Abstract
Trauma is the leading cause of non-pregnancy-related maternal death in the United States. Despite advances in treatment maternal and fetal outcomes are often poor. Women of childbearing age sustaining traumatic injury should be evaluated for possible pregnancy. Physiologic changes of pregnancy influence the evaluation and management of trauma. Medical treatment should be guided by maternal needs in order to optimize maternal and fetal outcomes. Maternal cardiac arrest should prompt consideration of emergent cesarean section. Anesthesiologists play a critical role in integrating the physiology of pregnancy with life support and trauma protocols and can help reduce morbidity and mortality.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Mirza FG, Devine PC, Gaddipati S. Trauma in pregnancy: a systematic approach. Am J Perinatol. 2010;22(7):579–86.
Pearlman MD. Motor vehicle crashes, pregnancy loss and preterm labor. Int J Gynaecol Obstet. 1997;57(2):127–32.
Ikossi DG, Lazar AA, Morabito D, et al. Profile of mothers at risk: an analysis of injury and pregnancy loss in 1,195 trauma patients. J Am Coll Surg. 2005;200:49–56.
Mattox KL, Goetzl L. Trauma in pregnancy. Crit Care Med. 2005;33(Suppl):S385–9.
El Kady D. Perinatal outcomes of traumatic injuries during pregnancy. Clin Obstet Gynecol. 2007;50:582–91.
Chames MC, Pearlman MD. Trauma during pregnancy: outcomes and clinical management. Clin Obstet Gynecol. 2008;51:398–408.
Aboutanos SB, Aboutanos MG, Dompkowski D, et al. Predictors of fetal outcome in pregnant trauma patients: a five-year institutional review. Am Surg. 2007;73:824–7.
Horon IL. Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality. Am J Public Health. 2005;95:478–82.
Horon IL, Cheng D. Effectiveness of pregnancy check boxes on death certificates in identifying pregnancy-associated mortality. Public Health Rep. 2011;126:195–200.
Fildes J, Reed L, Jones N, et al. Trauma: the leading cause of maternal death. J Trauma. 1992;32:643–5.
Harper M, Parsons L. Maternal deaths due to homicide and other injuries in North Carolina: 1992–1994. Obstet Gynecol. 1997;90:920–3.
Dannenberg AL, Carter DM, Lawson HW, et al. Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991. Am J Obstet Gynecol. 1995;172:1557–64.
Pearlman MD, Tintinalli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–7.
Schiff MA, Holt VL, Daling JR. Maternal and infant outcomes after injury during pregnancy in Washington state from 1989 to 1997. J Trauma. 2002;53:939–45.
Pak LL, Reece EA, Chan L. Is adverse pregnancy outcome predictable after blunt abdominal trauma? Am J Obstet Gynecol. 1998;179:1140–4.
El-Kady D, Gilbert WM, Anderson J, et al. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol. 2004;190:1661–8.
Schiff MA, Holt VL. Pregnancy outcomes following hospitalization for motor vehicle crashes in Washington state from 1989 to 2001. Am J Epidemiol. 2005;161:503–10.
Weiss HB, Songer TJ, Fabio A. Fetal deaths related to maternal injury. JAMA. 2001;286:1863–8.
Kuo C, Jamieson DJ, McPheeters ML, et al. Injury hospitalizations of pregnant women in the United States, 2002. Am J Obstet Gynecol. 2007;196:161.e1–6.
Hill C. Trauma in the obstetrical patient. Womens Health. 2009;5:269–85.
Hyde LK, Cook LJ, Olson LM, et al. The effect of motor vehicle crashes on adverse fetal outcomes. Obstet Gynecol. 2003;102:279–86.
Patteson SK, Snider CC, Meyer DS, et al. The consequence of high-risk behaviors: trauma during pregnancy. J Trauma. 2007;62:1015–20.
Gazmararian JA, Lazorick S, Spitz AM, et al. Prevalence of violence against pregnant women. JAMA. 1996;275:1915–20.
Tinker SC, Reefhuis J, Dellinger AM, et al. National Birth Defects Prevention Study. Epidemiology of maternal injuries during pregnancy in a population-based study, 1997–2005. J Womens Health (Larchmont). 2010;19:2211–8.
Fischer PE, Zarzaur BL, Fabian TC, et al. Minor trauma is an unrecognized contributor to poor fetal outcomes: a population-based study of 78,552 pregnancies. J Trauma. 2011;71:90–3.
Sperry JL, Casey BM, McIntyre DD, et al. Long-term fetal outcomes in pregnant trauma patients. Am J Surg. 2006;192:715–21.
Schiff MA, Holt VL. The injury severity score in pregnant trauma patients: predicting placental abruption and fetal death. J Trauma. 2002;53:946–9.
Biester EM, Tomich PG, Esposito TJ, et al. Trauma in pregnancy: normal revised trauma score in relation to other markers of maternofetal status–a preliminary study. Obstet Gynecol. 1997;176:1206–12.
Baerga-Varela Y, Zietlow SP, Bannon MP, et al. Trauma in pregnancy. Mayo Clin Proc. 2000;75:1243–8.
Tweddale CJ. Trauma during pregnancy. Crit Care Nurs Q. 2006;29:53–67.
