Damage control for the obstetric patient.

The management of trauma and hemorrhagic shock in the pregnant patient involves unique considerations owing to extensive alterations in physiology. In the third trimester of pregnancy, emergent delivery by cesarean section should be started within 4 minutes after the initiation of CPR for both maternal and fetal benefits. Stabilization of the maternal condition should take precedence over the fetal status in cases of penetrating or blunt trauma. Postpartum hemorrhage is managed by a succession of pharmacologic and surgical maneuvers prior to resorting to hysterectomy, particularly in a woman of low parity. Hepatic rupture and abdominal gestation are unique conditions to pregnancy that require damage control through a close partnership between the obstetrician and the surgeon.