What is the evaluation for pregnancy after a Motor Vehicle Accident (MVA)?

From the Guidelines

Pregnancy evaluation after a Motor Vehicle Accident (MVA) should include a systematic obstetrical examination to assess for potential obstetrical and fetal morbidity, as cohort studies have shown a moderately heightened risk of premature birth, birth by caesarean section, fetal distress, and fetal death subsequent to minor trauma. The evaluation should consider the severity of the trauma, with patients who have undergone more severe trauma (ISS score ≥ 9) being at higher risk for these complications 1. Key aspects of the evaluation include:

• Assessing the patient's overall condition and stability
• Performing a thorough obstetrical examination, including fetal monitoring and ultrasound evaluation to confirm gestational age and fetal well-being
• Evaluating for signs of fetal distress, such as abnormal fetal heart rate patterns or decreased fetal movement
• Assessing for potential maternal complications, such as placental abruption or uterine rupture
• Considering the need for hospital admission or close monitoring for patients who have experienced severe trauma or are showing signs of complications. The goal of the evaluation is to identify potential complications early and provide appropriate management to minimize risks to both the mother and the fetus, as supported by the guidelines for the management of urgent obstetric situations in emergency medicine 1.

From the Research

Evaluation of Pregnancy after a Motor Vehicle Accident (MVA)

The evaluation of pregnancy after a Motor Vehicle Accident (MVA) is crucial to ensure the well-being of both the mother and the fetus. According to 2, a multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus.

• Primary survey:
  • Every female of reproductive age with significant injuries should be considered pregnant until proven otherwise by a definitive pregnancy test or ultrasound scan 2.
  • A nasogastric tube should be inserted in a semiconscious or unconscious injured pregnant woman to prevent aspiration of acidic gastric content 2.
  • Oxygen supplementation should be given to maintain maternal oxygen saturation > 95% to ensure adequate fetal oxygenation 2.
• Transfer to health care facility:
  • Transfer or transport to a maternity facility is advocated when injuries are neither life- nor limb-threatening and the fetus is viable (≥ 23 weeks) 2.
  • When the injury is major, the patient should be transferred or transported to the trauma unit or emergency room, regardless of gestational age 2.
• Evaluation of a pregnant trauma patient in the emergency room:
  • In cases of major trauma, the assessment, stabilization, and care of the pregnant women is the first priority; then, if the fetus is viable (≥ 23 weeks), fetal heart rate auscultation and fetal monitoring can be initiated and an obstetrical consultation obtained as soon as feasible 2.
  • In pregnant women with a viable fetus (≥ 23 weeks) and suspected uterine contractions, placental abruption, or traumatic uterine rupture, urgent obstetrical consultation is recommended 2.
• Fetal assessment:
  • All pregnant trauma patients with a viable pregnancy (≥ 23 weeks) should undergo electronic fetal monitoring for at least 4 hours 2.
  • Pregnant trauma patients (≥ 23 weeks) with adverse factors including uterine tenderness, significant abdominal pain, vaginal bleeding, sustained contractions (> 1/10 min), rupture of the membranes, atypical or abnormal fetal heart rate pattern, high risk mechanism of injury, or serum fibrinogen < 200 mg/dL should be admitted for observation for 24 hours 2.

Risk Factors for Poor Fetal Outcome

According to 3, increased maternal age, loss of consciousness (LOC), high Injury Severity Score (ISS), and pelvic injury are risk factors for poor fetal outcome. Logistic regression revealed LOC and pelvic injury to be independent risk factors.

Incidence of Gestation-Related Complications

According to 4, most pregnant patients hospitalized for MVA suffered minor injuries, but there was still a considerable incidence of gestation-related complications, including uterine contractions, need for emergency delivery, and vaginal bleeding.

Management of Suspected Placental Abruption

According to 2, management of suspected placental abruption should not be delayed pending confirmation by ultrasonography as ultrasound is not a sensitive tool for its diagnosis.

Use of Radiographic Studies

According to 2, radiographic studies indicated for maternal evaluation including abdominal computed tomography should not be deferred or delayed due to concerns regarding fetal exposure to radiation.

Importance of Close Monitoring

According to 4, it is imperative that pregnant patients be closely monitored even after minor trauma due to the risk of gestation-related complications.