Page 180 - PJ MED OPS Handbook 8th Ed

Blunt Injury Considerations:
• The abdominal wall, uterus and amniotic fluid act as buffers to direct fetal injury; however,
direct, forceful impact may still induce fetal injuries. Treating the mother is the best way to
treat the fetus.
• Unrestrained women in MVA have a higher risk of fetal injury/death, and premature delivery.
It is imperative to document if the female was a restrained passenger, or unrestrained.
• If possible, try and determine the type of restraint used (e.g., lap belt vs lap and shoulder
belt; was lap belt worn properly, below the pregnant abdomen? Or was it across the belly?).
Airbags do not appear to increase risk of injury pregnant mothers or the fetus.

Penetrating Injury Considerations:
• As the pregnancy progresses, the uterus increases in size. This helps protect abdominal or-
gans from penetrating injury, but increases likelihood of uterine injury.
• The end result is generally excellent outcome for the mother; however the fetus usually does
poorly with penetrating uterine trauma.
• Be aware that compression/elevation of the abdominal organs as pregnancy progresses may
pre-dispose to more complex organ injury. Particularly in the high abdomen/low chest region.

Special Considerations:
• Blood Type is of HIGH importance in the pregnant patient when considering transfusion of
blood products, BUT it is MORE IMPORTANT to remember that for ANY pregnant trauma pa-
tient, they MUST be seen in the hospital right away. Remember, even relatively minor trauma
may lead to fetal loss.
• Amniotic Fluid Embolism, while relatively rare, can occur in trauma of the pregnant female.
Be alert for anaphylaxis type reaction, particularly involving the airway, following trauma.
Treat as if Anaphylaxis with IM/SC Epinephrine and transport immediately.
In the RARE, extenuating circumstance of having to deliver a baby in austere environment:
• Immediately call for medical support – Delivery is NOT recommended if at all avoidable in
the field.
○ If water has broken and contractions are present but NO perineum bulging or head
crowning is present, consider immediate transport.

178 n Pararescue Medical Operations Handbook / 8th Edition