Vehicular accidents: Look out for the pregnant ones

Motor accidents involving pregnant women are rarely mentioned as one of the causes of maternal mortality and morbidity in our part of the world. It is a very significant and sad incident that occurs on daily basis.

The pregnant woman, particularly one who is near term, is usually sluggish in an uncoordinated, imbalanced movement when walking. They may accidentally be knocked down by speeding cars and motorcycles. Most of these accidents occur during daily rides in cars and other automobiles, especially when they do not wear seatbelts.

Accidents may be head-on collision or ‘side hit’ by other vehicles. The would-be mothers may suffer death or severe body injuries, even with occasional pelvic bone fractures. The unborn babies are not spared either, even though they may appear to be cushioned within the womb.

Brain-damaged babies Brain-damaged babies or cerebral palsy is a common outcome after such blunt injuries.

The possible explanation is: * Deficient or insufficient blood flow within the uteroplacental system. Less oxygen perfusion to the brain tissues of the unborn child. * Thrombus within the umbilical placental line, resulting in less perfusion of blood and oxygen to the brain tissue of the unborn. * Accidental separation of part of the placenta (also known as abruption) * Premature birth and premature rupture of amniotic fluid membranes * Severe hypotension or hypertension as a result of the accident (pregnant woman in shock with consequential less perfusion of blood via placenta) * Fatal death is very common as a result of the above

Most of the traumatised pregnant women may experience infrequent uterine contractions and pains. Very severely injured pregnant women may go into premature labour within 48 hours.

Painful uterine contractions Mild to moderate injured pregnant mothers might experience painful uterine contractions after about 24 hours but will respond well to tocolysis (IV fluids and sedation).

All injured pregnant women should be treated according to the normal protocol for accident victims. This is a very challenging scenario, where the healthcare provider will be treating both the unborn as well as the mother. (Sonographic evaluation of the uterus and foetus, pelvic examination to rule out pelvic fractures and vaginal lacerations)

Emergency caesarian section Blood transfusions may be necessary with emergency caesarian sections and occasional supracervical hysterectomy to save the patient’s life. X-rays and CT scans may be diagnostic necessity even though they might be detrimental to the unborn babies.

Blood coagulation defective processes should be considered here as a consequence to the placental separation. Blood incompatibilities must also be considered. Prompt and adequate management is necessary. Doctors of other specialties must be consulted for assistance (general and orthopedic surgeons). Physician specialists and haematologists, pediatric and neonatologists should be available as part of the team.

Close family members as well as husbands must be cosigners of the informed consequent papers.

The status of the unborn in the uterus may be sacrificed, if immature, for the mother’s life and survival. Doctors should not discharge such patients hurriedly from the hospitals; six hours for mild accidents and about 24-48 hours for moderate accidents are very prudent.