{ "schema_version": 1, "kind": "condition", "id": "trauma-in-pregnancy", "name": "Trauma in pregnancy", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD35 - condition scope only, no dose ยท Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/", "review_status": "reviewed", "verified_against": "Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/", "verified_date": "2026-08", "treatments": [ { "id": 1808, "generic": "Rho(D) immune globulin", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": null, "adult_dose": "Rh-negative mother only. Under 12 weeks gestation, 150 micrograms. Over 12 weeks, 300 micrograms. More than that if the feto-maternal haemorrhage is large, which the Kleihauer-Betke test measures.", "adult_duration": "A single dose after the injury, repeated only as the Kleihauer-Betke result requires", "dose_source": "Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/", "rationale": "The cited article states that the mother's Rhesus type should be sought, that if she is Rh-negative there is a chance of iso-immunisation compromising later pregnancies, and that Rh immunoglobulin should be given regardless of mechanism - including a fall from standing - because sensitisation occurs at 0.01 to 0.03 mL of fetal blood in 70% of Rh-negative patients. It states the amounts by gestational age: 150 micrograms below 12 weeks, 300 micrograms above, and more where the feto-maternal haemorrhage is marked after massive blunt abdominal trauma.", "cautions": [ "EGYPT STOCKS ONLY THE 300 MICROGRAM PRESENTATION. All three registered products - RHOGAM, RHOPHYLAC and WINRHO SDF - are 300 micrograms; the 120 microgram WINRHO vial is withdrawn and there is no 150 microgram product. Below 12 weeks the article's amount cannot be dispensed as written here, and the 300 microgram dose is what is available.", "IT IS FOR AN RH-NEGATIVE MOTHER AND NOBODY ELSE. Check the blood group first. Giving it to an Rh-positive mother is useless and not harmless.", "THE KLEIHAUER-BETKE TEST SETS THE DOSE UPWARDS, NOT THE PRESENCE OF BLEEDING. The article notes the test only detects a feto-maternal haemorrhage above 5 mL while iso-immunisation can happen at 0.01 mL, so it is used to decide HOW MUCH extra is needed, not WHETHER to give the first dose.", "A FALL FROM STANDING COUNTS. The article names it explicitly. The threshold for giving this is far lower than the threshold for admitting the patient.", "TRANEXAMIC ACID IS SAFE IN SEVERE HAEMORRHAGE WITHIN 3 HOURS OF THE INJURY, the article states, and blood products should be given in a 1:1:1 ratio as for a non-pregnant patient. It gives no amount for tranexamic acid, so none is written here.", "TETANUS TOXOID IS SAFE IN PREGNANCY, the article states. It also names the antibiotics to avoid on teratogenic grounds: aminoglycosides, quinolones, metronidazole and sulfonamides. Enoxaparin and heparin are safe for thromboprophylaxis because they do not cross the placenta.", "THE MOTHER IS RESUSCITATED FIRST. The article asks for the uterus to be displaced off the vena cava with a wedge or roll, and warns that vasopressors further compromise placental blood flow." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - the patient is a pregnant woman.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "RHOGAM 300MCG/2ML PREFILLED SYRINGE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JOHNSON & JOHNSON > LAB TOP", "price_egp": 720.0, "pack_count": null, "unit_price": null, "strength_mg": 0.3, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINRHO SDF 300MCG (1500I.U.) I.M./I.V.VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CANGENE CORPORATION/CANADA > EGYPTIAN PHARMEX", "price_egp": 1215.0, "pack_count": null, "unit_price": null, "strength_mg": 0.3, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RHOPHYLAC 300MCG/2ML PREFILLED SYRINGE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CSL AG-SWITZERLAND > 2S PHARMA GROUP", "price_egp": 2280.0, "pack_count": null, "unit_price": null, "strength_mg": 0.3, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "trauma-in-pregnancy" }, { "id": 1809, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Trauma during pregnancy (falls, road traffic accidents, domestic violence) requires urgent assessment of both mother and fetus; the GP recognises and refers to obstetric emergency care.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Trauma during pregnancy (falls, road traffic accidents, domestic violence) requires urgent assessment of both mother and fetus; the GP recognises and refers to obstetric emergency care.", "cautions": [ "Abdominal trauma in pregnancy with bleeding, contractions, or reduced fetal movement needs immediate obstetric referral for possible placental abruption.", "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. No primary-care medicine is implied.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "trauma-in-pregnancy" } ] }