Suggested Algorithm for Management of Trauma During Pregnancy

STABILIZATION

• Maintain airway and oxygenation
• Deflect uterus to left
• Maintain circulatory volume
• Secure cervical spine if head or neck injury suspected
• Obstetrical consultation (if not done already. Ob should be notified along with the trauma team
  if a known pregnant ob trauma victim is in transport)

COMPLETE EXAMINATION

• Control external hemorrhage
• Identify/stabilize serious injuries
• Examine uterus
• Pelvic examination to identify ruptured membranes or vaginal bleeding
• Obtain initial blood work (including Kleihauer-Betke test if Rh negative)

Presence of:

• More than 4 uterine contractions in any one hour
• Rupture of amnionic membranes
• Vaginal bleeding
• Serious maternal injury
• Fetal tachycardia; late decelerations; non-reassuring tracing

Other definitive treatment (may be done concomitant
with monitoring):

• Suture lacerations
• Necessary x-rays
• Anti-D globulin if indicated
• Tetanus toxoid if indicated

Discharge with follow-up and instructions