Synopsis
Adapt trauma assessment to altered physiology, frailty and antithrombotic exposure while preserving standard life-saving priorities, timely imaging, haemorrhage control and medication reversal.
- Use the standard trauma sequence for all three groups; differences modify thresholds, positioning, doses and follow-up rather than replacing CABCDE priorities.
- Resuscitate the pregnant patient first and avoid supine aortocaval compression in later pregnancy with manual uterine displacement or left tilt that does not compromise spinal care.
- Do not withhold necessary CT or contrast because of pregnancy; discuss optimisation promptly, but maternal diagnosis and survival take priority over theoretical radiation risk.
Key red flags
Pregnancy with shock, abdominal pain, vaginal bleeding, uterine tenderness, contractions or reduced fetal movement requires maternal resuscitation plus immediate obstetric assessment for abruption, uterine injury and fetal compromise.
Investigation priorities
Identify life threats and pregnancy modifiers without delaying resuscitation.
Diagnose maternal head, spine, thoracic, abdominal or pelvic injury accurately.
Management branches
A pregnant patient has sustained potentially significant trauma.
- Run CABCDE, provide spinal protection as indicated and use manual uterine displacement or compatible left tilt in later pregnancy while treating maternal threats.
- Activate trauma, anaesthetic and obstetric teams, establish gestation and rhesus status and control haemorrhage with standard maternal priorities.
Key medicines
Four-factor prothrombin-complex concentrate for warfarin reversalFor emergency warfarin reversal, use the selected four-factor PCC product's INR- and weight-based intravenous regimen; for Beriplex, factor IX doses are 25, 35 or 50 IU/kg at INR 2–3.9, 4–6 or above 6, capped at 2,500, 3,500 or 5,000 IU respectively.
Phytomenadione for emergency warfarin reversalGive vitamin K1 5–10 mg by slow intravenous injection with PCC for severe bleeding, following the current local reversal protocol and selected product instructions.