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Practice Management Guidelines for the Diagnosis and Management of Injury in the Pregnant Patient: The EAST Practice Management Guidelines Work Group

Barraco, Robert D. MD, MPH; Chiu, William C. MD; Clancy, Thomas V. MD; Como, John J. MD; Ebert, James B. MD; Hess, L. Wayne MD; Hoff, William S. MD; Holevar, Michele R. MD; Quirk, J. Gerald MD, PhD; Simon, Bruce J. MD; Weiss, Patrice M. MD

Journal of Trauma and Acute Care Surgery: July 2010 - Volume 69 - Issue 1 - p 211-214
doi: 10.1097/TA.0b013e3181dbe1ea
Clinical Management Update

Trauma during pregnancy has presented very unique challenges over the centuries. From the first report of Ambrose Pare of a gunshot wound to the uterus in the 1600s to the present, there have existed controversies and inconsistencies in diagnosis, management, prognostics, and outcome. Anxiety is heightened by the addition of another, smaller patient. Trauma affects 7% of all pregnancies and requires admission in 4 of 1000 pregnancies. The incidence increases with advancing gestational age. Just over half of trauma during pregnancy occurs in the third trimester. Motor vehicle crashes comprise 50% of these traumas, and falls and assaults account for 22% each. These data were considered to be underestimates because many injured pregnant patients are not seen at trauma centers. Trauma during pregnancy is the leading cause of nonobstetric death and has an overall 6% to 7% maternal mortality. Fetal mortality has been quoted as high as 61% in major trauma and 80% if maternal shock is present. The anatomy and physiology of pregnancy make diagnosis and treatment difficult.

From the Department of Surgery (R.D.B.), Lehigh Valley Health Network, Allentown, Pennsylvania; Department of Surgery (W.C.C.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery (T.V.C.), New Hanover Regional Medical Center, Wilmington, North Carolina; Division of Trauma, Critical Care, Burn, and Metro Life Flight (J.J.C.), MetroHealth Medical Center, Cleveland, Ohio; Department of Emergency Medicine (J.B.E.), Elmhurst Memorial Occupational, Elmhurst, Illinois; Department of Obstetrics & Gynecology (W.H., P.M.W.), Carilion Clinic Roanoke, Virginia; Departments of Surgery, Trauma, and Critical Care (W.S.H.), St. Luke's Hospital & Health Network, Bethlehem, Pennsylvania; Department of Surgery (M.R.H.), Mt. Sinai Hospital Medical Center, Chicago, Illinois; Department of Obstetrics & Gynecology (J.G.Q.), Stony Brook University Medical Center, Stony Brook, New York; and Department of Surgery (B.J.S.), University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.

Submitted for publication December 3, 2008.

Accepted for publication March 3, 2010.

Address for reprints: Robert D. Barraco, MD, MPH, FACS, FCCP, Department of Surgery, Lehigh Valley Health Network, Cedar Crest & I-78, PO Box 689, Allentown, PA 18105-1556; email:

© 2010 Lippincott Williams & Wilkins, Inc.