Pregnant trauma ED considerations.

• A. Fetal monitoring, left uterine displacement to reduce aortocaval compression, avoid supine hypotension, coordinate with obstetrics.
• B. Emergent cesarean if maternal life endangered and fetus viable.
• C. Ignore fetal status; treat mother only.
• D. No imaging allowed in pregnancy.

Answer: (A)

In pregnant trauma, the uterus in late pregnancy can compress the aorta and inferior vena cava when the patient lies flat, reducing venous return and compromising both maternal stability and fetal oxygenation. The best initial approach is to place the patient with left uterine displacement (left lateral tilt) to lift the uterus off those vessels, improving hemodynamics. At the same time, start fetal monitoring to assess fetal status and guide obstetric decisions, and avoid the full supine position to prevent worsening hypotension from aortocaval compression. Coordinating with obstetrics ensures that delivery decisions and obstetric interventions are integrated with the mother’s resuscitation.

Imaging is not avoided in pregnancy when indicated; with proper shielding, radiographs or CT can be performed to evaluate injuries without unnecessary delay. While emergent cesarean delivery may be required in certain life-threatening maternal or fetal conditions, the immediate, universally applicable steps in trauma care for a pregnant patient focus on relieving aortocaval compression, monitoring the fetus, and involving obstetrics for coordinated care.