Trauma in the pregnant patient.

The tragedy of major trauma to the pregnant woman presents the dilemma of managing two lives. An understanding of the pregnant patient's altered response to trauma and attention to detail in applying appropriate diagnostic tests will help to guarantee a successful outcome. Liberal use of consultation is suggested for medical and legal reasons. Obstetric consultation is highly recommended to document pregnancy and to assist in assessing fetal well-being. The obstetrician can perhaps provide reassurance to the mother and the family by demonstrating fetal heart tones with the Doppler instrument and can then further provide the necessary counseling and follow-up regardless of the outcome of the pregnancy. The pregnant patient with significant trauma should be closely observed and records carefully documented. Patients with minor injuries usually do not require admission, whereas more significant injuries require longer periods of observation. Admission criteria include vaginal bleeding, uterine irritability, abdominal tenderness or pain, evidence of hypovolemia, a change in or absence of fetal heart tones, or leakage of amniotic fluid. Management should primarily be directed toward guaranteeing the health of the mother, which better insures the health of the fetus.