Trauma and pregnancy

In pregnant women sustaining severe abdominal injuries, the life of both mother and child are at risk. The duration of pregnancy is an important factor, since a small pregnant uterus is well protected against external influences by the bony pelvis. Fetal loss can be expected in 20 to 34 per cent of seriously injured patients; this is the result of placental separation with hemorrhage, uterine laceration, fetal head injury, or umbilical cord compression. Maternal shock and hemorrhage induce catecholamine-mediated uterine artery vasoconstriction and decreased uteroplacental perfusion. Maternal circulation is compensated at the expense of fetal circulation. Maternal mortality is not changed compared with non-pregnant patients. Fetal outcome has been related to injury severity scores, serum lactate, and serum bicarbonate levels, which correspond to placental hypoperfusion and hypoxia. Wearing seat belts does not increase the rate of fetal loss.

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