Blunt trauma in pregnancy.

Trauma is the most common cause of nonobstetric death among pregnant women in the United States. Motor vehicle crashes, domestic violence, and falls are the most common causes of blunt trauma during pregnancy. All pregnant patients with traumatic injury should be assessed formally in a medical setting because placental abruption can have dire fetal consequences and can present with few or no symptoms. Evaluation and treatment are the same as for nonpregnant patients, except that the uterus should be shifted off the great vessels. After initial stabilization, management includes electronic fetal monitoring, ultrasonography, and laboratory studies. Electronic fetal monitoring currently is the most accurate measure of fetal status after trauma, although the optimal duration of monitoring has not been established. Prevention of trauma through proper seat belt use during pregnancy and recognition of domestic violence during prenatal care is important.