The Generalist: Minor Trauma in Late Pregnancy
Ben Shepherd, MD; Heidi James, MD; and Vanessa Cardy, MD
Ben Shepherd walks us through the pitfalls and perils associated with minor abdominal trauma in late pregnancy. Women who experience this are at risk of placental abruption and fetomaternal hemorrhage and, as such, need to be closely monitored.
- Placental abruption:
- Placental abruption is the separation of the placenta from the uterine wall.
- Signs and symptoms:
- Abdominal pain, vaginal bleeding and uterine contractions
- The degree to which uteroplacental function is compromised will be the main factor in determining fetal outcome.
- Urgent delivery is required in most cases.
- Fetomaternal haemorrhage (FMH:)
- FMH is initially usually clinically silent.
- Eventually women may complain of decreased fetal movements.
- In FMH. there is a loss of fetal red blood cells into the maternal circulation, typically due to disruption of the normal barrier that prevents mixing within the placenta.
- How to detect FMH
- Most birthing units advocate a 4-hour cardiotocography (CTG) to detect changes in fetal wellbeing or signs of fetal anemia.
- Possibly the use of the Kleihauer (KL) blood test to further help identify FMH.
- If there are signs of fetal compromise, urgent delivery is indicated.
- Which women can be discharged?
- Clinical review and non-concerning 4-hour CTG and
- No uterine contractions
- Membranes intact
- No vaginal (PV) bleeding
- Normal KL (reassuring but not definitive)
- Discharge instructions:
- Return if
- PV bleeding
- Reduced fetal movements