Clinical Update - Trauma care of pregnant patients

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We have had two recent incidents involving pregnant patients sustaining trauma who have then been triaged to an obstetric unit rather than an emergency department (ED). On both occasions, this has resulted in delayed treatment due to obstetric units not being experienced in trauma care or set up to receive trauma patients.

Clearly, the triage decision in both cases was well intentioned, on both occasions the clinicians also contacted the receiving obstetric unit prior to conveyance and had their decision reinforced – an illustration of the lack of experience in dealing with trauma in Obstetric units and a lesson for us all.

Whilst it is normal practice to convey direct to an obstetric unit for most pregnancy related presentations, in the context of trauma, it is essential that the patient is managed initially through the trauma pathway.

Decision making may be complicated by normal physiological changes through pregnancy, which may make injuries and altered physiology difficult to differentiate. When assessing a pregnant trauma patient we must complete a thorough physical examination to ensure injuries are identified, as well as using physiological parameters to help identify/suspect any occult injuries. One patient, for example, had major chest and pelvic injuries which were not initially apparent at the scene. Remember that the best way to look after the baby is to look after mother and all Trauma Units have an Obstetric Trauma Team activation process which will ensure midwifery, obstetric and paediatric support to the ED.

In the event that you identify or suspect injuries in a pregnant trauma patient, please follow the trauma triage tool in deciding the most appropriate ED destination and provide an ATMISTER pre-alert, requesting an Obstetric Trauma Team.

If there is any support required in deciding the most appropriate destination for the patient, please call the Network Coordination Service (NCS) consultant for advice on 0300 330 3999, or speak to the CCD clinician on CH202. Please avoid calling the obstetric unit for advice unless you are satisfied that you have not been able to identify any injuries or physiological derangement.

Published 20th March 2021

Updated 21st March 2021