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.