ED Management of the Pregnant Trauma Patient

Contributor: Bill Mabie, MD 
Last Update: 8/6/2013

PURPOSE:  To define criteria to assure the timely and appropriate evaluation and treatment of all pregnant trauma patients.

PROTOCOL:

• Initial management is directed at resuscitation and stabilization of the pregnant mother because the fetal life at this point is dependent on her condition.
• Establishment of gestational age is crucial. The fetus becomes viable (able to live outside the mother) at about age 23 weeks gestation.  If the estimated gestational age is greater than or equal to 23 weeks, assessment of fetal status through fetal heart rate monitoring and/or ultrasound should be considered as soon as possible.
• The presence of two patients (mother and fetus) emphasizes the importance of working in concert with an obstetrical consultant.
• The appropriate timing, level of fetal monitoring, and location of fetal    monitoring will be determined after discussion between the OB/GYN    Service and Trauma Service and mutual agreement between the two services as to what would be best in each specific clinical situation.
• Consultation of the OB/GYN Service on less serious trauma patients   (non-Trauma or Trauma Consult patients) will be left to the judgment of the Trauma Surgery and Emergency Medicine physician.
• Obstetrical care will be managed by the OB/GYN Service.
• Labor and Delivery Nursing staff will assess the status of the fetus at the direction of the OB/GYN Service.
• Arrangements to provide this fetal monitoring is the responsibility of the Labor and Delivery Charge Nurse.
• The decision to perform a perimortem cesarean section is complex and should be made by the treating physicians in consultation with the family if possible.

1. OBTS = obstetric teaching service
2. SonoSite ultrasound machine in the trauma bay has an OB package for fetal biometry.
3. If less than 23 weeks gestation, trauma alert patient should be stabilized, then senior OB resident should be called for assessment of fetal status.
4. Documentation of fetal assessment by senior OB resident and OB nurse.
5. Contact OBTS attending and senior OB resident if a seriously injured pregnant woman is arriving by ambulance.  The obstetricians may be able to be present on arrival of the abulance.
6. If planning to deliver patient in Obstetric OR notify the Obstetric OR Supervisor, 304-4503  and CRNA 304-3044.
7. Order Kleihauer-Betke test with significant abdominal trauma.