St. Louis Pregnancy Trauma Attorneys

Trauma in Pregnancy

In the United States, approximately 5-8% of pregnant women experience trauma. Whether it is a minor or major trauma, there is an increased risk of first-trimester pregnancy loss, premature labor, premature rupture of membranes (the bag of water breaking early), placental abruption (when the placenta separates from the uterus wall), uterine rupture, and stillbirth. The most common mechanism of injury is blunt abdominal trauma with motor vehicle accidents accounting for as many as 70% of these injuries. Other possible causes of blunt trauma in pregnancy include assaults, many of which are the result of domestic violence, and falls.

Up to 20 weeks gestation, the uterus and fetus are largely protected by the bony structure of the pelvis; thus, pregnancy loss during this time is due to low blood pressure and/or low blood volume leading to less blood volume being supplied to the uterus and the developing fetus. After 20 weeks, compression of the aorta and the large vein returning blood to the heart by the growing uterus which can lead to decrease blood flow to the uterus and the developing fetus that can be compounded by direct injury to the uterus during trauma. In regard to some specific fetal-related injuries:

• A placental abruption, in which the placenta separates from the uterine wall, occurs in approximately 40% of severe blunt trauma. There are varying degrees of severity, but once 30% of the placenta has separated from the uterus the fetus will start showing signs of distress. This type of injury is the result of shearing forces between the placenta and uterine wall.
• Uterine rupture is a rare complication of trauma in pregnancy, occurring in less than 1% of all traumas in pregnancy. It may occur when there is a high-energy force directed at the abdomen and is typically seen with women who are late in their pregnancy. Unfortunately, this type of injury has a poor prognosis for the both the mother and the fetus due to the sudden onset of massive maternal hemorrhage.
• Direct injury to the fetus is also an uncommon occurrence because the uterus and amniotic fluid act as a barrier to outside forces. However, late in the pregnancy when the fetus is head down and low in the maternal pelvis, there is a risk of fetal skull fracture and brain injury with fracture of the mother’s pelvis. Again, the most common cause is a motor vehicle accident with the mechanism of injury typically being a compressive force applied to the pelvis.

Symptoms

With any abdominal trauma, pain and abdominal tenderness are common symptoms. In the pregnant woman, additional symptoms may include sudden onset of contractions, vaginal bleeding, or leaking of fluid. If the mother has sustained serious internal injury resulting in massive bleeding, symptoms of shock may be noticed – rapid heart rate, fast and shallow breathing, pale color, lightheadedness, and possible loss of consciousness.

Treatment

As with any trauma, the mother needs to be rapidly assessed for open airway, adequate breathing and circulation, any bleeding controlled and major injuries stabilized. Additional care and evaluation in regard to the fetus includes assessing for evidence of fetomaternal hemorrhage, preterm labor, placental abruption, and ruptured membranes.

A vaginal exam will be done to assess for uterine bleeding and/or leaking of fluids. External monitors will be placed to measure uterine contractions signifying preterm labor as well as fetal heart tones. An ultrasound will be done as soon as the mother is stable to evaluate the pelvic structures as well as the fetus and placenta. It can be used to quickly estimate gestational age and assess fetal heart rate, uterine and placental injury and abdominal or uterine bleeding. However, if the mother needs any imaging, x-rays or CT scans, they should not be delayed because of the pregnancy since the risk to the fetus is minimal. Furthermore, if there is evidence of internal injury to the mother, exploratory abdominal surgery should not be delayed.

Fetomaternal hemorrhage refers to the mixing of fetal and maternal blood, which occurs as a result of trauma in up to 30% of pregnant individuals. Depending on blood type, the maternal blood can form antibodies against the fetal blood which can affect subsequent pregnancies; thus, any individual with a negative blood type will be given a RhoGam shot that can prevent this from occurring.

The fetus should be placed on continuous external monitoring as soon as the mother has been stabilized to determine the presence of fetal heart tones and watch fetal status. Monitoring the fetal status also is indicative of how well the placenta is being perfused, or how much blood flow it is receiving. With a placental abruption, in which the placenta separates from the uterine wall, the mother will begin bleeding into the uterus and the blood flow to the placenta will be greatly decreased; in the early stages, an abruption will not be evident on ultrasound but rather, signs of fetal distress will be noticed on the external monitoring. If at any point the heart rate looks non-reassuring or shows signs of fetal distress, emergency cesarean section will be considered if the pregnancy is beyond 24 weeks. Early delivery of the fetus occurs in approximately one-quarter of all traumas in pregnancy.

In the unfortunate circumstances of a mother going into cardiac arrest, CPR will be started immediately and any fetus over 24 weeks will be emergently delivered by cesarean section and sent to a neonatal intensive care unit. The best fetal outcomes are those in which the baby is delivered within 5 minutes; delivery may also increase the effects of CPR since more blood volume will be returning to the heart, rather than the uterus. And unfortunately, there are also cases where the fetus does not survive the trauma; in this circumstance, an obstetrician will be consulted and discuss the options for removal of the fetal tissue depending on how far along the woman is.

Prognosis

Depending on the severity of the injury, maternal and/or fetal death is always a possibility. Of those individuals who are hospitalized for their injuries, one-quarter are delivered due to signs of fetal distress, that the baby just is not happy. If greater than 25 weeks gestation, there is approximately a 45% fetal and 72% maternal survival with an emergent cesarean section; as the gestational age increases, the baby’s chance of survival dramatically increases but the biggest threat to the mother remains – hemorrhage.

Representing St. Louis Accident Victims

We understand how traumatic it can be to suffer an injury while pregnant. Our St. Louis catastrophic injury attorneys are ready to discuss the details of your claim and how it will affect your future and your family’s future. For a free consultation, call (314) 322-8515 today. We are on your side during this difficult time.