Trauma

What is trauma?

Trauma is physical injury that occurs suddenly. Just as trauma can happen outside of pregnancy, it also can happen during pregnancy. About 70 percent of pregnancy trauma results from motor vehicle accidents. Another common cause is falling, which often happens because a womans balance gets thrown off as the bodys center of gravity shifts during late pregnancy and because muscles of the lower back are strained while the front abdominal muscles are stretched, thereby weakening your posture. Sadly, domestic violence also constitutes another major cause of pregnancy trauma.

How common is trauma during pregnancy?

Trauma occurs in about 1 in 12 pregnancies and thus is once of the most common pregnancy conditions. In many cases, the trauma is minor to moderate, as might happen for instance were you to trip down two or three stairs. However, severe trauma also can occur in pregnant women. Researchers have found that many such cases involve improper use of seatbelts, particularly failure to lay the shoulder belt over the shoulder. During an accident, this can result in especially high force imparted to the abdomen.

How is trauma during pregnancy diagnosed?

The main diagnostic procedure to check the abdomen is called Focused Assessment with Sonography in Trauma (FAST). In this exam, gel would be applied to your body and you would be assessed with an ultrasound scanner much like an abdominal ultrasound test thats done routinely in pregnancy care, except that the priority is to assess for organ damage and blood inside the abdomen and pelvis. FAST does not expose you, or your fetus, to ionizing radiation. In many cases of trauma, however, the FAST exam will have to be followed by computed tomography (CT) imaging of the head and neck, and/or abdomen and pelvis, or by plain radiography (simple X-ray scans).

We live in a society that is very much concerned about radiation exposure, but in which people often do not consider the importance of dosage. It is true that ionizing radiation can cause severe birth defects, particularly when exposure occurs around 8-15 weeks gestation. However, clinical guidelines demand the use of radiation for diagnosis when needed during pregnancy, because the danger of birth defects is present only at radiation doses above 0.05 Gray. The dosage that you would receive from a simple X-ray scan, or from a CT scan, even a CT scan directed at the pelvis, is far below this threshold, whereas the risk of fetal death due to unseen blood loss or other events inside the body is significant. Furthermore, while there is a type of scanning called magnetic resonance imaging (MRI) that provides much of the same information as CT but without imparting ionizing radiation, MRI scanning takes longer, so it is often not a good option in an emergency situation.

Considering a more modest situation, if you have tripped and possibly fractured a bone in your ankle, doctors will want a simple X-ray scan of your lower leg and foot. Refusing such a scan due to fear of radiation would be extremely imprudent, and would most likely lead to a more serious situation if you were to leave the hospital with an unrecognized fracture.

Does trauma cause problems during pregnancy?

Severe trauma can produce damage to internal organs, severe blood loss, serious orthopedic injuries, internal infections, and various other complications that can be fatal, if not recognized and treated.

Does trauma during pregnancy cause problems for the baby?

Any trauma that puts the mothers health and life at risk can harm or kill the baby. The perspective of trauma surgeons is thus that what is good for the mother is good for the baby. This includes any needed diagnostic tests and any surgical procedure or medication that is absolutely vital to save the mother.

What to consider about taking medications when you are pregnant or breastfeeding:

• Any risks to yourself and your baby if you do not treat the trauma. When trauma involves the head, neck, chest, back, pelvis or large bones of the extremities, a womans life and limbs are in jeopardy.
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat trauma during pregnancy?

Drugs that are often needed in the management of trauma include anesthetics and other painkillers, antibiotics, and sometimes drugs that modify the force of heart contractions and the pressure within blood vessels. Whenever there is a choice between one drug or another to achieve the same purpose, doctors will choose the drug that is known to be least harmful, or least risky, to the developing baby.

Who should NOT stop taking medication for trauma during pregnancy?

Every mother who requires an emergency procedure, or treatment for infection, due to trauma must accept medication that the trauma surgeon and obstetrician deem necessary for the mothers survival and recovery. Survival of the baby in a wounded mother correlates strongly with survival of the mother. 

What should I know about choosing a medication for my trauma during pregnancy?

You may find Pregistrys expert reports about the individual medications to treat trauma here and here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my trauma when I am breastfeeding?

Drugs that are often needed in the management of trauma include anesthetics and other painkillers, antibiotics, and sometimes drugs that modify the force of heart contractions and the pressure within blood vessels. Whenever there is a choice between one drug or another to achieve the same purpose, doctors will choose the drug that is known to be least harmful, or least risky, to the developing baby.

What alternative therapies besides medications can I use to treat my trauma during pregnancy?

If you need emergency surgery, treatment for an infection, or you need a tube inserted through your throat so that you can breathe, or to facilitate surgery, medications will be needed. However, during the recovery period, physical therapy will play a central role, particularly after injuries of the bones or soft tissue. 

What can I do for myself and my baby when I have trauma during pregnancy?

Cooperate with the emergency medical service and with the trauma team at the hospital. In the event that your trauma is the result of assault or domestic violence, do not hide this from your doctors, or from a counselor or social worker who may come to speak with you. Let somebody know what is happening.

Resources for trauma in pregnancy:

For more information about trauma during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

• National Domestic Violence Hotline: Pregnancy and Abuse
• March of Dimes: Abuse and Pregnancy