Trauma in pregnancy

About the podcast

Dr Caroline Leech is an emergency medicine and prehospital emergency medicine consultant working at University Hospitals Coventry and Warwickshire NHS Trust and we are delighted to have her joins us in this episode of ThePTN podcast to discuss trauma in pregnancy!

It’s not uncommon for phrases like ‘pregnant trauma patient’, ‘maternal trauma’ or ‘obstetric emergency’ to trigger a visceral fear response in many: not only is it unfamiliar territory but the number of complex patients involved has suddenly doubled! That said, it is not an uncommon presentation to EDs with an estimated 6-8% of all pregnancies experiencing some degree of trauma; thankfully most are minor trauma! In the major trauma patient, we need to be wary of the anatomical and physiological changes seen in pregnancy along with specific obstetric injuries, all on top of our ‘normal’ trauma considerations.

Caroline provides through and insightful commentary on managing these patients. The key take homes are: maintain an even higher index of suspicion for the possibility of bleeding, have an appreciation of the anatomical & physiological changes that may mask this and involve the obstetric, paediatric and obstetric anaesthetics teams early.

As always, level 1 and 2 learning areas listed in the show notes.

Trauma in pregnancy – ThePTN podcast

Caroline Leech joins the podcast to discuss important considerations in management of trauma in the pregnant patient. Covering physiology, changes to normal management and obstetric injuries.

Learning areas in this podcast:

Can outline the key consideration in the care of the pregnant trauma patient:

  • Demonstrates a basic understanding of
    the physiological changes in pregnancy
    and their impact in trauma such as effects on the respiratory and circulatory system.
  • Can activate the obstetric and paediatric/neonatal teams as required
  • Understands the basic principles of inferior vena cava compression and importance of repositioning and can assist in compression reduction techniques
  • Demonstrates an understanding of the signs and symptoms of placenta abruption and Uterine rupture
  • Demonstrates an understanding of traumatic perimortem caesarean section
  • Understands the importance of ensuring a Kleihauer–Betke test is taken on pregnant women following a traumatic injury

Links:
RCOG (Royal College of Obstetricians and Gynaecologists) Green Top guidance on maternal collapse in pregnancy and the puerperium (No 56): here.

Tibbott, J, Di Carlofelice, M, Menon, R, Ciantar, E. Trauma and pregnancy. The Obstetrician & Gynaecologist 2021; 23: 258– 264. here.

RCEM Learning: Carfiac Arrest in the Pregnant Patient here.

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