus is very susceptible to hypoxia.

Following a major mechanism, most pregnant trauma patients should be evaluated at a designated trauma center with an OB-GYN consultation available. One prospective study of 205 pregnant patients in the second half of pregnancy found that patients presenting with contractions, vaginal bleeding, and uterine tenderness as well as those with direct trauma to the abdomen were more likely to have obstetric complications.¹³

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