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Maternal Abdominal Trauma

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Acute Abdomen During Pregnancy

Abstract

Trauma complicates 7% of pregnancies and is the leading nonobstetric cause of death among pregnant women. The most common traumatic injuries are motor vehicle crashes, assaults, falls, and domestic violence. Approximately 90% of traumatic injuries during pregnancy are classified as minor, yet 60–70% of fetal losses after trauma result from minor injuries. Penetrating trauma most commonly includes the growing uterus and the fetus, protecting maternal intra-abdominal organs. In such cases, especially stab wounds, the maternal outcome is excellent. In minor trauma, tocodynamometric monitoring of 4 h is recommended. It is extended to 24 h if indicated. Ultrasonography has low sensitivity but high specificity for placental abruption. The Kleihauer-Betke test should be performed after major trauma to determine the degree of fetomaternal hemorrhage, regardless of Rh status. A maternal left lateral tilt of 30o improves the effectiveness of cardiopulmonary resuscitation. Unique aspects of advanced cardiac life support include early intubation, removal of all uterine and fetal monitors, and perimortem cesarean delivery within 4–5 min from maternal death. Proper seat belt use reduces the risk of maternal and fetal injuries in motor vehicle crashes. The lap belt should be placed as low as possible under the protuberant portion of the abdomen, and the shoulder belt should be positioned off to the side of the uterus, between the breasts, and over the midportion of the clavicle. All women of childbearing age should be routinely screened for intimate partner violence.

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  1. Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia

    Goran Augustin

  2. School of Medicine, University of Zagreb, Zagreb, Croatia

    Goran Augustin

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Augustin, G. (2023). Maternal Abdominal Trauma. In: Acute Abdomen During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-031-26021-6_25

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