Continuous fetal monitoring should be instituted as soon as the mother’s status allows, preferably in the emergency department for patients not promptly going to labor and delivery. Fetal morbidity or mortality can occur in mothers without significant injury. Fetal compromise may not be apparent during initial evaluation, but should placental abruption occur, it will do so generally by 24 hours. This can be effectively screened for by 4 hours of monitoring of the potentially viable fetus.²¹

Trauma Complications²²

• Vaginal bleeding
• Preterm rupture of membranes
• Placental abruption
• Maternal pelvic fractures
• Fetal death²³
• Fetal fractures especially skull, clavicles, and long bones
• Intracranial hemorrhage
• Indirect injury is generally due to fetal hypoxia secondary to: maternal hypotension, fetal hemorrhage, placental abruption or other injury, cord injury, uterine injury
• Other: spontaneous abortion, preterm delivery, and RBC isoimmunization

Summary

In order to translate the knowledge available for trauma in pregnancy in a rapidly usable format, this article provides an accessible tool for emergency physicians. A key goal is to avoid unnecessary delays in management caused by the uncertainty of applying accepted principles to this population.

Generally, medications, tests, treatments, and procedures required for a mother’s stabilization should not be withheld because of pregnancy. The viable fetus should be promptly placed on continuous monitoring until under the care of an obstetrician.

Contributor Disclosures

Contributors

Dr. Roemer is an associate professor and assistant residency program director, department of emergency medicine, at the University of Oklahoma. Dr. Katz is a clinical professor, department of obstetrics and gynecology, at Oregon Health Sciences University and medical director, women’s services, Sacred Heart Medical Center. Dr. Becerra is a resident in the department of emergency medicine at the OU School of Community Medicine. Dr. Ogburn is a professor of obstetrics and gynecology and director of the division of maternal-fetal medicine at SUNY Stony Brook School of Medicine in New York. Dr. Bowes is an emeritus professor of obstetrics and gynecology at the University of North Carolina School of Medicine. Dr. Benjamin Roemer is a practicing emergency physician at the Northwest Medical Center in Tucson. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Southwest Regional Medical Center in Waynesburg, Pa., and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine.

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards and American College of Emergency Physicians policy, contributors and editors must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter. Dr. Roemer, Dr. Katz, Dr. Becerra, Dr. Ogburn, Dr. Bowes, Dr. Benjamin Roemer, and Dr. Solomon have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this educational activity.