Trauma in pregnancy remains one of the major contributors to maternal and fetal morbidity and mortality. Accidental injuries affect up to 6–7% of all pregnant patients. When a pregnant woman presents with a major trauma, two lives are at risk. According to the Advanced Trauma Life Support Program, the first consideration in management for the traumatic injuries in pregnancy is to stabilize the mother’s condition. The second consideration is to assess the fetus. Injured pregnant women have the increased risk of placental abruption and the risk of fetal distress, prematurity, low birth weight, and fetal death. Placental abruption after trauma occurs in 2–4% of minor accidents and in up to 50% of major injuries. In blunt maternal-fetal trauma, maternal mortality from placental abruption is less than 1%, but fetal death ranges from 20% to 35%. Fetal distress associated with placental abruption requires immediate intervention. Fetal injuries after trauma may be treatable, but only if they are recognized. Vast majority of penetrating trauma cases (e.g., gunshot, stab wound) are fatal to the fetus, whereas injured fetus after blunt maternal trauma should be considered as surgically treatable.
The incidence of birth trauma has decreased in recent decades because of the improvement in obstetric techniques. However, birth injuries still occur and represent an important problem for the clinician. The incidence of birth trauma is 2–7 per 1000 live birth. Birth injury is usually associated with unusual compressive or traction forces in association with abnormal presentation of the fetus.
A pediatric surgeon, obstetrician, and neonatologist should participate in the evaluation and management of fetal and birth trauma. Every pediatric surgeon must be familiar with the treatment of birth trauma.
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