Management of Trauma in Pregnancy: A Practical Approach to Evidence Based Care

Abstract

Introduction: Trauma averagely affects one per 12 pregnancies and is a major non-obstetric cause of mortality among pregnant women, as well as fetal outcomes. Considering the change in therapeutic approaches base on several studies on the management of trauma in pregnancy, it is necessary to update the provided care. Therefore, this review study was performed with aim to collect the optimal care for pregnant patients with trauma using an evidence-based approach based on the most updated articles and guidelines. Methods: In this review study, all articles and guidelines were searched without time limitation in databases such as Irandoc, Magiran, Scopus, Up-to-date, Science direct, Google Scholar, PubMed, Web of science, Cochrane Library, CINAHL, and Medline using the keywords such as “Trauma” and “pregnancy” and their Persian equivalents by two researchers. After searching, the content of all available articles and guidelines was evaluated to find the most relevant evidence. Results: Based on the results of the reviewed studies and guidelines, assessment and management of traumatized pregnant women requires a coordinated approach from a team of professionals. Furthermore, in all reviewed articles, the primary objective of treating victims of trauma in pregnancy was to stabilize the mother's condition and then evaluation of the fetus condition. Primary care of pregnant women similar to that of non-pregnant women is based on the principles of Advanced Cardiac Life Sup­port (ACLS). Some of the unique aspects of this procedure include early intubation, resuscitation in the left lateral decubitus position or with manual displacement of uterus, and performing perimortem cesarean section. Routine screening of women for domestic violence, recommending the correct use of a seat belt and not turning off the airbag while driving are from the important strategies to reduce the traumatic effects in pregnancy. Conclusion: According to the evidence, management of trauma in pregnancy should be done as a team and with regard to specific aspects and changes of this period. The use of strategies to prevent trauma also have a significant role in reducing the effects of this complication in pregnancy.

Keywords

• advanced cardiac life sup­port
• cesarean section
• domestic violence
• pregnancy
• trauma