From the Research
For pregnant trauma patients, a comprehensive evaluation should include complete blood count, blood type and Rh status, coagulation studies, and fibrinogen levels, as recommended by the most recent study 1. When evaluating a pregnant patient with trauma, it is essential to consider the unique physiological changes that occur during pregnancy, which can mask significant blood loss and compromise both maternal and fetal well-being.
- A complete blood count, blood type and Rh status, coagulation studies, and fibrinogen levels should be ordered to assess for potential bleeding and coagulopathy.
- Urinalysis should be performed to check for hematuria and proteinuria, which can indicate renal injury or pre-eclampsia.
- Focused Assessment with Sonography for Trauma (FAST) examination should be conducted to detect free fluid, and obstetric ultrasound is essential to assess fetal viability, placental location, and amniotic fluid volume.
- Cardiotocography (CTG) or electronic fetal monitoring should be initiated for viable pregnancies (typically >23-24 weeks) to detect signs of fetal distress or placental abruption, as recommended by 2.
- Kleihauer-Betke test or flow cytometry for fetal hemoglobin is recommended to quantify fetal-maternal hemorrhage, especially in Rh-negative mothers, as stated in 2. Additional imaging may include chest and pelvic X-rays with abdominal shielding when necessary, and CT scans for severe trauma, weighing risks against benefits, as suggested by 1. Laboratory tests should be repeated periodically during observation, as physiologic changes of pregnancy can mask significant blood loss, making serial laboratory evaluations crucial for detecting deterioration before clinical decompensation occurs. Pregnant women maintain normal vital signs until losing 30-35% of blood volume, emphasizing the importance of close monitoring and prompt intervention, as highlighted in 3.