Shah KH, Simons RK, Holbrook T, et al. Trauma in pregnancy: maternal and fetal outcomes. J Trauma. 1998;45:83–6.
American College of Obstetricians and Gynecologists. ACOG educational bulletin Obstetric aspects of trauma management. Number 251, September 1998 (replaces Number 151, January 1991, and Number 161, November 1991). Int J Gynaecol Obstet. 1999;64:87–94.
Romero VC, Pearlman M. Mortality due to trauma. Semin Perinatol. 2012;36:60–7.
Petrone P, Talving P, Browder T, et al. Abdominal injuries in pregnancy: a 155-month study at two level 1 trauma centers. Injury. 2011;42:47–9.
Theodorou DA, Velmahos GC, Souter I, et al. Fetal death after trauma in pregnancy. Am Surg. 2000;66:809–12.
Leggon RE, Wood GC, Indeck MC. Pelvic fractures in pregnancy: factors influencing maternal and fetal outcomes. J Trauma. 2002;53:796–804.
Aboutanos MB, Aboutanos SZ, Dompkowski D, et al. Significance of motor vehicle crashes and pelvic injury on fetal mortality: a five year institutional review. J Trauma. 2008;65:616–20.
Cannada LK, Pan P, Casey BM, et al. Pregnancy outcomes after orthopedic trauma. J Trauma. 2010;69:694–8.
El Kady D, Gilbert WM, Xing G, et al. Association of maternal fractures with adverse perinatal outcomes. Am J Obstet Gynecol. 2006;195:711–6.
Lavery JP, Staten-McCormick M. Management of moderate to severe trauma in pregnancy. Obstet Gynecol Clin North Am. 1995;22:69–90.
Tinker SC, Reefhuis J, Dellinger AM, et al. Epidemiology of maternal injuries during pregnancy in a population-based study, 1997–2005. J Womens Health. 2010;19:2211–8.
Kvarnstrand L, Milsom I, Lekander T, et al. Maternal fatalities, fetal and neonatal deaths related to motor vehicle crashes during pregnancy: a national population-based study. Acta Obstet Gynecol Scand. 2008;87:946–52.
Pearlman MD, Philips ME. Safety belt use during pregnancy. Obstet Gynecol. 1996;88:1026–9.
Schiff M, Albers L, McFeely P. Motor vehicle crashes and maternal mortality in New Mexico: the significance of seat belt use. West J Med. 1997;167:19–22.
Motozawa Y, Hitosugi M, Abe T, Tokudome S. Effects of seat belts worn by pregnant drivers during low-impact collisions. Am J Obstet Gynecol. 2010;203:62.e1–8.
Metz T, Abbott JT. Pregnancy after motor vehicle crashes with airbag deployment: a 30-case series. J Trauma. 2006;61:658–61.
Sirin H, Weiss HB, Sauber-Schatz EK, et al. Seat belt use, counseling and motor-vehicle injury during pregnancy: results from a multi-state population-based survey. Matern Child Health J. 2007;11:505–10.
Klinich KD, Flannagan CAC, Rupp JD, et al. Fetal outcome in motor-vehicle crashes: effect of crash characteristics and maternal restraint. Am J Obstet Gynecol. 2008;198:450.e1–9.
Astarita DC, Feldman B. Seat belt placement resulting in uterine rupture. J Trauma. 1997;42:738–40.
Fusco A, Kelly K, Winslow J. Uterine rupture in a motor vehicle crash with airbag deployment. J Trauma. 2001;51:1192–4.
Schultze PM, Stamm CA, Roget J. Placental abruption and fetal death with airbag deployment in a motor vehicle accident. Obstet Gynecol. 1998;92(Pt 2):719.
Schiff MA, Mack CD, Kaufman RP, et al. The effect of airbags on pregnancy outcomes in Washington State. Obstet Gynecol. 2010;115:85–92.
Mendez-Figueroa H, Dahlke JD, Vrees RA, et al. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013;209:1–10.
Kady E, Gilbert WM, Xing G, et al. Maternal and neonatal outcomes of assaults during pregnancy. Obstet Gynecol. 2005;105:357–63.
Connolly AM, Katz VL, Bash KL, et al. Trauma and pregnancy. Am J Perinatol. 1997;14:331–6.
Schiff MA. Pregnancy outcomes following hospitalization for a fall in Washington state from 1987 to 2004. BJOG. 2008;115:1648–54.
Dunning K, Lemasters G, Bhattacharya A. A major public health issue: the high incidence of falls during pregnancy. Matern Child Health J. 2010;14:720–5.
Lymberly JK, Gilleard W. The stance phase of walking during late pregnancy; temporospatial and ground reaction force variables. J Am Podiatr Med Assoc. 2005;95:247–53.
Butler EE, Colon I, Druzing ML, et al. Postural equilibrium during pregnancy: decreased stability with an increased reliance on visual cues. Am J Obstet Gynecol. 2006;195:1104–8.
Fries EC, Hellebrandt FA. The influence of pregnancy on the location of the center of gravity, postural stability, and body alignment. Am J Obstet Gynecol. 1943;46:374–80.
McCrory JL, Chambers AJ, Daftary A, Redfern MS. Dynamic postural stability during advancing pregnancy. J Biomech. 2010;43:2434–9.
Palladino CL, Singh V, Campbell J, et al. Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstet Gynecol. 2011;118:1056–63.
