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  6. Abdominal Trauma / Fall in Pregnancy (321)
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Abdominal Trauma / Fall in Pregnancy (321)

Warning

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Abdominal trauma in pregnancy can range from mild (e.g. single fall from standing height) to major (e.g. high force blunt trauma). All women ≥ 23 weeks reporting direct abdominal trauma or a fall should be invited to attend Triage for assessment.

Assessment

  • Enquire about the severity of trauma and mechanism of the injury, using open questions
  • Enquire whether the woman was aware of direct trauma to her abdomen
  • Gestational age
  • Bleeding/ rupture of membranes
  • Fetal movements
  • Pain/tightenings
  • If history of assault must be seen in hospital setting
  • Refer as appropriate if other injuries (i.e. Minor injuries, Emergency Department, physiotherapy)

Examination

Maternal observation includes:

  • MEWs (Maternal Early warning score)
  • Abdomen – abdominal exam for tenderness/contractions/bruising
  • Fetal heart auscultation
  • Vaginal loss- SROM/APH

Investigations

  • CTG (if ≥ 26+0 weeks)
  • Kleihauer if trauma to abdomen ≥ 20 weeks gestation and Rh Negative

Treatment

  • Anti-D within 72 hours of event for Rh negative women with abdominal trauma in ≥ 12 weeks.

  • If minor trauma/assessment normal – reassure and send home with call back advice

  • If more significant trauma (especially road traffic accident (RTA/seatbelt injury), bleeding, tightenings, ROM, any concerns - Obstetric Middle Grade review/admit 24 hours.

  • If the woman’s condition is unstable or if there is any concern about the mother or baby – admit to LW/inform obstetric staff urgently.

  • If history of non – sexual assault, obtain careful history and full examination must be recorded with obstetric review.

  • If additional sexual assault described, inform police surgeon.

Editorial Information

Last reviewed: 28/08/2024

Next review date: 28/08/2027

Author(s): Mairi MacDermid.

Version: 3

Approved By: Maternity Governance Group

Document Id: 321