Trauma in pregnancy.

In summary, salient points are as follows: The obstetrician must be aware of the normal physiology of pregnancy and the unique response of the pregnant patient to stress and trauma. Maternal stabilization is paramount in the initial management of trauma. With regard to motor vehicle trauma, the three-point restraint system is superior to lap-belt restraint and should be worn by all pregnant women. In the case of maternal survival, placental abruption is the most common cause of fetal death. This may be managed expectantly in many cases. In abdominal trauma requiring laparotomy, the gravid uterus must not compromise maternal care. Management will depend on maternal condition at the time of laparotomy and along a projected course of convalescence. Fetal gestational age and clinical status also must be considered. Vaginal delivery is not contraindicated following exploratory laparotomy. Fetal demise is not an indication for hysterotomy. Postmortem cesarean section is well supported medicolegally. Elapsed time from maternal death and the gestational age of the fetus are the critical factors affecting perinatal outcome.