Shadigian E, Bauer ST. Pregnancy-associated death: a qualitative systematic review of homicide and suicide. Obstet Gynecol Surv. 2005;60(3):183–90.
Krulewitch CJ, Pierre-Louis ML, de Leon-Gomez R, et al. Hidden from view: violent deaths among pregnant women in the District of Columbia, 1988–1996. J Midwifery Womens Health. 2001;46(1):4–10.
Sachs BP, Brown DA, Driscoll SG, et al. Maternal mortality in Massachusetts. Trends and prevention. N Engl J Med. 1987;316(11):667–72.
Ho EM, Brown J, Graves W, et al. Maternal death at an inner-city hospital, 1949–2000. Am J Obstet Gynecol. 2002;187(5):1213–6.
Thaden P, Thoennes N. Extent, nature and consequences of intimate partner violence: findings from the national violence against women survey. Washington, DC: US Department of Justice; 2000.
Truman JS. National criminal victimization survey: criminal victimization, 2010. Washington, DC: US Department of Justice, Bureau of Justice Statistics; 2011. http://www.bjs.gov/content/pub/pdf/cv10.pdf.
Ribe JK, Teggatz JR, Harvey CM. Blows to the maternal abdomen causing fetal demise: report of three cases and a review of the literature. J Forensic Sci. 1993;38:1092–6.
Dietz PM, Rochat RW, Thompson BL, et al. Differences in the risk of homicide and other fatal injuries between postpartum women and other women of childbearing age: implications for prevention. Am J Public Health. 1998;88:641–3.
Horon IL, Cheng D. Enhanced surveillance for pregnancy-associated mortality—Maryland, 1993–1998. JAMA. 2001;285:1455–9.
Lin P, Gill LR. Homicides of pregnant women. Am J Forensic Med Pathol. 2011;32:161–3.
Wiencrot A, Nannini A, Manning SE, et al. Neonatal outcomes and mental illness, substance abuse, and intentional injury during pregnancy. Matern Child Health J. 2012;16:979–88.
Chang J, Berg CJ, Saltzman LE, et al. Homicide: a leading cause of injury deaths among pregnancy and postpartum women in the United States, 1991–1999. Am J Public Health. 2005;95:471–7.
Ghandi SG, Gilbert WM, McElvy SS, et al. Maternal and neonatal outcomes after attempted suicide. Obstet Gynecol. 2006;107:984–90.
Schiff MA, Grossman DC. Adverse perinatal outcomes and risk for postpartum suicide attempt in Washington state, 1987-2001. Pediatrics. 2006;118:e669–75.
Maghsoudi H, Samnia R, Garadaghi A, et al. Burns in pregnancy. Burns. 2006;32:246–50.
Guo SS, Greenspoon JS, Kahn AM. Management of burn injuries during pregnancy. Burns. 2001;27:394–7.
Chama CM, Na’aya HU. Severe burn injury in pregnancy in northern Nigeria. J Obstet Gynaecol. 2002;22:20–2.
Van Haren RM, Thorsen CM, Valle EJ, et al. Hypercoagulability after burn injury. J Trauma Acute Care Surg. 2013;75:37–43, discussion 43.
Rode H, Millar AJ, Cywes S, et al. Thermal injury in pregnancy—the neglected tragedy. S Afr Med J. 1990;77:346–8.
Karimi H, Momeni M, Rahbar H. Burn injuries during pregnancy in Iran. Int J Gynaecol Obstet. 2009;104:132–4.
Roderique JD, Gebre-Giorgis AA, Stewart DH, et al. Smoke inhalation injury in a pregnant patient: a literature review of the evidence and current best practices in the setting of a classic case. J Burn Care Res. 2012;33:624–33.
Fatovich DM. Electric shock in pregnancy. J Emerg Med. 1993;11:175–7.
Einarson A, Bailey B, Inocencion G, et al. Accidental electric shock in pregnancy: a prospective cohort study. Am J Obstet Gynecol. 1997;176:678–81.
Rayburn W, Aronow R, DeLancey B, et al. Drug overdose during pregnancy an overview from a metropolitan poison control center. Obstet Gynecol. 1984;64:611–4.
Perrone J, Hoffman RS. Toxic injestions in pregnancy: abortifacient use in a case series of overdose patients. Acad Emerg Med. 1997;4:206–9.
Bailey B. Are there teratogenic risks associated with antidotes used in the acute management of the poisoned pregnant woman? Birth Defects Res A Clin Mol Teratol. 2003;67:133–40.
Hardt N, Wong TD, Burt MJ, et al. Prevalence of prescription and illicit drugs in pregnancy-associated non-natural deaths of Florida mothers, 1999–2005. J Forensic Sci. 2013. doi:10.1111/1556-4029.12219.
Brown SA, Seifert S, Rayburn WF. Management of envenomations during pregnancy. Clin Toxicol (Phila). 2013;51:3–15.
Brookfield KF, Gonzalez-Quintero VH, Davis JS, et al. Maternal death in the emergency department from trauma. Arch Gynecol Obstet. 2013;288(3):507–12. doi:10.1007/s00404-013-2772-5.
Crosby WM. Traumatic injuries in pregnancy. Clin Obstet Gynecol. 1983;26:902–12.
