Trauma in Pregnancy

The pregnancy traumatic injury is among the factors that lead to fetal and maternal morbidity as well as well leading to the increased mortality rate in the United States. To illustrate, motor accidents, assault, and violence are among the elements that contribute injury-based maternal death. In relation to the above information, the physiologic and anatomic pregnancy changes can also mimic or mask the injury, therefore, hindering the process of diagnosing trauma in pregnancy (Jain ET AL., 2015). According to the researchers, the trauma is capable of complicating one out of twelve pregnancies, hence, contributing to nonobstetric, which, in turn, lead to death among the expectant ladies. However, 9 out of 10 pregnancy conditions are minor cases, but 60% -70% of fetal losses relating to trauma emanates from minor injuries (World Health Organization, & UNICEF, 2017). Indeed, it is essential for physicians managing trauma in pregnancy to have a complete understanding of symptoms, mechanism of injury, diagnostic modalities, and potential complications of this disease in order to be able to offer the necessary interventions. 

Possible Injury Mechanism

According to the American College of Obstetricians and Gynecologists denotes that there are various factors that contribute to trauma in pregnancy. For instance, the above condition may emanate from physical abuse, where the expectant ladies encounter beating among other things that can lead to harm or injury. Moreover, homicide is a factor that contributes to pregnancy-based parental death (World Health Organization, & UNICEF, 2017). In this case, when the mother dies, the fetus will also succumb to death because of ceased supply of nutrients and oxygen. Furthermore, the blunt trauma and penetrating trauma may also occur from different aspects including gunshots and vehicle accidents (Jain ET AL., 2015). In connection with the above information, the blunt trauma affecting the abdomen may put pregnant ladies at the risk of direct fetal injury and placental abruption. 

On the other hand, premature labor, placental abruption, and uterine rupture, as well as catastrophic and uncommon incidences, can result in trauma in pregnancy. In the illustration, the premature labor refers to the uterine contractions experienced before 36 weeks of gestation period and it is always accompanied by labor pain. Conversely, if the physicians have identified the above signs, it is essential to investigate whether the patients have traumatic issues (Mendez-Figueroa ET AL., 2013).  Besides, placental abruption is another condition that contributes to fetal death, although it is not connected to maternal death. The above condition is notable in 1-5% of minor trauma and it is diagnosed through bleeding edges of the placenta (Jain ET AL., 2015). Nevertheless, the uterine rupture is also a mechanism for trauma in pregnancy and it commonly occurs during the 3^rd semester. This condition is accompanied by a high force that makes the uterine to break, hence, it leads to bladder injuries and pelvic fractures. In addition, trauma in pregnancy can be associated with catastrophic and uncommon sign such as gigantic lung thrombotic embolus (World Health Organization, & UNICEF, 2017). As a matter of fact, the above factors represent the possible mechanism of injury concerning traumatic pregnancy.  

Physical Exam Findings

In most cases, the physicians investigate the trauma in pregnancy by focusing on physical signs. To be specific, the determination of this condition is carried out through the secondary survey that involves vaginal examination and early rectal examination. The above procedure helps in evaluating the cervix for fetal position, dilation and effacement as well as the presence of amniotic fluid and blood (Mendez-Figueroa ET AL., 2013). To be specific, in case the vaginal bleeding is evidenced during the third or second trimester, the cervical assessment is supposed to be deferred to an extent of excluding the placenta previa. Otherwise, the vaginal bleeding that occurs before labor pain start is considered abnormal, hence, it can act as a symptom of placental abruption, preterm labor, uterine rupture, and placenta previa. In addition, the trauma’s abdominal sonography since it can help to identify undiagnosed intrauterine pregnancy (Jain ET AL., 2015).  Conversely, all the above factors are useful factors that facilitate physical identification of trauma in pregnancy. 

Applicable Diagnostic Modalities

There are various diagnostic modalities helpful in examining the case of trauma in pregnancy. To be specific, the ultrasound is the leading diagnostic modality that is commonly used to examine the pregnant trauma patient. This tool helps to identify well-being and fetal age as well as denting fetal heart rate and motion, hence, facilitating the detection of abruption. Indeed, the CT scan is carried out on patients with various issues including pelvic fracture, rib fissure, blood loss, hematuria, base deficit, and unexplained hypotension as well as ALOC emanating from intoxication, drugs and head injury (Mendez-Figueroa ET AL., 2013). Significantly, the CT scan is helpful in determining complications such as injury, blood loss, and feral injuries. In addition, the fetal monitoring is also a vital diagnostic modality that plays a role of recording the fetal heart rate and uterine contractions particularly when the pregnant person has relatively minor intestinal trauma (Jain ET AL., 2015). Indeed, all the above diagnostic modalities are used to enhance the identification of trauma in pregnancy. 

Interventions Required

The physicians can use suitable methods of handling women suffering from pregnancy trauma. For instance, the clinical offices should have thorough knowledge concerning physiologic and anatomic changes linked with normal pregnancy in order to point out any derangements succeeding the injury. Conversely, the above tactic is helpful in determining the suitable course of action for instigating treatment for traumatic pregnancy. Moreover, healthcare givers are supposed to carry out the left-lateral displacement of uterine through inclining the whole maternal body to in between 25 to 30 degrees (World Health Organization, & UNICEF, 2017). Furthermore, there are special aspects of improved cardiac life supports that need to be used in such cases and they entail removal of the entire uterus, early intubation, and application of fetal monitors as well as the use of perimortem cesarean delivery. Still, the proper application of seat belt can minimize the risk of fetal and maternal injuries emanating from the motor vehicle accidents (Jain ET AL., 2015). Undeniably, the women at childbearing age are supposed to go for routine checkups and screening to determine whether they are at risk of suffering from traumatic pregnancy condition. 

Potential Complications

There are several factors that act as the potential complications for trauma in pregnancy. In particular, placental abruption is one of the problems identified through the placenta shearing away from the uterus. Indeed, the above condition can contribute to serious health issues and it may eventually lead to fetal death (Mendez-Figueroa ET AL., 2013). Moreover, the labor experienced before 37 weeks is another complication identifiable through the lower abdomen, pelvic, and lower back pressure or pain as well as ruptured membranes, and abdominal or vaginal cramps. In connection with the above information, the aspect of experiencing contractions for more than six hours signals preterm labor and it, therefore, requires further examination (World Health Organization, & UNICEF, 2017). In addition, the tearing or rupture of uterine muscles is also a complication that can result from penetrating and blunt traumas from fetal or internal maternal part like fractured bone (Jain ET AL., 2015). Conversely, the presence of any of the above signs indicates that trauma in pregnancy is at its worst stage.

References

Jain, V., Chari, R., Maslovitz, S., Farine, D., Bujold, E., Gagnon, R. … & Gouin, K. (2015). Guidelines for the management of a pregnant trauma patient. Journal of Obstetrics and Gynaecology Canada, 37(6), 553-571.

Mendez-Figueroa, H., Dahlke, J. D., Vrees, R. A., & Rouse, D. J. (2013). Trauma in pregnancy: An updated systematic review. American Journal Of Obstetrics and Gynecology, 209(1), 1-10.

World Health Organization, & UNICEF. (2017). Managing complications in pregnancy and childbirth: A guide for midwives and doctors. Integrated Management of Pregnancy and Childbirth, 1-492.