Presentation
High speed motor vehicle accident in a 35 week pregnant patient.
Patient Data
Age: 40 years
Gender: Female
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Chest:
- Undisplaced fractures through the lateral aspects of the left 3rd-6th and the right 1st and 2nd ribs anteriorly.
Abdomen/Pelvis
- Third trimester fetus within the uterus.
- Heterogenous placental enhancement with several moderate sized non-enhancing segments, suspicious for but not diagnostic of abruption.
- Large right-sided retroperitoneal hematoma with active contrast extravasation from the right ovarian vein.
- Lap-belt subcutaneous bruising.
- Bilateral lateral wall subcutaneous contusions.
Case Discussion
Never refuse or delay a referral for a trauma CT because a patient is pregnant. In severe trauma in a pregnant patient, a CT is justified if the mother is unwell as her condition may be life threatening to not only herself but also the fetus.
Traumatic injuries in pregnancy are divided into maternal injuries, injuries to the gravid uterus and injuries to the fetus. Direct injury to the fetus is uncommon as it is protected by the maternal body wall, the uterus and amniotic fluid. Thus injuries to the fetus are most common in the third trimester when the volume of amniotic fluid relative to the volume of the fetus is reduced.