types of Trauma
![Picture](/uploads/1/5/4/1/15416176/7063877.png?418)
The types of trauma suffered by pregnant patients are essentially the same as those of non-pregnant patients, with the major difference being the pattern of injury in pregnancy. The protrusion of the abdomen makes these patients much more susceptible to abdominal trauma with the risks increasing as the pregnancy progresses: 10-15% in the first trimester,30-32% in the second trimester and 50-54% in the third (Hill, 2009).
Types of Trauma include:
1. Motor Vehicle Accidents
2. Assaults
3. Falls
4. Penetrating Wounds
5. Burns
Risk factors for maternal trauma include a young age, use of drugs or alcohol and domestic violence.
Types of Trauma include:
1. Motor Vehicle Accidents
2. Assaults
3. Falls
4. Penetrating Wounds
5. Burns
Risk factors for maternal trauma include a young age, use of drugs or alcohol and domestic violence.
![Picture](/uploads/1/5/4/1/15416176/7439798.jpg?328)
Motor Vehicle Accidents
Motor Vehicle Crashes or MVC's, account for the largest percentage of traumas in pregnancy at 55%. Severe injury occurs in approximately 10% of these cases with a high likelihood of preterm delivery, placental abruption, cesarean delivery and increased maternal and fetal mortality. The more severe the maternal trauma, the greater the chance of pregnancy loss. The single best way to prevent injury in an MVC is to wear a seat belt. The belt protects the mother from being ejected from the vehicle after the collision and eliminates secondary impacts in the interior of the car.
Motor Vehicle Crashes or MVC's, account for the largest percentage of traumas in pregnancy at 55%. Severe injury occurs in approximately 10% of these cases with a high likelihood of preterm delivery, placental abruption, cesarean delivery and increased maternal and fetal mortality. The more severe the maternal trauma, the greater the chance of pregnancy loss. The single best way to prevent injury in an MVC is to wear a seat belt. The belt protects the mother from being ejected from the vehicle after the collision and eliminates secondary impacts in the interior of the car.
![Picture](/uploads/1/5/4/1/15416176/4698902.jpg?333)
Assaults
Assaults and Domestic Violence (DV) are the second largest cause of maternal trauma in the United States at 20%. Approximately one third of all women who present to the emergency room are subject to secondary domestic violence. In some circumstances, pregnancy actually increases the frequency and severity of DV. Most cases of maternal homicide are the direct result of domestic violence. Poor reporting rates of DV should be of particular concern to the emergency nurse. Systematic abuse assessment should be done on all pregnant patients by using a single direct question " Have you been hit, slapped, kicked or hurt during this pregnancy?". 95% of women who are abused during pregnancy were abused before they were pregnant. Abused women are usually younger, single and have lower income and education compared with non-abused women, although anyone at any age or socioeconomic level can be abused.
Assaults and Domestic Violence (DV) are the second largest cause of maternal trauma in the United States at 20%. Approximately one third of all women who present to the emergency room are subject to secondary domestic violence. In some circumstances, pregnancy actually increases the frequency and severity of DV. Most cases of maternal homicide are the direct result of domestic violence. Poor reporting rates of DV should be of particular concern to the emergency nurse. Systematic abuse assessment should be done on all pregnant patients by using a single direct question " Have you been hit, slapped, kicked or hurt during this pregnancy?". 95% of women who are abused during pregnancy were abused before they were pregnant. Abused women are usually younger, single and have lower income and education compared with non-abused women, although anyone at any age or socioeconomic level can be abused.
![Picture](/uploads/1/5/4/1/15416176/8535796.png?343)
Falls
Falls also account for approximately 20% of maternal traumas. They may be more common in the second and third trimesters due to weight gain, increased joint mobility and changes to the center of gravity. Blunt abdominal trauma is usually what occurs from a fall. Women who state they have fallen should be particularly screened for domestic violence, as this is sometimes used as the reason for their injuries.
Falls also account for approximately 20% of maternal traumas. They may be more common in the second and third trimesters due to weight gain, increased joint mobility and changes to the center of gravity. Blunt abdominal trauma is usually what occurs from a fall. Women who state they have fallen should be particularly screened for domestic violence, as this is sometimes used as the reason for their injuries.
![Picture](/uploads/1/5/4/1/15416176/4960720.jpg?353)
Penetrating Wounds
Penetrating wounds such as gunshot (GSW) and stab wounds account for approximately 9-10% of maternal traumas. 6% of injuries in pregnancy are directly attributable to firearms. In a significant percentage of penetrating injuries, the uterus is the only organ that is injured. Maternal outcomes are generally good with penetrating injuries, but there is a corresponding high percentage (40-70%) of fetal loss as the uterus, amniotic fluid, placenta and fetus absorb most of the energy from the penetrating object.
Penetrating wounds such as gunshot (GSW) and stab wounds account for approximately 9-10% of maternal traumas. 6% of injuries in pregnancy are directly attributable to firearms. In a significant percentage of penetrating injuries, the uterus is the only organ that is injured. Maternal outcomes are generally good with penetrating injuries, but there is a corresponding high percentage (40-70%) of fetal loss as the uterus, amniotic fluid, placenta and fetus absorb most of the energy from the penetrating object.
![Picture](/uploads/1/5/4/1/15416176/5246202.png?354)
Burns
Burns are a unique and serious problem in pregnant patients. The exact incidence of burns in pregnancy is not known. They may occur at any time in the pregnancy and usually occur at home from exposure to house fires, hot water or flammable liquids or gases. The degree of complications and the risk of maternal death are directly proportional to the total body surface area burned and the type of burn. When the total body surface area burned exceeds 40%, maternal and fetal mortality approach 100%. Maternal and fetal deaths usually occur more from inhalation injuries than from the burn itself. Carbon monoxide freely crosses the placenta. Because fetal hemoglobin has a higher affinity for binding carbon monoxide, the effects are more pronounced on the fetus. (Romero and Pearlman, 2012)
Burns are a unique and serious problem in pregnant patients. The exact incidence of burns in pregnancy is not known. They may occur at any time in the pregnancy and usually occur at home from exposure to house fires, hot water or flammable liquids or gases. The degree of complications and the risk of maternal death are directly proportional to the total body surface area burned and the type of burn. When the total body surface area burned exceeds 40%, maternal and fetal mortality approach 100%. Maternal and fetal deaths usually occur more from inhalation injuries than from the burn itself. Carbon monoxide freely crosses the placenta. Because fetal hemoglobin has a higher affinity for binding carbon monoxide, the effects are more pronounced on the fetus. (Romero and Pearlman, 2012)