Abdominal Trauma / Fall in Pregnancy (321)

Please report any inaccuracies or issues with this guideline using our online form

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