Evaluation and Initial Management of Minor Fall in Late Pregnancy
Pregnant patients at ≥23 weeks with abdominal trauma should receive maternal stabilization first, followed by fetal assessment and observation. Electronic fetal monitoring for at least 4 hours is recommended for viable pregnancies (≥23 weeks) after trauma. [1]
Immediate Triage and Transport Decisions
Maternal stabilization takes priority over fetal evaluation in all trauma. [1]
Urgent obstetric evaluation and hospital observation are indicated when any of the following are present:
- Uterine tenderness, significant abdominal pain, or any vaginal bleeding. [1]
- Suspected uterine contractions (including sustained contractions). [1]
- Rupture of membranes. [1]
- Atypical or abnormal fetal heart rate pattern during evaluation. [1]
- High-risk mechanism of injury. [1]
- Serum fibrinogen <200 mg/dL. [1]
Patients with viable gestations (≥23 weeks) should be transferred/transported to a maternity facility when injuries are not life- or limb-threatening. [1]
Maternal Assessment and Stabilization Steps
Two large-bore intravenous lines should be placed if clinically indicated. [1]
Oxygen supplementation should be used to maintain maternal oxygen saturation >95% to support fetal oxygenation. [1]
Radiographic studies needed for maternal evaluation should not be delayed due to concerns about fetal radiation exposure. [1]
A coagulation panel including fibrinogen should be obtained in addition to routine labs. [1]
Fetal Monitoring and Observation
All pregnant trauma patients with viable pregnancy (≥23 weeks) should undergo electronic fetal monitoring for at least 4 hours. [1]
Observation for 24 hours is recommended when adverse factors are present, including:
- Uterine tenderness. [1]
- Significant abdominal pain. [1]
- Vaginal bleeding. [1]
- Sustained contractions (>1/10 minute). [1]
- Rupture of membranes. [1]
- Atypical or abnormal fetal heart rate pattern. [1]
- High-risk mechanism of injury. [1]
- Serum fibrinogen <200 mg/dL. [1]
If monitoring exceeds 4 hours and the patient is admitted, an obstetrical ultrasound should be performed prior to discharge. [1]
Placental Abruption and Uterine Injury Considerations
Management of suspected placental abruption should not be delayed pending ultrasonography because ultrasound is not sensitive for its diagnosis. [1]
Urgent obstetrical consultation is recommended for viable pregnancies (≥23 weeks) with suspected uterine contractions, placental abruption, or traumatic uterine rupture. [1]
Rh(D) Immune Globulin After Abdominal Trauma
Anti-D immune globulin is recommended for all Rh(D)-negative pregnant trauma patients. [1]
Rh(D) immune globulin dosing for typical antenatal prophylaxis is 300 mcg (1500 IU) at 28 weeks of gestation. [2]
Additional dosing guided by fetomaternal hemorrhage quantification (eg, Kleihauer-Betke test) is recommended for Rh(D)-negative pregnant trauma patients. [1]
Speculum/Digital Cervical Examination Precautions
In bleeding at or after 23 weeks, speculum or digital vaginal examination should be deferred until placenta previa is excluded by prior or current ultrasound. [1]