Assessment and stabilization of the mother should take first priority
Nonviable fetus (<23-24wks)
Standard treatment for trauma
No obstetric intervention will alter the outcome of a pre-viable fetus
Consider RhoGAM 50mcg in Rh negative patients
Viable fetus (>23-24wks)
Consider RhoGAM 300mcg in Rh negative patients
Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery
Fetal monitoring (continuous cardiotocographic monitoring)
If no risk factors for fetal loss, minimum 4-6 hours
If risk factors for fetal loss/abruption, monitor for 24 hours
The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes. 
Standard treatment for trauma
No obstetric intervention will alter the outcome of a pre-viable fetus
Consider RhoGAM 50mcg in Rh negative patients
No obstetric intervention will alter the outcome of a pre-viable fetus
Consider RhoGAM 300mcg in Rh negative patients
Avoid pressors - compromises blood flow to uterus leading to decreased fetal O2 delivery
Fetal monitoring (continuous cardiotocographic monitoring)
If no risk factors for fetal loss, minimum 4-6 hours
If risk factors for fetal loss/abruption, monitor for 24 hours
The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes. 
If no risk factors for fetal loss, minimum 4-6 hours
If risk factors for fetal loss/abruption, monitor for 24 hours
The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes. 
The duration of cardiotocographic monitoring should be extended to 24 hours if, during the first 4 hours, she develops > 4 contractions per hour, persistent uterine tenderness, a worrisome fetal monitor strip, vaginal bleeding, or rupture of the membranes. 
Allow patient to roll onto left side to unload uterine compression of IVC → increases venous return to heart
In the setting of maternal cardiac arrest, consider Perimortem Cesarean delivery if no ROSC within 4 minutes
>3 contractions/hr
Persistent uterine TTP
Worrisome strip
Vaginal bleeding
PROM
Serious maternal injury
Partial abruption with stable mom/fetus and <32wk may have expectant care (with easy access to emergent C-section)
Abruption = risk DIC
Frequent uterine activity more predictive of abruption than US
>8 contractions/hr for 4hrs - high risk for abruption
3-7 contractions/hr for 4hrs - extend monitoring for 24hrs
<3 contractions/hr for 4hrs - safe for discharge
>8 contractions/hr for 4hrs - high risk for abruption
3-7 contractions/hr for 4hrs - extend monitoring for 24hrs
<3 contractions/hr for 4hrs - safe for discharge
Trauma in pregnancy
Diaphragmatic trauma
Comorbid diseases in pregnancy
Liver trauma
Headache during pregnancy
Splenic trauma
Vaginal bleeding in pregnancy 
Pelvic fractures