# Trauma in pregnancy - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD35 - condition scope only, no dose · Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/ - Verified date: 2026-08 ## Verified against - Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/ ## Treatment metadata - Rho(D) immune globulin — injection - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text TRAUMA IN PREGNANCY Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD35 - condition scope only, no dose · Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/ Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Run the standard trauma algorithm: primary, secondary and tertiary survey - Vital signs shift through normal pregnancy, so read them against pregnancy values - Ask every woman of childbearing age whether pregnancy is possible and send a beta-hCG - Ask about previous preterm labour, placental abruption and placenta praevia - Get obstetric help urgently, above all in the second or third trimester - Bleeding from the vagina before labour is always abnormal [vaginal bleeding] - It may mean abruption, early labour, the cervix opening early, or placenta praevia - Cloudy, white or green discharge suggests the membranes have gone, raising infection risk - Contractions after an injury are a concerning finding [uterine contractions] SIGNS - what you find (10) - Concerning findings: penetrating abdominal injury, vaginal bleeding, ruptured membranes, a bulging perineum, contractions or an abnormal fetal heart rate [uterine contractions · vaginal bleeding] - Ruptured membranes risk cord prolapse, an obstetric emergency needing immediate caesarean - If the circulation allows, include a speculum examination - Palpate for fundal height, which estimates gestation and may be the only clue in an unresponsive patient [loss of consciousness] - The uterus rises above the pubic bone between 8 and 12 weeks - From 20 weeks it climbs about a finger’s breadth at a time until 40 weeks - It reaches the sternum at 36 weeks, then drops as the head engages - A fundal height that does not match known dates suggests uterine injury, twins or growth restriction - Avoid low blood pressure and give oxygen, because the fetus tolerates hypoxia badly [hypotension · hypoxia] - If rapid sequence intubation is needed, pregnancy calls for lower doses of suxamethonium TESTS (12) - Fetal heart sounds can be heard with a stethoscope from 20 weeks; before that use a Doppler - They are detectable from as early as 12 weeks, usually between 110 and 160 bpm - Fetal hypoxia first shows as a fast heart, then slows as oxygen falls further - Any sustained rate below 120 bpm means fetal distress, and points to maternal blood loss - Past 24 weeks, monitor the fetal heart for 4 to 6 hours after arrival - Fear of radiation must not delay the right diagnosis; the mother comes first, not the fetus - An abdominal x-ray gives the fetus 0.1 to 0.3 rads; abdominal and pelvic CT gives 3 to 4 rads - A pregnancy should accumulate under 10 rads in total, and no one study should pass 5 rads - Between 8 and 15 weeks a high dose (>10 rads) may cause growth restriction and brain defects; past 15 weeks no dose-dependent effect appears - Ultrasound and MRI have no known harmful effect on the fetus - Keep eFAST in the secondary survey; it finds blood or air in the chest, round the heart, or in the abdomen - Radioactive iodine must not be given therapeutically in pregnancy IF NOT THIS - what else fits (5) - Blunt abdominal trauma heads the listed differential - Placental abruption needing emergency management - Penetrating abdominal trauma completes the three - Free fluid confined to the pelvis on ultrasound is of unclear meaning in pregnancy - MRI is safe in pregnancy but often impractical in an emergency, on availability and time Source StatPearls "Pregnancy Trauma" - disease-level clinical article Status traced to the source above Rx: Prevention of Rh iso-immunisation | Main treatment PREVENTION OF RH ISO-IMMUNISATION 1. RHO(D) IMMUNE GLOBULIN [1st line] Adult 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. - A single dose after the injury, repeated only as the Kleihauer-Betke result requires Peds Adult-only condition - paediatric section not applicable Source Pregnancy Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430926/ Why 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. Caution 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. Egypt RHOGAM 300MCG/2ML PREFILLED SYRINGE JOHNSON & JOHNSON > LAB TOP 720.00 EGP WINRHO SDF 300MCG (1500I.U.) I.M./I.V.VIAL CANGENE CORPORATION/CANADA > ... 1215.00 EGP RHOPHYLAC 300MCG/2ML PREFILLED SYRINGE CSL AG-SWITZERLAND > 2S PHARMA GROUP 2280.00 EGP MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. - Refer, with advice Peds Adult-only condition - paediatric section not applicable Source No dose - referral pathway, no medicine given in primary care Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)