MacDermott Roisin, Berger Ferco H, Phillips Andrea, Robins Jason A, O'Keeffe Michael E, Mughli Rawan Abu, MacLean David B, Liu Grace, Heipel Heather, Nathens Avery B, Qamar Sadia Raheez
Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
Tory Trauma Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
Diagnostics (Basel). 2024 Jan 26;14(3):276. doi: 10.3390/diagnostics14030276.
Trauma is the leading non-obstetric cause of maternal and fetal mortality and affects an estimated 5-7% of all pregnancies. Pregnant women, thankfully, are a small subset of patients presenting in the trauma bay, but they do have distinctive physiologic and anatomic changes. These increase the risk of certain traumatic injuries, and the gravid uterus can both be the primary site of injury and mask other injuries. The primary focus of the initial management of the pregnant trauma patient should be that of maternal stabilization and treatment since it directly affects the fetal outcome. Diagnostic imaging plays a pivotal role in initial traumatic injury assessment and should not deviate from normal routine in the pregnant patient. Radiographs and focused assessment with sonography in the trauma bay will direct the use of contrast-enhanced computed tomography (CT), which remains the cornerstone to evaluate the potential presence of further management-altering injuries. A thorough understanding of its risks and benefits is paramount, especially in the pregnant patient. However, like any other trauma patient, if evaluation for injury with CT is indicated, it should not be denied to a pregnant trauma patient due to fear of radiation exposure.
创伤是导致孕产妇和胎儿死亡的主要非产科原因，估计影响所有妊娠的5%-7%。值得庆幸的是，孕妇是创伤病房中就诊患者的一小部分，但她们确实有独特的生理和解剖变化。这些变化增加了某些创伤性损伤的风险，妊娠子宫既可能是主要损伤部位，也可能掩盖其他损伤。妊娠创伤患者初始管理的主要重点应是孕产妇的稳定和治疗，因为这直接影响胎儿结局。诊断性影像学在初始创伤性损伤评估中起着关键作用，在孕妇中不应偏离常规程序。创伤病房的X线片和超声重点评估将指导是否使用对比增强计算机断层扫描（CT），CT仍然是评估是否存在需要进一步改变治疗方案的损伤的基石。全面了解其风险和益处至关重要，尤其是对于孕妇。然而，与任何其他创伤患者一样，如果有必要进行CT损伤评估，不应因担心辐射暴露而拒绝为妊娠创伤患者进行检查。
