Versorgung verletzter schwangerer Patientinnen

Trauma in pregnant patients accounts for the majority of deaths unrelated to pregnancy of the mother and fetus. Anatomical and physiological changes during pregnancy need to be considered in the assessment and treatment of the patients. Hypotension associated with shock results in fetal compromise due to the lack of autoregulation in the uterine blood flow; therefore, oxygen and volume should be generously administered. Furthermore, after 20 weeks of gestation the pregnant patient should not be placed in a supine position but tilted 20?° to the left to ensure venous return to the heart. Pregnant patients are assessed and treated according to the advanced trauma life support (ATLS®) concept in the ABCDE (airway, breathing, circulation, disability, exposure) order, followed by F for fetal assessment and surveillance. When warranted, imaging techniques using ionizing radiation should not be withheld because of fear for the unborn child. If justifiable, magnetic resonance imaging (MRI) and sonography should be applied. Care should be taken not to underdiagnose and undertreat the pregnant trauma patient.