Trauma in Pregnancy

Modified ATLS for pregnant trauma patients.

AHS Official

Updated: 05/03/2025

PregnancyATLSPerimortem C-sectionOBRhoGam

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⚠️ Early OB consult required.

⚠️ 4-minute rule for perimortem C-section (attending required).

🚨Key ATLS Modifications

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Airway: early intubation if GCS <8 or unable to maintain SpO₂ >95% on supplemental O₂. Anticipate airway edema — most experienced provider. High aspiration risk: apply cricoid pressure; consider early NG/OG. Maintain C-spine precautions.
Breathing: chest tubes 1–2 spaces above inframammary fold (elevated diaphragm)
Circulation: left lateral uterine displacement ≥20wk. Volume > pressors. Norepinephrine if refractory.
MTP same as adults EXCEPT: fibrinogen target >200
If O- RhD negative not available → RhD+ acceptable; give RhoGam after

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4-minute rule: CPR >4 min with gravid uterus ≥20wk → perimortem C-section. Fetal femur ≥4cm = ≥20wk on US.

🔬Labs & RhoGam

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👶Fetal Monitoring & Exam Restrictions

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<22 weeks

Document fetal heart rate.

≥22–24 weeks

Continuous fetal heart rate monitoring, duration per OB.

Avoid digital vaginal exam at ≥20 weeks until ultrasound excludes placenta previa
Rebound and guarding may be blunted — proceed to CT for concerning mechanisms
Uterine rupture is not reliably detectable by exam — get ultrasound
Consider eclampsia in the differential for any seizure

☢️Imaging in Pregnancy

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Order X-ray and CT for the same indications as a non-pregnant patient — do not withhold indicated imaging
Order abdominal shielding to protect the fetus when feasible
Tell radiology the patient is pregnant so alternative studies can be suggested
Avoid iodine-containing radioactive isotopes; use contrast cautiously; minimize repeat exams
Prefer ultrasound where it answers the question