Imaging of Trauma in Pregnant Patients

Abstract

Trauma during pregnancy presents a clinical challenge because the health and survival of both the mother and fetus are key clinical concerns. Given the prevalence of trauma in pregnancy, affecting an estimated 5%–7% of pregnancies, knowledge of the appropriate treatment of such patients is crucial for emergency and general radiologists. Although US is the default imaging modality during pregnancy, urgent and accurate diagnosis frequently requires the use of CT, despite the potential risk of exposure to ionizing radiation and contrast media. As such, the radiologist must be familiar with both obstetric-specific injuries and how pregnancy may complicate otherwise familiar traumatic presentations. The authors discuss the general treatment of the pregnant trauma patient, with an emphasis on radiologic evaluation. They provide an overview of various imaging modalities available for evaluation of pregnant patients with traumatic injuries, emphasizing their potential risks, benefits, and limitations. The relative role of imaging assessment versus electronic fetal monitoring in a patient with suspected placental abruption is discussed. Proposed grading methods and management pathways for placental abruption, with respect to fetal age and maternal stability, are reviewed. Relevant cases are presented, demonstrating key obstetric abnormalities that may be seen in patients with pregnancy-related trauma.