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Outcomes of minor trauma in pregnancy – is fetal monitoring really necessary?
  1. S Khan,
  2. H Smith,
  3. A J Thomson
  1. Royal Alexandra Hospital, Paisley, UK

Abstract

Introduction There is a lack of evidence to support management of minor trauma in pregnancy; North American guidelines recommend 4 h' continuous CTG monitoring. The aim of this study was to review management and outcomes of pregnant women presenting following minor trauma.

Methods Women attending obstetric triage over an 8-month period following minor trauma, were identified from a computerised database (n=59; median gestational age 28.5 weeks and range 14–39). Case notes were reviewed and outcomes retrieved.

Results The most common mechanisms of trauma were ‘fall’ (n=33), RTA (n=15) and assault (n=11). Majority of patients had no injuries (n=47); 2 women sustained a fracture and 10 sustained a sprain, abrasion or contusion. 24 women complained of symptoms including pain, reduced fetal movements, vaginal bleeding and contractions. All women above 24 weeks' gestation (n=42) had a CTG performed (median duration of 50 min, range=15–216 min). 11 women were Rhesus negative, two of whom did not have Kleihauer testing and did not receive anti-D immunoglobulin. No ultrasound scans were performed as part of the initial management. There was one spontaneous spontaneous abortion within a fortnight of presentation (23 weeks') in a woman who was involved in a major RTA. There were no other complications or adverse outcomes.

Conclusion While one woman had a spontaneous loss at 23 weeks, overall outcome following minor trauma in pregnancy was favourable. Assessment of fetal monitoring is of no benefit apart from providing maternal reassurance. Kleihauer testing and anti-D should be offered to all Rhesus negative women.

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