American College of Obstetricians and Gynecologists. Committee on Obstetric Practice Safety for Maternal-Fetal Medicine. Committee Opinion No. 573: magnesium sulfate use in obstetrics. Obstet Gynecol. 2013;122:727–8.
Doyle LW, Crowther CA, Middleton P, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009;(1):Art. No.: CD004661. doi:10.1002/14651858.CD004661.pub3.
Ali J, Yeo A, Gana TJ, et al. Predictors of fetal mortality in pregnant trauma patients. J Trauma. 1997;42:782–5.
Barraco RD, Chiu WC, Clancy TV, et al. Practice management guidelines for the diagnosis and management of injury in the pregnant patient: the EAST practice management guidelines work group. J Trauma. 2010;69:211–4.
Pearlman M, Tintinalli J. Evaluation and treatment of the gravida and fetus following trauma during pregnancy. Obstet Gynecol Clin North Am. 1991;18(2):371–80.
Shah AJ, Kilcane BA. Trauma in pregnancy. Emerg Med Clin North Am. 2003;21:615–29.
Ellingsen CL, Eggebø TM, Lexow K. Amniotic fluid embolism after blunt abdominal trauma. Resuscitation. 2007;75:180–3.
Kramer JS, Rouleau J, Siu S, et al. Amniotic fluid embolism: incidence, risk factors and impact on perinatal outcomes. BJOG. 2012;119:874–9.
Rose G, Strohm P, Zuspan FP. Fetomaternal hemorrhage following trauma. Am J Obstet Gynecol. 1985;153:844–7.
Fujitani S, Baldisseri MR. Hemodynamic assessment in a pregnant and peripartum patient. Crit Care Med. 2005;33(10 Suppl):S354–61.
Pilkington S, Carli F, Dakin MJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74(6):638–42.
Collins JS, Lemmens HJ, Brodsky JB, et al. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obes Surg. 2004;14(9):1171–5.
El-Orbany M, Woehlck M, Salem MR. Head and neck position for direct laryngoscopy. Anesth Analg. 2011;113(1):103–9.
Robitaille A, Williams SR, Tremblay MH, et al. Cervical spine motion during tracheal intubation with manual in-line stabilization: direct laryngoscopy versus GlideScope® videolaryngoscopy. Anesth Analg. 2008;106:935–41.
Maruyama K, Yamada T, Kawakami R, et al. Randomized cross-over comparison of cervical-spine motion with the AirWay Scope or Macintosh laryngoscope with in-line stabilization: a video-fluoroscopic study. Br J Anaesth. 2008;101:563–7.
Yeatts DJ, Dutton RP, Hu PF, et al. Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. J Trauma Acute Care Surg. 2013;75:212–9.
Quinn AC, Milne D, Columb M, et al. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case–control study in the UK. Br J Anaesth. 2013;110:74–80.
Gress Jr FC. Uterine vascular response to hemorrhage during pregnancy, with observations on therapy. Obstet Gynecol. 1966;27(4):549–54.
John PR, Shiozawa A, Haut ER, et al. An assessment of the impact of pregnancy on trauma mortality. Surgery. 2011;149:94–8.
Wilkening RB, Mescha G. Fetal oxygen uptake, oxygenation, and acid-base balance as a function of uterine blood flow. Am J Physiol. 1983;244(6):H749–55.
Advanced Trauma Life Support (ATLS) for doctors. Chicago: American College of Surgeons Committee on Trauma; 2012. http://www.facs.org/trauma/atls/index.html.
Shackford SR, Hollingworth-Fridlund P, Cooper GF, et al. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma. 1986;26(9):812–20.
Sasser SM, Hunt RC, Faul M, et al. Center for Disease Control and Prevention (CDC). Guidelines for field triage of injured patients. Recommendations of the national expert panel on field triage, 2011. MMWR Recomm Rep. 2012;61(RR-1):1–20.
Brown JB, Stassen NA, Bankey PE, et al. Mechanism of injury and special consideration criteria still matter: an evaluation of the national trauma triage protocol. J Trauma. 2011;70:38–44, discussion 44–5.
Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S829–61.
Siddiqui N, Goldszmidt E, Haque SU, Carvalho JCA. Ultrasound simulation of internal jugular vein cannulation in pregnant and nonpregnant women. Can J Anaesth. 2010;57:966–72.
Chatterjee DJ, Bukunola B, Samuels TL, et al. Resuscitation in massive obstetric haemorrhage using an intraosseous needle. Anaesthesia. 2011;66(4):306–10.
NAMET. PHTLS Trauma First Response. St. Louis, MO: Mosby/JEMS; 2011.
Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated reported by the American Society of Anesthesiologists Task force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198–208.
Mittermayr M, Streif W, Haas T, et al. Hemostatic changes after crystalloid or colloid fluid administration during major orthopedic surgery: the role of fibrinogen administration. Anesth Analg. 2007;105:905–17.
Thorsen K, Ringdal KH, Strand K, et al. Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major surgery. Br J Surg. 2011;98:894–907.
Morgan TJ, Venkatesh B, Hall J. Crystalloid strong ion difference determines metabolic acid-base change during acute normovolaemic haemodilution. Intensive Care Med. 2004;30:1432–7.
Bulger EM, May S, Kerby JD, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized controlled trial. Ann Surg. 2011;253:431–41.
Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291:1350–7.
Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013;369:1243–51.
Duke MD, Guidry C, Guice J, Stuke L, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg. 2012;73:674–8.
The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.
The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357:874–84.
Winstedt D, Hanna J, Schött U. Albumin-induced coagulopathy is less severe and more effectively reversed with fibrinogen than is synthetic colloid-induced coagulopathy. Scand J Clin Lab Invest. 2013;73(2):161–9.
Hartog CS, Kohl M, Reinert K. A systemic review of third-generation hydroxyethyl starch (HES 130/0.4) in resuscitation: safety not adequately addressed. Anesth Analg. 2011;112:635–45.
Caballo C, Escolar G, Diaz-Ricart M, et al. Impact of experimental haemodilution on platelet function, thrombin generation and clot firmness: effects of different coagulation factor concentrates. Blood Transfus. 2013;11:391–9.
Haase N, Perner A. Hydroxyethyl starch for resuscitation. Curr Opin Crit Care. 2013;19(4):321–5.
FDA Safety Communication: Boxed Warning on increased mortality and severe renal injury, and additional warning on risk of bleeding, for use of hydroxyethyl starch solutions in some settings. June 24, 2013. http://www.fda.gov/biologicsbloodvaccines/safetyavailability/ucm358271.htm.
Kauvar DS, Wade CE. The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care. 2005;9 Suppl 5:S1–9.
Duchesne JC, McSwain NE, Cotton BA, et al. Damage control resuscitation: the new face of damage control. J Trauma. 2010;69:976–90.
Holcomb JB, Hess JR. Early massive trauma transfusion: state of the art. J Trauma. 2006;60:1.
Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248:447–58.
Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307–10.
Dries DH. Hypotensive resuscitation. Shock. 1996;6:311–6.
Doreide E, Deaken CD. Pre-hospital fluid therapy in the critically injured patient—a clinical update. Injury. 2005;35:1001–10.
Karpati PCJ, Rossignol M, Pirot M, et al. High incidence of myocardial ischemia during postpartum hemorrhage. Anesthesiology. 2004;100:30–6.
Palmer RM. Postpartum hemorrhage is not the only setting for maternal myocardial ischemia. Anesthesiology. 2004;101:1035–7.
Sihler KC, Napolitano NM. Complications of massive transfusion. Chest. 2010;137:209–20.
Duchesne JC, Hunt JP, Wahl G, et al. Review of current blood transfusion strategies in a mature level I trauma center: we were wrong for the last 60 years? J Trauma. 2008;65:272–6.
Teixeria PG, Inaba K, Shulman I, et al. Impact of plasma transfusion in massive transfused trauma patients. J Trauma. 2009;66:693–7.
Murad MH, Stubbs JR, Gandhi MJ, et al. The effect of plasma transfusion on morbidity and mortality: a systematic review and meta-analysis. Transfusion. 2010;50:1370–83.
Johansson PI, Oliveri R, Ostrowski SR. Hemostatic resuscitation with plasma and platelets in trauma. A meta-analysis. J Emerg Trauma Shock. 2012;5:120–5.
Holcomb JB, Zarzabal LA, Michalek JE, et al. Trauma Outcomes Group: increased platelet: RBC ratios are associated with improved survival after massive transfusion. J Trauma. 2011;71(2 Suppl 3):S318–28.
Ho KM, Leonard A. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39:46–54.
Snegovskikh D, Clebone A, Norwitz E. Anesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage. Curr Opin Anaesthesiol. 2011;24:274–81.
Ho KM, Leonard A. Risk factors associated with hypomagnesemia in massive transfusion. Transfusion. 2011;51(2):270–6.
Chaiwat O, Lang JD, Vavilala MS, et al. Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. Anesthesiology. 2009;110:351–60.
Stansbury LG, Dutton RP, Stein DM, et al. Controversy in trauma resuscitation: do ratios of plasma to red blood cells matter? Transfus Med Rev. 2009;23:255–65.
Allen SR, Kashuk JL. Unanswered questions in the use of blood component therapy in trauma. Scand J Trauma Resusc Emerg Med. 2011;19:5.
Nascimento B, Callum J, Rubenfeld G, et al. Clinical review: fresh frozen plasma in massive bleedings-more questions than answers. Crit Care. 2010;14:202.
Spahn DR, Cerny V, Coasts TJ. Management of bleeding following major trauma: a European guideline. Crit Care. 2007;11:R17.
Grasseto A, De Nardin M, Ganzerla B, et al. ROTEM® guided coagulation factor concentrate therapy in trauma: 2-year experience in Venice, Italy. Crit Care. 2012;16:428.
Schöchl H, Maegele M, Solomon C, et al. Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med. 2012;20:15.
Schöchl H, Schlimp CJ. Trauma bleeding management: the concept of goal-directed primary care. Anesth Analg. 2013. doi:10.1213/ANE.0b013e318270a6f7.
Fries D, Innerhofer P, Schobersberger W. Time for changing coagulation management in trauma-related massive bleeding. Curr Opin Anaesthesiol. 2009;22:267–74.
Brohi K, Singh J, Heron M, et al. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–30.
Brohi K, Cohen MH, Gantner MT, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008;65:1211–7.
