Introduction
Pregnancy-related trauma can range widely from minor injuries to significant injuries. Pregnancy-related trauma has skyrocketed over the last 25 years, ranking first among non-obstetrical maternal deaths in the US. There is a 40 to 50 percent chance of fetal death following significant trauma. There is a higher chance of delivering a baby who is premature or has a low birth weight, even with mild trauma that happens in the first or second trimester.
What Is the Etiology?
Trauma during pregnancy may have a complex etiology. The mechanics of the expanding belly cause an imbalance, which raises the risk of maternal falls from standing or elevated surfaces like stairs. The doctor must also watch for non-accidental reasons, whether self-inflicted or not. Pregnancy is associated with an increase in domestic violence, which puts both the mother and the fetus in clear danger of harm. Four to eight percent of pregnancies involve domestic abuse, which carries a five percent chance of fetal death.
The usual physiology of the woman who is pregnant complicates the assessment and therapy of pregnancy trauma. The gravid uterus is highly susceptible to blunt force injuries and penetrations into the abdomen. Eighty-two percent of trauma-related fetal deaths and fifty percent of all traumatic injuries during gestation are caused by motor vehicle accidents. The primary cause of this can be attributed to incorrect seat belt usage.
What Are the Obstetric Complications of Trauma?
The obstetric complications of trauma are,
Placental Abruption:
Depending on the degree of injury, placental disruption can occur in 5 to 50 percent of instances, which is a serious consequence of maternal trauma. In blunt trauma cases, it is the most frequent cause of fetal death. Almost all abruptions happen within 24 hours of the injury, and most happen within 2 to 6 hours. Even small stress can result in disruption, so it takes a high index of suspects to identify. Clinical impressions, laboratory investigations, and fetal examinations are used to diagnose abruption. Typical symptoms include abdominal pain, uterine soreness, vaginal hemorrhage, uterine contractions or hypertonicity, premature labor, or an atypical or unusual EFM tracing. Sonographic abnormalities are rare; retroplacental hematoma is detected in 2 to 25 percent of abruptions. Since ultrasound is not a reliable method of diagnosing placental abruption, treatment should never be postponed until the results of an ultrasound are obtained.
Uterine Rupture:
Post-trauma uterine rupture is uncommon (0.6 percent among all maternal injuries). Still, it is more common in women who have a scarred uterus or have had a direct abdominal impact in the latter half of their pregnancy. The fundal region is involved in 75 percent of uterine ruptures. The extent of the rupture might range from serosal bleeding and abrasions to the total avulsion of the uterus.
The indications and symptoms of uterine rupture: ascent of the fetal presenting part, palpable fetal parts, uneven uterine contour, maternal shock, ascension of the abdomen, guarding and tenderness, and peritoneal irritation. Fetal death is almost common, and maternal mortality has been linked to severe uterine rupture. In 17.5 percent of cases, it is the reason for perinatal death connected to MVC.8 An emergency laparotomy should be performed to stop bleeding and promote resuscitation in cases of suspected uterine rupture involving a mother or a fetus.
Preterm Labour:
Preterm labor can be caused by traumatic damage during pregnancy in a number of ways. In 20 percent of cases, placental abruption can result in preterm labor. Extravasation of blood near the placental edge can cause decidual necrosis, triggering prostaglandin synthesis and premature labor or delivery. Additionally, lysosomal enzyme instability following uterine trauma may start with the production of prostaglandins. Preterm labor is also linked to early rupture of the membranes.
Regardless of the mechanism, trauma (even with minor injuries) is associated with a 2-fold higher risk of preterm delivery. 100 The risk is higher with increasing injury severity and among those injured early in gestation. 100 Signs of preterm labor should be sought in every patient with a viable fetus. EFM should be used to assess the regularity and frequency of contractions. When regular contractions are noted, the fetal fibronectin test or cervical length assessment to determine the risk for preterm labor should be considered.
When membrane rupture is suspected, a speculum examination, comprising a nitrazine paper assessment and the ferning test, should be performed. Based on gestational age and patient location, consideration should be given to steroids (and any other indicated medications, such as antibiotics and magnesium sulfate), relocation to a tertiary care center, and neonatology consultation if the patient is at high risk of preterm delivery due to preterm labor or preterm premature rupture of membranes. Iatrogenic premature delivery is frequently recommended to enhance the prognosis of the mother or fetus.
Direct Fetal Injury:
Direct fetal injury occurs in fewer than one percent of cases of blunt maternal trauma. Reduced force applied to the fetus is achieved via the uterus, amniotic fluid, and soft tissues of the mother. The skull and brain of the fetus are frequently directly injured by blunt abdominal trauma. One proposed explanation is a fetal skull fracture caused by a maternal pelvis fracture in late pregnancy with an engaged fetal head. Another possibility is a head injury sustained during deceleration.
How Is It Treated?
The fundamentals of advanced trauma life support do not change regardless of the patient's gestational age. As usual, the fetus will be taken care of in proportion to the care given to the mother patient. The best early treatment for the fetus is excellent maternal resuscitation. Consulting with obstetricians is crucial after determining gravidity. Human chorionic gonadotropin (hCG) testing is recommended for almost all female patients between the ages of 10 and 55. Transferring to a suitable trauma center offering obstetrically specialized treatment has been shown to improve mother and newborn outcomes after injury.
Conclusion
The consequences for traumatized pregnant women vary depending on the nature and severity of the trauma. Due to the fetus's ability to shield the pelvic organs beneath, penetrating trauma generally has a 30 to 80 percent fetal death rate and a low mother fatality rate. The degree of force used during blunt trauma determines the morbidity and mortality rates. Several studies indicate that pregnant patients with blunt trauma had morbidity rates ranging from 5 to 45 percent. Moderate to severe bleeding is associated with a high risk of embryonic death in numerous studies.
