Objectives

1. Review the etiology of trauma in pregnant patients.

2. Discuss the physiologic changes of pregnancy and their impact on anesthetic management of a pregnant trauma patient.

3. List the various causes of maternal and fetal morbidity and mortality associated with different types of trauma.

4. Be able to triage a pregnant trauma patient and know the impact of gestational age on resuscitation.

5. Review the principles of cardiorespiratory resuscitation in a pregnant patient, including perimortem cesarean delivery.

Trauma complicates approximately 7 percent of all pregnancies and is responsible for 0.3 percent to 0.4 percent of maternal hospital admissions [2]. Trauma is the most common cause of maternal death in the United States [1]. Mechanisms of trauma during pregnancy include motor vehicle accidents, domestic violence [3], falls [4], and penetrating injuries [5]. Pregnancy has its own unique injuries due to the expanding uterus and developing fetus that must be taken into consideration in the pregnant trauma patient.

Many providers are involved in the care of the pregnant patient from the trauma scene, to the emergency department, and to the operating room. The anesthesiologist can play a key role in the care and management of the pregnant trauma victim. All anesthesiologists have training in obstetric anesthesia during their residency and frequently cover obstetric units in hospitals where pregnant patients are cared for. On the other hand, most nonobstetric physicians have little obstetric exposure and may be uncomfortable caring for the pregnant patient because of unfamiliarity with the physiologic changes of pregnancy or the evaluation of fetal well-being.