Wolberg AS, Meng ZH, Monroe III DM, et al. A systematic evaluation of the effects of temperature on coagulation enzyme activity and platelet function. J Trauma. 2004;56:1221–8.
Kostousov V, Wang YW, Cotton BA, et al. Influence of resuscitation fluids, fresh frozen plasma and fibrinolytics on fibrinolysis in a thromboelastography-based, in-vitro, whole-blood model. Blood Coagul Fibrinolysis. 2013;24:489–97.
CRASH-2 Trial Collaborators. Effects of TXA on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized placebo-controlled trial. Lancet. 2010;376:2–32.
CRASH-2 Trial Collaborators. Effect of TXA in traumatic brain injury: a nested randomized, placebo controlled trial. CRASH-2 Intracranial Bleeding Study. BMJ. 2011;343:d3795. doi:10.1136/bmj.d3795.
Huang F, Wu D, Ma G, et al. The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: a metaanalysis. J Surg Res. 2014;186(1):318–27. doi:10.1016/j.jss.2013.08.020.
Rappold JF, Pusateri AE. Tranexamic acid in remote damage control resuscitation. Transfusion. 2013;53:96S–9.
Shakur H, Elbourn D, Gülmezoglu M, et al. The WOMAN Trial World Maternal Antifibrinolytic Trial: tranxexamic acid for post-partum haemorrhage: an international randomized, double blind placebo controlled trial. Trials. 2010;11:40. doi:10.1186/1745-6215-11-40.
Sentürk M, Cakmak Y, Yildiz G, et al. Tranexamic acid for cesarean section: a double-blind placebo-controlled randomized clinical trial. Arch Gynecol Obstet. 2013;287:641–5.
Levy JH, Szlam F, Tanaka KA, et al. Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding. Anesth Analg. 2012;114:261–74.
Hiippala ST, Myllyla GJ, Vahtera EM. Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg. 1995;81:360–5.
Sørensen B, Spahn DR, Innerhofer P, et al. Clinical review: prothrombin complex concentrates—evaluation of safety and thrombogenicity. Crit Care. 2011;15:201.
David JS, Godier A, Dargaud Y, et al. Case scenario: management of trauma-induced coagulopathy in a blunt trauma patient. Anesthesiology. 2013;119:191–200.
Boffard KD, Riou B, Warren B, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma. 2005;58:8–15.
Kobayashi T, Nakabayashi M, Yoshioka A, et al. Recombinant activated factor VII (rFVIIA/NovoSeven®) in the management of severe postpartum haemorrhage: initial report of a multicentre case series in Japan. Int J Hematol. 2012;95:157–63.
Huber AW, Raio L, Alberio L, et al. Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study. J Perinat Med. 2011;40:43–9.
Seoud M, Cheaib S, Birjawi G, et al. Successful treatment of severe retroperitoneal bleeding with recombinant factor VII in a woman with placenta percreata invading into the left broad ligament: unusual repeated antepartum intra-abdominal bleeding. J Obstet Gynaecol Res. 2010;36:183–6.
Nohira T, Osakabe Y, Suda S, et al. Successful management by recombinant activated factor VII in a case of disseminated intravascular coagulopathy caused by obstetric hemorrhage. J Obstet Gynaecol Res. 2008;34:623–30.
Fries D. The early use of fibrinogen, prothrombin complex concentrate, and recombinant-activated factor VIIIa in massive bleeding. Transfusion. 2013;53:91S–5.
Frank LR. Is MAST in the past? The pros and cons of MAST usage in the field. FEMS. 2000;25:38–41, discussion 44–5.
Pease CS, Magrina JF, Finely BE. The use of MAST suit in obstetrics and gynecology. Obstet Gynecol Surv. 1984;39:416–22.
Miller S, Martin HB, Moris JL. Anti-shock garment in post-partum haemorrhage. Best Pract Res Clin Obstet Gynecol. 2008;22(6):1057–74.
Sutherland T, Downing J, Miller S, et al. Use of the non-pneumatic anti-shock garment (NASG) for life-threatening obstetric hemorrhage: a cost-effectiveness analysis in Egypt and Nigeria. PLoS One. 2013;8(4):62282. doi:10.1371/journal.pone.0062282.
Lester F, Stenson A, Meyer C, et al. Impact of the Non-pneumatic Antishock Garment on pelvic blood flow in healthy postpartum women. Am J Obstet Gynecol. 2011;204:409.e1–5.
Abdelazin A. Fetal Fibronectin (Quick Check fFN test®) for detection of premature rupture of fetal membranes. Arch Gynecol Obstet. 2013;287(2):205–10.
van der Ham DP, van Teefelen AS, Mol BW. Prelabor rupture of membranes: overview of diagnostic methods. Curr Opin Obstet Gynecol. 2012;24(6):408–12.
Macones GA, Hankins GD, Spong CY, et al. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol. 2008;112(3):661–6.
Muehnch MV, Baschat AA, Reddy UM, Mighty HE, Weinder CP, Scalea TM, Harman CR. Kleihauer-Betke testing is important in all cases of maternal trauma. J Trauma. 2004;57(5):1094–8.
Kim YA, Makar RS. Detection of fetomaternal hemorrhage. Am J Hematol. 2012;87(4):417–23.
