All patients (trauma or medical) who are known to be pregnant are included in this management plan. The gestational age is irrelevant.
Pregnant women suffering trauma:
- The rhesus status of the mother must be confirmed Please check "Anti-D".
- If the mother is rhesus negative, pregnant and suffers truncal trauma, she must be given rhesus Anti-D immunoglobulin.
- Dose: 250 international units <20 weeks, 500 international units >20 weeks.
- A Kleihauer's test must performed to estimate the volume of foetal leak.
- Further follow-up is performed in the Obstetrics Dept.
If such a patient is discharged from the ED (which is unlikely) then, an obstetric out-patient appointment must be made.
The Obstetric Dept must be informed on all pregnant patients admitted to CUH.
In cases of penetrating injuries - treat the mother first, if stable refer to the Obstetric Registrar.
Blunt "minor" abdominal trauma
- Blunt trauma - commonly seat-belt injury or assault.
- Once mother is stable refer to the Obstetric Registrar.
- Check FH, Kleihauer, exclude abruption and even if no marks on abdomen.
- ALL cases (even apparently trivial trip or fall etc) of trauma in the third trimester must be referred to the antenatal ward for 4 hours of tochography.
- Do NOT request an ultrasound scan as tochography is far more sensitive at excluding third trimester abruption.