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Introduction
Sadly, trauma is a fact of life for the pregnant woman as much as for others. This may be in the form of a physical assault, a motor traffic accident, a domestic accident or an accident at work.

When a pregnant woman is injured, especially if it is somewhere around the abdomen or pelvis, the ensuing anxiety becomes two-pronged. "Am I alright and is my baby alright?" This concern is readily understandable and explainable. The natural maternal instinct is for the preservation of her child. However, it is also true that nature makes pregnancies fairly safe from considerable trauma, even when this is directly inflicted on the abdomen or pelvis.

Miscarriage or premature labour are not common consequences, even of major trauma. However, there may be other less serious consequences of trauma that may call for specific actions. This chapter sets out to explain these and other related questions.


Causes of trauma in pregnancy

Is trauma a major issue in pregnancy?
Look at it in this context. Among women of childbearing age (16-45 years), trauma is a leading cause of hospitalization and occupies one of the three top spots in causes of death among people of this age group throughout the Western world. Pregnant women are included in these statistics.


What are the causes of trauma in pregnancy?
Violent assaults - usually from another member of the family - and road traffic accidents are the leading causes of trauma in pregnancy. There are also accidental injuries, sustained at home or in the workplace. Falls are relatively common.


How often does trauma to the pregnant woman lead to fetal loss or premature labour?
This is a difficult, if not impossible, question to answer.
The outcome depends on several independent factors, including the area of injury, the severity of the injury, the gestational age and, not least, the psychological fallout, especially if it was a case of assault.
Area and severity of trauma in pregnancy

What is the importance of the area of injury?
For obvious reasons, the farther the injury is from the abdomen, the better the prospects for the pregnancy. If the injury is completely away from the pregnant uterus, then the prognosis for the pregnancy is good.

A direct penetrating trauma to the uterus reduces the prospects for the fetus quite substantially. It is not always so well spelt-out, however. A remote injury could be so severe that part of the treatment could involve the sacrifice of the pregnancy. This is rare.


What about the severity of the injury?
An injury sustained on the pregnant abdomen could lead to fetal demise simply because of its severity. This may be in the form of direct trauma to the fetus itself, or perforation of the womb, with resultant severe internal bleeding.
It could also lacerate the placenta (afterbirth). All these make the fetal prognosis quite poor.

It is said that, in cases of direct abdominal trauma, the baby may protect the mother: how is this?
This is a tragic but true role-reversal. In advanced pregnancy, trauma sustained directly on the abdomen, when very severe, may kill the baby but leave the mother in a relatively less serious con­dition. This is simply because the pregnant uterus offers an effective physical shield against injury to the vital organs in the abdomen.
Even though there were hundreds of recorded gun-shot wounds to the abdomen of pregnant women through­out the twentieth century and into this century, the last recorded maternal death from such an injury was in 1912! (Of-course that was before Iraq). There are more advantages (some undesirable) to being pregnant than you ever imagined...                               

16. Trauma in Pregnancy

By Joe Kabyemela, MD

Causes Severity Outcome Pelvic fracture