Injuries and trauma during pregnancy: What to watch out for

Pregnant women are at higher risk of injury for a number of reasons. It’s important to be ware of the risk, know how to prevent injuries and also know what to watch out for in order to treat pregnant women as effectively and promptly as possible. Throughout this post I want to mention 4 main points that are important to know about this topic, but before I do there are some interesting facts worth knowing.

Women who are pregnant are especially susceptible to injuries, mainly due to motor vehicle accidents and domestic violence. The amount of domestic violence is dangerously under-reported, though it’s known that the amount is raised during pregnancy. Car accidents are the main cause of trauma in pregnant women, and the risk of getting into an accident increases as the pregnancy progresses. Of all the women who get into car accidents during pregnancy, only 8% are in the first trimester but 50% are in the 3rd trimester.  If you are pregnant, or know someone who is make sure to remind them to drive safely every time they take a trip, but even MORE so as their pregnancy progresses.

Now that you have raised your level of suspicion, let’s talk about the things that you can do, and that are important to know to prevent and treat pregnant woman from injuries.

  1. Putting a seatbelt on properly can save the life of the fetus, and the mother.
    I hope this sounds self evident, but unfortunately the incorrect placement of a seatbelt is the cause for an unexplainable amount of preventable injuries after car accidents. The seatbelt is very well designed in order to use anatomical points on the body that are strategically safe, so putting it on properly is essential whether you are pregnant or not. The shoulder strap should rest on your collar bone (clavicle), and the lower strap should rest across your lap on the 2 hip bones that you can feel by looking for that pointy part at the front of your hips. This is part of the pelvic bones, and the point that sticks out is the anterior (front) superior (higher) iliac spine.

    Pregnant woman often find it uncomfortable to tuck the lower strap underneath the large pregnant belly, and too often rest it across the large part of the stomach. This is extremely dangerous to both the fetus and the mother! If a woman gets into a car accident while the seatbelt is in this position, it can cause damage to the uterus, which can cause internal bleeding, destabilising both the mother and the unborn baby. It is absolutely essential that the mother put her seatbelt on properly, placing the lower strap underneath her stomach across the pelvic bones that were mentioned above.

  2. If a pregnant woman sustains an injury, they should be taken to a hospital as quickly as possible. 
    This is another point that may seem obvious when you look read it, however unfortunately it is not so. There is a tendency to start treatment in the field, at the sight of the crash. There are 2 main things that should be done in the field, and both are in extreme cases. The first is to stop bleeding, especially if it’s heavy bleeding. Direct pressure is the best way to do this. The second is to make sure that an airway is established, however this is only done by medical professionals so if you are not a medical professional, only the first one applies to you.

    If there is any doubt or a question whether a pregnant woman has sustained injuries that are dangerous to her or the fetus, she should be taken to a hospital immediately to be checked out. Only in a hospital setting the appropriate steps can be taken to check the status of the mother and her fetus. The evacuation to the hospital should be done as soon as possible, because if she has sustained any significant injury, the clock is ticking and every minute counts. Minimize the treatment that she receives in the field as much as possible, and get her out of there immediately.

  3. Pregnant woman should not be immobilised on their back for an extended period of time, especially on a hard surface.
    This is an interesting point, and it is because of a phenomenon known as supine hypotensive syndrome. If a pregnant woman is laying on her back, the uterus with the fetus inside is also being pushed to her back because of gravity. This puts direct pressure on the inferior vena cava, which is the main blood vessel responsible for returning blood from the lower extremities back to the heart. By obstructing this blood flow, she is severely impairing her body’s ability to circulate blood, which is what she needs both on a regular basis but even more so if she has sustained an injury.

    When a person is injured, there is a tendency to lay them down on their back, because it is comfortable and easy to assess them and treat them this way. First responders often do this as normal practice, and even more of an emphasis is put on this position if someone has a suspected injury to their spinal cord. Pregnant women should not be put on their back for extended periods of time, rather they should lay on their left side if possible. If they need to be put on a spinal board, the medical team doing so can tilt the board periodically to make sure that the gravity is not pulling the uterus with the fetus inside on to her inferior vena cava.

  4. Treating the mother is the first priority, and also the most effective way to treat the fetus.
    This point may be more relevant for medical professionals than for first responders, but it’s interesting to understand as well. Often there are debates if a woman should undergo X-Rays or Computed Tomography exams which have high amounts of radiation, if she is pregnant. There are 2 important points to understand. First, as the pregnancy advances the risks of complications from radiation to the fetus are dramatically reduced. Second, the best way to treat the fetus is to treat the mother. If doctors don’t want to risk too much radiation to the baby and because of this they decide not to perform an imaging exam they risk missing critical injuries that can then be fatal to both the fetus AND the mother. It is therefor essential to give the mother the treatment necessary, and do the procedures and imaging exams that are necessary for her as well.

First aid is a mandatory skill for any responsible citizen to have, though as a parent it is even more essential. Know how to take care of your kids in the time of emergency, and what to look out for. 

 

 

 

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