Injury in motor vehicle accidents during pregnancy: A pregnant issue

Trauma is the leading nonobstetric cause of morbidity and mortality in pregnancy; approximately one out of every 15 pregnancies is complicated by trauma. Motor vehicle accidents are a major cause of trauma during pregnancy. Severe injury occurs in approximately 10% of cases, a situation associated with high likelihood of preterm delivery, placental abruption, cesarean delivery and increased maternal and fetal mortality. Nevertheless, obstetric complications may also occur with less severe injuries. All pregnant trauma patients should be managed according to Advanced Trauma Life Support guidelines. In total, 2-6 h of observation with fetal monitoring are recommended for pregnant trauma patients who are not admitted. Poor maternal and fetal outcome can be predicted by the presence of several risk factors such as ejection from the vehicle, pedestrian or motorcycle injury, lack of seatbelt use, abdominal, pelvic or intracranial injury, loss of consciousness, maternal tachycardia, low Glasgow coma scales, hypotension and abnormal fetal heart rate. Treating the mother correctly is beneficial for the fetus, thus trauma guidelines should be adhered to, despite the need for multidisciplinary efforts and concern for the fetus. Approximately 2% of admitted pregnant trauma patients die; perimortem cesarean delivery should be considered when the fetus is viable (i.e., gestational age >24 weeks) within minutes of maternal death.