oa Case report: Trauma in Pregnancy, The Golden Hour

Background: The evaluation of the pregnant trauma patient presents unique challenges. There are two patients potentially at risk; the mother and the fetus who both require evaluation and management.¹ Physiological changes like ligaments laxity, weight gain, and changes in the center of gravity make pregnant women at increased risk for trauma.² Knowing the other physiological changes is crucial for the adapted trauma management in pregnancy.³ This case study reports on major trauma in a pregnant woman that was under-evaluated at first assessment leading to maternal and fetal mortality. Case presentation: A 30-year-old pregnant lady (36 weeks) presented to a community hospital following a motor vehicle accident. She had sutures for a facial wound then she was sent home. A few hours later she presented to a tertiary hospital with hemoptysis. A Focused Assessment with Sonography in Trauma (FAST) ultrasound showed possible hepatic and splenic injuries and fetal death so she was transferred urgently to the operating room. Findings: The patient underwent laparotomy for the repair of the injured abdominal organs, in addition to a C-section complicated by uterine atony. After the failure of medical management, she underwent a hysterectomy then she progressed quickly into Disseminated Intravascular Coagulation (DIC) and passed away a few hours later. Conclusion: Trauma in pregnancy should always be taken seriously to avoid under-evaluation of major injuries. Basic principles of advanced trauma life support (ATLS) were not followed in this case and major injuries were missed. Patients in high-speed collisions should be referred to a trauma center instead of a community hospital in order not to lose the time window of the golden hour.