Trauma in Pregnancy

Author: Rashid Abuelhassan, Himanshu Mirani / Editor: Sandi Angus / Codes: / Published: 28/01/2026

This module examines the unique challenges of managing trauma in pregnant patients and equips healthcare providers with the essential knowledge to optimise outcomes for both mother and foetus in traumatic situations. It guides learners in recognising the physiological changes of pregnancy that affect trauma assessment and management. It also outlines key considerations in prehospital and inpatient care, as well as appropriate discharge criteria for minor injuries.

Learning objectives

After completing this session, you will be able to:

• Outline the physiological and anatomical differences in the pregnant patient, the alterations to the ATLS protocol and how to modify the approach.
• List some possible injuries associated with different mechanisms.
• List all possible features of high-risk injury and their signs.
• Know how to utilise the required resources correctly and in a timely manner
• Know the limits in being able to manage pregnant patients with significant trauma.

References

1. Rogoz R. Trauma PI Report: New activation criteria for pregnant trauma patients. 2024 Mar 12.
2. Battaloglu E, et al. Epidemiology and outcomes of pregnancy and obstetric complications in trauma in the United Kingdom. Injury. 2016 Jan;47(1):1847. 
3. Mendez-Figueroa H, Dahlke JD, Vrees RA, Rouse DJ. Trauma in pregnancy: an updated systematic review. Am J Obstet Gynecol. 2013 Jul 1;209(1):110.
4. Office for National Statistics. Domestic abuse in England and Wales: year ending March 2018 [Internet]. Office of National Statistics (ONS); 2018.
5. World Health Organization. Intimate partner violence during pregnancy: information sheet. WHO; 2011.
6. Qureshi H, et al. BCSH guideline for the use of antiD immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):820.
7. The National Institute For Health And Care Excellence (NICE). Scope of Service Document: Major Trauma Service Delivery Guideline [Internet]. NICE and NCGC; 2014.
8. Rose CH, et al. Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy. Am J Obstet Gynecol. 2015 Nov 1;213(5):653.e1-656.
9. Bedson R, Riccoboni A. Physiology of pregnancy: clinical anaesthetic implications. Contin Educ Anaesth Crit Care Pain. 2014 Apr;14(2):6972.
10. Demetriou C, et al. National variation in guidance for the management of pregnant women presenting with major trauma. Ann R Coll Surg Engl. 2024 Jul;106(6):52833.
11. Open Critical Care Project. Left lateral uterine tilt [Internet]. opencriticalcare.org; 2023. [Accessed 15 January 2026]
12. Kohl M, Kacmar R. Cardiopulmonary Resuscitation in Pregnancy. Open Anesthesia. Last updated: 12/19/2024.
13. Physiopedia contributors. Physiological Changes in Pregnancy. In: Physiopedia [Internet]. Physiopedia; 2022. p. 312958.
14. Pearlman MD, Tintinallli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990 Jun;162(6):1502-7; discussion 1507-10.
15. Krywko DM, Toy FK, Mahan ME, Kiel J. Pregnancy Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Sep 22].
16. ATLS Subcommittee; American College of Surgeons Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS ): the ninth edition. J Trauma Acute Care Surg. 2013 May;74(5):1363-6
17. Ormsby EL, et al. Pelvic free fluid: clinical importance for reproductive age women with blunt abdominal trauma. Ultrasound Obstet Gynecol. 2005 Sep;26(3):2718.
18. Kelly M, Hirshberg J. Fetal Heart Rate Tracing Interpretation. [online] Open Anesthesia, 2023.
19. Irving T, Menon R, Ciantar E. Trauma during pregnancy. BJA Educ. 2021 Jan;21(1):109.
20. Mushambi MC, Kinsella SM, et al. Obstetric Anaesthetists Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015 Nov;70(11):1286306.
21. Davies C, Windsor S. Cardiac Arrest in the Pregnant Patient. RCEMLearning, updated in 2024.
22. Part 10.8: Cardiac Arrest Associated With Pregnancy. Circulation. 2005;112(24_suppl):150153. doi:10.1161/CIRCULATIONAHA.105.166570.  [Cited in August 2025]
23. Walls RM, Hockberger RS, Gausche-Hill M, Rosen P, editors. Rosens emergency medicine: concepts and clinical practice. Philadelphia, PA: Elsevier; 2023.
24. Jara-Almonte G, Fairbrother H. Resuscitation of the Pregnant Trauma Patient Pearls and Pitfalls. 2015.
25. Anesthesia Key. Obstetrics. [Internet]. 2019 
26. A Level 5 Diploma in First Response Emergency & Urgent Care course materials, FREUC Pre Reading.[Internet]. [Accessed in August 2025]
27. St Mungos. Resuscitative Hysterotomy. [Internet]. 2017. [Accessed in August 2025]