The University of Kansas Hospital
Practice Management Guideline for the Pregnant Trauma Patient
Signature _________________________________________________________
Micheal Moncure, MD Medical Director, Trauma Program
Signature _________________________________________________________
Carl P. Weiner, MD Chairman of the Department of Obstetrics and Gynecology
Signature _________________________________________________________
Christopher Ruder, RN Vice President, Patient Care Services
Formulation 7/99
Date
Revised 10/2004, 5/2008, 7/2008 Reviewed 10/2004, 5/2008, 7/2008
Date
Date
Position Responsible for Recommendation Updates
______________________________________
Elizabeth Carlton, RN Trauma Program Manager
I. Purpose: Trauma is the most frequent cause of non-obstetric related maternal death in the
United States of America. According to the Committee on Trauma of the American College of
Surgeons, accidental injury occurs in 6% to 7% of all pregnancies and is the most common
cause of death in the gravid patient. The causes of maternal injury include: 42% MVC’s, 34%
falls, 18% assaults, < 1% burns. The purpose of this guideline is to define the practice for
management of the critically injured pregnant patient. The most important aspect of the
management of the pregnant trauma patient is the immediate involvement of appropriate staff
and adequate communication between staff physicians.
II. Recommendation:
a. Trauma Activation of the Pregnant Trauma Patient:
i. Any pregnant trauma patient will be activated per established trauma activation
criteria. Pregnant trauma patients meeting trauma consult criteria will be
activated as type 2 activation.
ii. The emergency department will notify the following staff and inform them of
the arrival of the pregnant trauma patient and request their presence in the
trauma bay:
1. OB Chief Resident
2. OB unit – x5450
3. Neonatology - x6350
iii. An obstetrics tray has been prepared and will be present in the trauma room.
This tray includes appropriate instruments necessary for emergent delivery.
This tray should accompany the patient in areas other than labor and delivery or
the operating room (i.e. SICU, Radiology).
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b. Resuscitation of the Pregnant Trauma Patient:
i. Resuscitation will be directed by the Trauma Service and follow ATLS®
guidelines.
1. The primary survey of the injured pregnant patient addresses the
airway/cervical spine control, breathing and circulation with the mother
receiving treatment priority.
2. The secondary survey will include obtaining a complete history,
including an obstetrical history, performing a physical examination, and
evaluating and monitoring the fetus.
ii. After completion of the primary survey, the OB team will complete the obstetric
exam as indicated to determine fetal status and need for further diagnostics.
1. Evaluate gestational age & fetal status
2. Determine need for level of fetal monitoring or other diagnostics
iii. Trauma team assumes primary responsibility for the management of the patient
until all life threatening injuries are identified and treated.
iv. Emergency Cesarean: If the mother goes into cardiac arrest; have one provider
watch the clock and call out the number of minutes BLS or ACLS is being
performed. If two minutes pass, start preparing for delivery. The baby must be
delivered within four to five minutes of the mother's cardiac arrest. Tilt the
mother up 30 degrees to deliver the baby.
c. Management & Admission of the Pregnant Trauma Patient:
i. Emergent disposition to the Operating Room:
1. The Obstetrics team will determine the need for fetal monitoring. At a
minimum, fetal heart tones will be documented before and after the
beginning of the case.
2. A fetal resuscitation area will be set-up in the same room if indicated by
determination of viability.
3. Confirm notification of neonatal resuscitation team if indicated.
ii. Mother is seriously injured and requires ICU admission:
1. Patient will be preferably admitted to the SICU.
2. The Obstetrics team will determine the need for fetal monitoring.
3. A labor & delivery nurse may monitor the patient in the ICU
iii. Mother has non-life-threatening injuries and can be admitted to acute care:
1. Obstetrics team will co-manage the patient for the first 24 hours.
2. After the first 24 hours, primary service will be determined based on
patients needs.
iv. Consults: Many pregnant trauma patients are victims of abuse. Consult the
Bridge program and social work as indicated.
d. Management of the pregnant trauma patient in active labor and/or delivering:
i. Immediately notify
1. Obstetric team
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2. Neonatal Intensivist and the NICU staff if indicated
ii. Once stabilized the newborn should be transported to the neonatal intensive care
unit for definitive management.
iii. All management for the mother will be performed in collaboration with the
Obstetrics staff and Trauma staff.
e. Perimortem C-section:
i. Should be considered when there are signs of fetal life, maternal demise is
eminent and fetus is thought to be medically viable.
f. Management of non-admitted activated pregnant trauma patients
i. Patients meeting trauma activation criteria who do not warrant an admission
will be monitored as determined by the obstetrical team.
Reference:
American College of Surgeons: Advanced Trauma Life Support ATLS®, 6th edition, Chicago,
American College of Surgeons, 1997
Kuhlman RS, Cruikshank DP. Maternal Trauma during Pregnancy. Clin Obstet Gynecol, 1994;
37: 274-293.
Van Hook, JW: Trauma & Pregnancy. Clin Obs Gynae 2002; 45: 414-424.
American College of Surgeons: Advanced Trauma Life Support ATLS®, 7th edition, Chicago,
American College of Surgeons, 2004
Practice Management Guideline for the Diagnosis and Management of Injury in the Pregnant
Patient: the EAST Practice Management Guideline Work Group. (2005)
2005 American Heart Association (Circulation. 2005; 112: IV-150- IV-153)
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TRAUMA IN PREGNANCY
PRACTICE GUIDELINE
ALGORITHM
Pregnant Trauma Activation
Consider Bridge consult if indicated
Mandatory OB Consult
Notify NICU 6350



Primary Survey: ABC’s
Mother receives treatment
priority.
Secondary Survey: Complete
history, obstetrical history,
physical exam and fetal
evaluation
Observation only
ATLS® RESUSCITATION
ICU
Admit
Emergent
disposition
to OR
NOTIFY: OB Team &
Neonatal Resus team
Have neonatal resus room
available if indicated




Admit to Trauma
SICU preferred
OB team determines
fetal monitoring.
L & D nurse responsible
for fetal monitoring
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Observe and
monitor a
minimum of 4
hours in L & D
Floor
admit



Trauma & OB will co-manage for the
first 24 hours.
Patients may be admitted to Labor &
Delivery
May transfer to OB as primary after
24 hours.