Chambers E, Davies L, Evans S, et al. Comparison of haemoglobin F detection by the acid elution test, flow cytometry and high-performance liquid chromatography in maternal blood samples analyzed for fetomaternal haemorrhage. Transfus Med. 2012;22(3):199–204.
Cosmi E, Rampon M, Saccardi C, Zanardo V, Litta P. Middle cerebral artery peak systolic velocity in the diagnosis of fetomaternal hemorrhage. Int J Gynaecol Obstet. 2012;117(2):128–30.
Nguyen CP, Goodman LH. Fetal risk in diagnostic radiology. Semin Ultrasound CT MRI. 2012;33:4–10.
Sadro C, Bittle M, O’Connell K. Imaging the pregnant trauma patient. Ultrasound Clin. 2011;6:97–103.
Yousefzadeh D, Ward M, Reft C. Internal barium shielding to minimize fetal irradiation in spiral CT: a phantom simulation experiment. Radiology. 2006;239:751–8.
Webb JA, Thomsen HS, Morcos SK. Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005;15:1234–40.
Ma OJ, Mateer JR, DeBehnke DJ. Use of ultrasonography for the evaluation of pregnant trauma patients. J Trauma. 1996;40(4):665–8.
Goodwin H, Holmes JF, Wisner DH. Abdominal ultrasound examination in pregnant trauma patients. J Trauma. 2001;50:689.
Bochiocchio GV, Haan J, Scalea TM. Surgeon-performed focused assessment with sonography for trauma as an early screening tool for pregnancy after trauma. J Trauma. 2002;52(6):1125–8.
Sadro C, Bernstein MP, Kanal KM. Imaging of Trauma: part 2, abdominal trauma and pregnancy—a radiologist’s guide to doing what is best for the mother and baby. AJR Am J Roentgenol. 2012;199:1207–19.
Rothenberger DA, Quattlebaum FW, Zabel J, et al. Diagnostic peritoneal lavage for blunt trauma in pregnant women. Am J Obstet Gynecol. 1977;129(5):479–81.
Scorpio RJ, Esposito TJ, Smith LG, et al. Blunt trauma during pregnancy: factors affecting fetal outcome. J Trauma. 1992;32(2):213–6.
National Spinal Cord Injury Statistics Center. UAB spinal cord injury info sheet #15. Birmingham, AL: University of Alabama; 2009. https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202012%20Feb%20Final.pdf. Updated February 2012. Accessed 12 Oct 2013.
Ghidini A, Simonson MR. Pregnancy after spinal cord injury: a review of the literature. Top Spinal Cord Inj Rehabil. 2011;16(3):93–103.
Furlan JC. Autonomic dysreflexia—a clinical emergency. J Trauma Acute Care Surg. 2013;75:496–500.
Hughes SJ, Short DJ, Usherwood MM, et al. Management of the pregnant woman with spinal cord injuries. Br J Obstet Gynaecol. 1991;98(6):513–8.
Krassioukov A, Warburton DE, Teasell R, et al. A systematic review of the treatment of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):682–95.
Katz VL, Thorp Jr JM, Cefalo RC. Epidural analgesia and autonomic hyperreflexia: a case report. Am J Obstet Gynecol. 1990;162(2):471–2.
Periera L. Obstetric management of the patient with spinal cord injury. Obstet Gynecol Surv. 2003;58(10):678–87.
Owen MD, Stiles MM, Opper SE, et al. Autonomic hyperreflexia in a pregnant paraplegic patient. Case report. Reg Anesth. 1994;19(6):415–7.
Takatsuki A, Ohtsuka M. Clinical trial of a method for confirming the effects of spinal anesthesia in patients with spinal cord injury. J Anesth. 2012;26(6):914–7.
Camune BD. Challenges in the management of pregnant women with spinal cord injury. J Perinat Neonatal Nurs. 2013;27(3):225–31.
Biderman P, Einav S, Fainblut M, et al. Extracorporeal life support in patients with multiple injuries and severe respiratory failure: a single-center experience. J Trauma Acute Care Surg. 2013;75:907–12.
Ried M, Bein T, Philipp A, et al. Extracorporeal lung support in trauma patients with severe chest injury and acute lung failure: a 10-year institutional experience. Crit Care. 2013;17:R110. http://ccforum.com/content/17/3/R110.
Plotkin JS, Shah JB, Lofland GK, et al. Extracorporeal membrane oxygenation in the successful treatment of traumatic adult respiratory distress syndrome: case report and review. J Trauma. 1994;37(1):127–30.
Cunningham JA, Devine PC, Jelic S. Extracorporeal membrane oxygenation in pregnancy. Obstet Gynecol. 2006;103:792–5.
King PT, Rosalion A, McMillan J, et al. Extracorporeal membrane oxygenation in pregnancy. Lancet. 2000;356:45–6.
Robertson LC, Allen SH, Konamme SP, et al. The use of extra-corporeal membrane oxygenation in the case of a pregnant woman with severe h1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int J Obstet Anesth. 2010;19:443–7.
Grasselli G, Bombino M, Patroniti P, et al. Use of extracorporeal respiratory support during pregnancy: a case report and literature review. ASAIO J. 2012;58:281–4.
Ho CH, Chen KB, Liu SK, et al. Early application of extracorporeal membrane oxygenation in a patient with amniotic fluid embolism. Acta Anaesthesiol Taiwan. 2009;47(2):99–102.
