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Multiple trauma in pregnancy: what risks ? health-nutrition-fitness.

Multiple trauma in pregnancy : what is risks ? 



The association between multiple traumas and pregnancy is more frequent due to changes in the working activity of pregnant women and their movements. Find out more about multiple traumas and pregnancy by reading this article.


Multiple trauma in pregnancy: what risks ? health-nutrition-fitness.
Multiple trauma in pregnancy: what risks ? health-nutrition-fitness.



The association between multiple traumas and pregnancy is more and more frequent , due to the intensification of the working activity of women facing a pregnancy; moreover, there are more and more women who continue to work until the end of gestation and those who use the car every day for travel.

The combination of these factors has caused an increase in obstetric trauma and mortality from the pregnant woman and the fetus.

The pregnant woman has, in fact, physical and physiological characteristics different from those of the non-pregnant woman, and it is important to know them to deal with multiple traumas in pregnancy in the best possible way.


Multiple trauma in pregnancy


Traumatisms have become the leading cause of non-obstetric death in pregnancy; and in the context of the mother-fetus binomial, the latter can be damaged both by the trauma itself and by the state of health of the mother.


The anatomical  and physiological changes  that occur in a woman during pregnancy are able to change her body's response to trauma. Consequently, the effects of trauma during pregnancy will be conditioned by the following factors:

  • Management age.
  • Type and severity of the trauma.
  • Alterations produced on the fetal-placental physiology.

It is essential to concentrate the initial attentions on the mother  so that once the mother is stabilised, assistance can be given to the fetus.



Cardiovascular system

Due to the changes that occur during pregnancy, the pregnant woman has an increase in blood flow, which makes it essential to monitor any haemorrhage of the mother that may occur following the trauma.

This increase in blood volume means that - in the event of bleeding - the mother needs more time to get into shock. The oxygenation of the fetus would be compromised much earlier. For this reason, although the loss of blood does not always affect the mother's state of health, action must be taken quickly.


Perineal organs


It is also important to explore possible lesions to the vagina, perineum and rectum, following trauma, as this could indicate damage to gynecological-obstetric structures.

Cardiopulmonary resuscitation (CPR)


As for practicing a CPR on pregnant women, there is a debate about when to perform an emergency case, if there is no reaction after the maneuvers: if after a certain period of time the maneuvers of CPR or while they are being performed?

To make decisions, other factors must be taken into account, such as the fetal viability (fetus over 24 weeks of gestation), the state of health of the mother ...

Penetrating trauma
The increase in the size of the uterus during pregnancy causes the abdominal organs to move, thus increasing the risk of damage to the uterus and reducing the risk of damage to other bowels.

Multiple trauma and pregnancy: specific lesions of the pregnant woman


There are certain types of injuries that can present you only when multiple trauma and pregnancy coincide:


Uterine trauma


A blow to the uterus can even cause the uterine muscle (myometrium) and the rest of its layers to tear , causing an emergency situation for the mother and the fetus.

Uterine rupture can be total or partial and is usually accompanied by these signs and symptoms:
  • Fetal bradycardia ( fetal heart rate decreases).
  • Abdominal pain.
  • Reduction or cessation of contractions (if any).
  • Maternal tachycardia or hypotension due to blood loss.
  • Vaginal hemorrhage.
  • Hematuria (blood in the urine).
  • Increase of fetal presentation or of easily palpable parts of the fetus , if the fetus is expelled from the abdominal cavity.

The treatment in the case of a uterine rupture focuses on the stabilisation and anesthesia of the mother, and on surgery (laparotomy) aimed at the extraction of the fetus.




Uterine contractions


Uterine contractions can occur before the time of delivery: following a trauma, in front of stressful situations, in the case of dehydration ... It is the most common obstetric problem among those caused by trauma.


Depending on the health condition of the woman and the fetus (intact or not amniotic sac, weeks of gestation, fetal and maternal condition), there are several suitable maneuvers, from case to case, for each situation:

  • Maternal and fetal monitoring.
  • Administration of tocolytic drug (to block contractions).
  • Allow the birth to take place.
  • Attitude of waiting.


Placental detachment


Due to trauma during pregnancy, a premature detachment  of the normal inserted placenta may also occur . It consists in the total or partial detachment of the placenta before the fetal expulsion in a pregnancy of over 20 weeks.


This situation is a matter of life and death, since the placenta is the organ that oxygenates and nourishes the fetus and that if it detaches completely, it no longer supplies blood to the fetus.
Some of the signs and symptoms that may appear are:

  • Fetal hypoxia.
  • Visible (vaginal) or internal bleeding.
  • Abdominal pain.
  • Disseminated intravascular coagulation   
  • Shock and other complications.

The treatment in this situation focuses on the stabilisation of the mother and on the extraction of the fetus (via cesarean or vaginal delivery).


Feto-maternal haemorrhage


The passage of fetal blood to the mother's circulation is more common in women who have suffered trauma. The consequences of this bleeding are associated with its intensity and can be:

  •  Rh sensitisation in mothers with Rh - and fetus with Rh +.
  • Arrhythmias.
  • Anemia.
  • Fetal death due to excess blood loss.

To avoid Rh sensitisation, all women with Rh will be given Rh immuno-globin in advance. At the same time, the state of maternal and fetal health will be evaluated, in order to evaluate the subsequent procedure.

Premature rupture of membranes


It consists of breaking the amniotic sac before spontaneous labor begins. The following factors must be evaluated to determine the procedure to be followed:

  • Weeks of gestation and fetal maturity.
  • Amount of amniotic fluid lost.
  • Risk of infection.
  • Characteristics of amniotic fluid.


Multiple trauma in pregnancy: fetal lesions



In the trauma that occurs during pregnancy, the health of the fetus is also subject to risk. One of the problems that the fetus can present, in addition to those previously exposed, is the risk of fetal distress .


The consequences of trauma on the fetus are due to the alteration of oxygenation and perfusion of the placenta. Fetal distress is diagnosed by external monitoring, and its symptoms are:
  • Alterations in fetal heart rate variability.
  • Fetal decelerations after uterine contractions.


Regarding multiple traumas in pregnancy, remember ...



Each situation should be evaluated on a case-by-case basis, and depending on the health condition of the mother and fetus, certain measures will be implemented rather than others.




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Multiple trauma in pregnancy: what risks ? health-nutrition-fitness. Multiple trauma in pregnancy: what risks ? health-nutrition-fitness. Reviewed by Health-nutrition-fitness.net on July 03, 2019 Rating: 5

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