Management of the Pregnant Trauma Patient in the Emergency Department - Trauma EXTRA Supplement (Trauma CME) -

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Publication Date: October 2020 (Volume 22, Supplement 10)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 10/15/2023. This course is included with an Emergency Medicine Practice subscription

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Authors

Peer Reviewer

Editor-in-Chief

Introduction

Few things in emergency practice evoke more anxiety than the pregnant trauma patient. Emergency clinicians must simultaneously manage both the mother and the baby, only 1 of whom can verbalize complaints. Trauma in pregnancy provokes anxiety in the patient (who often is concerned about possible complications to her unborn child due to the trauma) as well as in clinicians (who recognize that intrauterine complications may not have outward manifestations). Awareness of the changes in maternal physiology during pregnancy and attention to a broad differential of possible complications of trauma in pregnancy (even with relatively minor trauma) are requisite to avoid catastrophe, as the physiology and nature of injuries can be strikingly different in a pregnant patient than in a nonpregnant patient. This supplement reviews the approach to the pregnant trauma patient, highlights pitfalls of management, and discusses controversies in testing and imaging, including issues regarding radiation exposure for the fetus. An evidence-based approach to clinical decision-making is presented, from the care of minor injuries to the perimortem cesarean section.

Excerpt From This Issue

In the first hour of your shift, a 30-week pregnant patient arrives from a relatively minor MVC. She is limping due to ankle pain and reports a sore neck. Otherwise, she appears well, and she reassures you that she doesn't have any abdominal pain. She is insistent that she does not want any radiation, that she does not want to be observed, and that she would like to be discharged. You are concerned about the potential risk to the fetus and wonder what the best practice recommendations are for managing the mother and fetus in this situation . . .

As you mull this over, a second pregnant patient arrives. She is 24 weeks pregnant and fell while jogging. She thinks that she felt a contraction as the nurse was getting her into a gown. While well-appearing and embarrassed by her clumsiness, there is something about her clinical presentation that causes you concern.