Weinberg L, Kay C, Liskaser F, et al. Successful treatment of peripartum massive pulmonary embolism with extracorporeal membrane oxygenation and catheter-directed pulmonary thrombolytic therapy. Anaesth Intensive Care. 2011;39(3):486–91.
Smith IJ, Gillham MJ. Fulminant peripartum cardiomyopathy rescue with extra-corporeal membranous oxygenation. Int J Obstet Anesth. 2009;18(2):186–8.
Ngatchou W, Ramadan AS, Van Nooten G, et al. Left tilt position for easy extracorporeal membrane oxygenation cannula insertion in late pregnancy patients. Interact Cardiovasc Thorac Surg. 2012;15:285–7.
Chapman BC, Moore EE, Barnett C, et al. Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation. Am J Surg. 2013;206:917–23. doi:10.1016/j.amjsurg.2013.07.024.
Harr JN, Moore EE, Ghasabyan A, et al. Functional fibrinogen assay indicates that fibrinogen is critical in correcting abnormal clot strength following trauma. Shock. 2013;39:459. doi:10.1097/SHK.0b013e3182787122.
Hill CC, Pickinpaugh J. Trauma and surgical emergencies in the obstetric patient. Surg Clin North Am. 2008;88:282–7.
Nelson-Piercy C. Chapter 9: Cardiac disease in Center for Maternal and Child Enquiries (CMACE). Saving mother’s lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118:1–203.
Hui D, Morrison LJ, Windrim R, et al. The American Heart Association 2010 guidelines for the management of cardiac arrest in pregnancy: consensus recommendations on implementation strategies. J Obstet Gynaecol Can. 2011;33:858–63.
Morris S, Stacey M. Resuscitation in pregnancy. BMJ. 2003;327:1277–9.
Rees GA, Willis BA. Resuscitation in late pregnancy. Anaesthesia. 1988;43:347–9.
Mathur D, Leon SB. Perimortem caesarean section: a review of the anaesthetist’s nightmare. Trends Anaesth Crit Care. 2013;3(6):327–30. http://x.doi.org/10/10/16/j.tacc.2013.05.002.
Jeejeebhoy FM, Zelop CM, Windrim R, et al. Management of cardiac arrest in pregnancy: a systematic review. Resuscitation. 2011;82:801–9.
Suresh MS, LaToya MC, Munnur U. Cardiopulmonary resuscitation and the parturient. Best Pract Res Clin Obstet Gynaecol. 2010;24:383–400.
Kundra P. Manual displacement of the uterus during Caesarean section. Anaesthesia. 2007;62:460–5.
Nanson J, Elcock D, Williams M, et al. Do physiological changes in pregnancy change defibrillation energy requirements? Br J Anaesth. 2001;87:237–9.
Farinelli CK, Hameed AB. Cardiopulmonary resuscitation in pregnancy. Cardiol Clin. 2012;30:453–61.
Morris Jr JA, Rosenbower TH, Jurkowich GJ, et al. Infant survival after cesarean section for trauma. Ann Surg. 1996;223:481–8.
DePace NL, Betesh JS, Kotler MN. “Postmortem” cesarean delivery with recovery of both mother and offspring. JAMA. 1982;248:971–3.
Katz VL, Dotters DH, Droegmueller W. Perimortem cesarean delivery. Obstet Gynecol. 1986;68:571–6.
Katz VL, Balderston K, DeFreest M. Perimortem cesarean delivery: were our assumptions correct? Am J Obstet Gynecol. 2005;192:1916–20.
Clark SL, Hankins GD, Dudley DA, et al. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol. 1995;172(4 Pt 1):1158–67.
Einav S, Kaufman N, Sela HY. Maternal cardiac arrest and perimortem cesarean delivery: evidence or expert-based? Resuscitation. 2012;83:1191–200.
Center for Maternal and Child Enquiries (CMACE). Saving mother’s lives: reviewing maternal deaths to make motherhood safer: 2006–08. The eighth report on confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118:1–203.
Lipman SS, Wong JY, Arafeh J, et al. Transport decreases the quality of cardiopulmonary resuscitation during simulated maternal cardiac arrest. Anesth Analg. 2013;116:162–7.
Bernstein IM, Watson M, Simmons GM, et al. Maternal brain death and prolonged fetal survival. Obstet Gynecol. 1989;74:734–77.
Mallampalli A, Powner DJ, Gardner MO. Cardiopulmonary resuscitation and somatic support of the pregnant patient. Crit Care Clin. 2004;20:747–61.
Field DR, Gates EA, Creasy RK, et al. Maternal brain death during pregnancy: medical and ethical issues. JAMA. 1988;260:816–22.
Craft Jr JB, Coaldrake LA, Yonekura ML, et al. Ketamine, catecholaimes, and uterine tone in pregnant ewes. Am J Obstet Gynecol. 1983;146(4):429–34.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Hack, A.K.F. (2014). Trauma in the Pregnant Patient. In: Scher, C. (eds) Anesthesia for Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0909-4_16
Download citation
DOI: https://doi.org/10.1007/978-1-4939-0909-4_16
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-0908-7
Online ISBN: 978-1-4939-0909-4
eBook Packages: MedicineMedicine (R0)