Initial evaluation and management of major trauma in pregnancy Though the rates of intimate partner violence or assaults rise during pregnancy, these account for only 2 to 3 percent of total traumas in pregnancy. Burns can cause thermal injury and inhalation of carbon monoxide from the fire which could lead to extreme fetal hypoxia. Methods: The potential for reasonable outcome should be carefully considered before pushing the margins of survivability. The most common pregnancy-related traumas are minor incidents, including motor vehicle crashes and mild blunt abdominal trauma. INTRODUCTION. 2012 Spring;1(1):23-6. doi: 10.5812/atr.5291. The best initial treatment for the fetus is the optimum resuscitation of the mother. The lap belt should be placed as low as possible under the protuberant portion of the abdomen and the shoulder belt positioned off to the side of the uterus, between the breasts and over the midportion of the clavicle (Figure 4). Placental abruption may occur when trauma involving acceleration and deceleration deforms the uterus and shears the placenta off its implantation site. Would you like email updates of new search results? During 1990-2003, six pregnant patients with severe trauma were treated at Kaunas University of Medicine Hospital. trauma-specific treatment methods, however they do learn how to minimize the potential for re-triggering a person's trauma. PDF Trauma In Pregnancy Anatomical And Physiological Considerations Is the mother receiving appropriate basic life support and advanced cardiac life support care, including: CPR with compressions performed with the mother angled to the left? Clin Obstet Gynecol. With major trauma . The Kleihauer-Betke test allows identification of fetal blood cells. Disclaimer, National Library of Medicine Patients must speak with a health care provider for . 8600 Rockville Pike "Any pregnant woman who's been traumatically injured should be checked out by an OB-GYN just to ensure there's no vaginal bleeding, premature rupture of membranes, uterine contractions anything that can lead to complications.". Proper seat belt use reduces the risk of maternal and fetal injuries in motor vehicle crashes. 2013 Mar;31(1):141-56. doi: 10.1016/j.anclin.2012.10.002. Rasmussen PE, Nielsen FR. 2022 May 18;10(1):e39. Force from trauma can sheer the placenta from the uterine wall and lead to fetal demise. Uterine rupture, though rare, usually occurs in the third trimester and is associated with high risk of fetal and maternal mortality. Copyright 2014 by the American Academy of Family Physicians. 2009 May;5(3):269-83; quiz 284-5. doi: 10.2217/whe.09.6. 2019 Jun;45(3):383-392. doi: 10.1007/s00068-017-0839-x. The treatment of pregnant patients with traumatic injuries requires knowledge of the fundamentals of general trauma management as well as the specific anatomic and physiologic changes brought about by pregnancy. A view from the bench: Perspectives on COVID-19 and pregnancy from an immunologist, Fetoscopic laser ablation for placental anastomoses for twin-to-twin transfusion syndrome, Mayo study finds that pregnancy increases risk for women to develop first-time symptomatic kidney stones. 2, 4, 5, 11 Due to the protection of the . Seat belt use actually decreases during pregnancy, because women fear that the seat belt will hurt the fetus. Traumatic injuries to the pregnant patient: a critical literature review. 2011 Dec;27(12):1367-9. doi: 10.1007/s00383-011-2915-3. Although trauma in pregnancy is rare, it is one of the most common causes of morbidity and mortality to pregnant women and fetus. Hypercoagulability on arrival TEG, assessed by an increased angle and MA, is associated with increased rates of thromboembolic events in trauma patients. It should be performed in pregnant women who sustain major trauma to detect fetomaternal transfusion, regardless of Rh status, to determine the degree of fetomaternal hemorrhage.8 Although the Kleihauer-Betke test screens for the degree of trauma in all patients, the result is used only to dictate Rh immune globulin therapy in Rh-negative patients. PMC treatment of trauma in pregnancy - pingiiit.org Evaluation and treatment of the gravida and fetus following trauma during pregnancy. This site needs JavaScript to work properly. Paul A Elliott DO PA. 506 SW Federal Hwy Ste 101, Stuart, FL 34994. PDF Orthopaedic Trauma in the Pregnant Patient Epub 2017 Sep 15. Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint. Laboratory: blood type, Rh factor test, hematocrit measurement, Kleihauer-Betke test, coagulation studies, If greater than 20 weeks' gestation, monitor for contractions, If fewer than three contractions per hour, monitor for four hours, then discharge, If three to seven contractions per hour, monitor for 24 hours, then discharge, All Rh-negative patients should receive Rh immune globulin therapy unless the injury is remote from the uterus (e.g., isolated distal extremity), Perform manual uterine displacement, or 25- to 30-degree left lateral tilt, Decreased chest wall compliance with breast hypertrophy and diaphragmatic elevation, Use cricoid pressure, if assistance is available, Perform compressions higher on the sternum (slightly above center of sternum), Remove fetal and uterine monitors before defibrillation, Loss of adequate cardiac shock dose; produces skin burns at monitor sites, Heimlich maneuver; use chest thrust if unable to encircle the gravid abdomen, Start intravenous therapy above diaphragm, Early tracheal intubation; use short laryngoscope handle and smaller endotracheal tube, Difficult ventilation with pharyngeal edema, breast hypertrophy, diaphragmatic elevation, Consider other etiologies (e.g., magnesium toxicity), Consider left wide paddle, adhesive pad, or breast displacement, Dextrorotation of the heart; breast hypertrophy, Verify endotracheal tube with carbon dioxide detector, Esophageal detector more likely not to reinflate after compression, Tailor ventilator support to oxygenation and ventilation, Perform emergency hysterotomy after four minutes, Decreased aortocaval and venous compression, Continue all maternal resuscitative efforts (cardiopulmonary resuscitation, positioning, defibrillation, and drugs) during and after cesarean delivery. Siebenga J, van der Schoot JT, Keeman JN. 2022 Jun 9;13:911460. doi: 10.3389/fneur.2022.911460. Trauma in Pregnancy: Emergency Department Management - EB Medicine HHS Vulnerability Disclosure, Help A systematic review of studies on trauma in pregnancy reported the following estimates of trauma prevalence by subtype of trauma [ 3 ]: Domestic violence - 8307/100,000 live births. Di Filippo S, Godoy DA, Manca M, Paolessi C, Bilotta F, Meseguer A, Severgnini P, Pelosi P, Badenes R, Robba C. Front Neurol. All women of childbearing age should be routinely screened for intimate partner violence. Trauma in Pregnancy: Assessment, Management, and Prevention The inferior vena cava may be compressed by the gravid uterus, causing the patient to be at risk of supine hypotension syndrome. An official website of the United States government. A uterine fundus measurement of 3 to 4 cm above the umbilicus correlates with a 23- to 24-week singleton gestation, and is a quick, easy assessment of gestational age that can be made in the field. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. Disclaimer, National Library of Medicine Is vaginal bleeding or membrane rupture present that may require neonatal delivery? 2-4 In 1990, one of the few prospective . These situations require clinical judgment about the extent of maternal and fetal assessment. doi: 10.22037/aaem.v10i1.1573.. eCollection 2022. Maxillofacial trauma in a pregnant patient: Contemporary management All female patients of childbearing age with significant trauma should have a human chorionic gonadotropin (-HCG) performed and be shielded for X-rays whenever possible. A retrospective analysis over a 5-year period]. Fracture management in pregnant patients is challenging. Treating a pregnant woman does not differ from the ITLS (International Trauma Life Support) principles, however, one has to consider the possibility of pregnancy-characteristic injuries as well as the fact that physiological pregnancy can mask some life and health threatening symptoms. Trauma in pregnancy | Emergency Care Institute [PDF] Treatment of trauma in pregnancy | Semantic Scholar Phone Icon. Order a pregnancy test Treat the mother first, most of the time it is also the best way to treat the fetus Do not deviate from established trauma guidelines Image when indicated Left lateral decubitus position Kleihauer-Betke test and RhoGAM Buckle up, especially if you are pregnant Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. The anatomic and physiologic changes make treatment of the pregnant trauma patient complex. The effect of trauma on the pregnant woman and unborn fetus can be devastating. Is the mother's cardiac arrest caused by a chronic hypoxic state? Wallberg CD, Smart DM, Mackelprang JL, Graves JM. Introduction. Trauma in pregnancy has a wide spectrum, ranging from mild (single fall from standing height or striking the abdomen on an open drawer) to major (penetrating or high force blunt injury such as motor vehicle accident). Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. What is the status of the fetus at the time of the mother's cardiac arrest? PDF Management of The Pregnant Trauma Patient - State University of New Gestational age less than 20 weeks: emergency hysterotomy is not indicated for a single fetus, but it may be indicated for more than one fetus. "Even if mom looks good and has normal vital signs, there can be signs of fetal distress," says Dr. Loomis. 2012 Nov;30(4):937-48. doi: 10.1016/j.emc.2012.08.003. Abstract. Would you like email updates of new search results? The fetus is unlikely to survive if mom doesn't survive. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. She cannot be declared refractory to CPR and advanced cardiac life support unless all interventions have been implemented and implemented well. Gestational age greater than 23 weeks: emergency hysterotomy is indicated to save the life of both the mother and fetus. 1 This energy transfer takes place in three stages that condition the greater or lesser traumatic effect: pre-collision (prevention), collision (initial . There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). This site complies with the HONcode standard for trustworthy health information: verify here. Thus, for a pregnant female, even what look like normal blood gas or lab values may actually be signs of impending respiratory failure. Has too much time passed for the mother to survive? In out-of-hospital settings, is bystander support available? This site needs JavaScript to work properly. In minor trauma, four to 24 hours of tocodynamometric monitoring is recommended. Prostaglandins are produced in response to severe trauma which could cause preterm labor. Unable to load your collection due to an error, Unable to load your delegates due to an error. >> Cite two specific injuries unique . Ned Tijdschr Geneeskd. A placental abruption may become apparent shortly after the injury. Hydronephrosis during . Trauma during pregnancy - PubMed Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma: 84% of women had blunt injuries and 16% had penetrating injuries. or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Epub 2011 Apr 26. Has the mother responded to arrest interventions? Unique aspects of advanced cardiac life support include early intubation, removal of all uterine and fetal monitors, and performance of perimortem cesarean delivery. The abdomen is the most common target for blows, kicks, and other assaults. Do not lose sight of the goal of this dramatic event: a live, neurologically intact infant and mother. Adequate oxygenation and pulse oximeter monitoring are im-portant because hypoxia is a signifi-cant factor in fetal distress. Przystpujc do udzielania pomocy kobiecie. Trauma is defined as a "fatal injury at the organic level, result of an acute exposure to a type of mechanical, thermal, electrical, chemical, or radiant energy, in amounts that exceed the threshold of physiological tolerance". Major trauma has been associated with 7 percent of maternal and 80 percent of fetal mortality. 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Appropriate referrals should be made to community-based advocacy groups for persons who have experienced IPV, and a plan should be made to ensure the safety of the patient and other vulnerable persons living in the household.11, When feasible, patients who have experienced major trauma should be transported to a hospital that has the resources to perform a timely trauma evaluation.3 Because placental abruption has been reported to occur up to 24 hours following trauma, monitoring via tocodynamometry should be continued for a minimum of 24 hours if at least six uterine contractions have occurred or if there are nonreassuring fetal heart rate patterns, vaginal bleeding, significant uterine tenderness, serious maternal injury, or a positive Kleihauer-Betke test result.3,13 If none of these findings are present, the patient may be discharged home with precautions.3 Table 1 provides evaluation and discharge criteria for blunt trauma in pregnancy.9,12, Between 24 and 34 weeks' gestation, if delivery appears imminent, 12 mg of betamethasone should be administered intramuscularly to promote fetal lung maturity, and repeated in 24 hours. 2012 Nov;30(4):919-36. doi: 10.1016/j.emc.2012.08.002. AU - Asensio, J. Initial evaluation and management of major trauma in pregnancy Though the rates of intimate partner violence or assaults rise during pregnancy, these account for only 2 to 3 percent of total traumas in pregnancy. Burns can cause thermal injury and inhalation of carbon monoxide from the fire which could lead to extreme fetal hypoxia. Methods: The potential for reasonable outcome should be carefully considered before pushing the margins of survivability. The most common pregnancy-related traumas are minor incidents, including motor vehicle crashes and mild blunt abdominal trauma. INTRODUCTION. 2012 Spring;1(1):23-6. doi: 10.5812/atr.5291. The best initial treatment for the fetus is the optimum resuscitation of the mother. The lap belt should be placed as low as possible under the protuberant portion of the abdomen and the shoulder belt positioned off to the side of the uterus, between the breasts and over the midportion of the clavicle (Figure 4). Placental abruption may occur when trauma involving acceleration and deceleration deforms the uterus and shears the placenta off its implantation site. Would you like email updates of new search results? During 1990-2003, six pregnant patients with severe trauma were treated at Kaunas University of Medicine Hospital. trauma-specific treatment methods, however they do learn how to minimize the potential for re-triggering a person's trauma. PDF Trauma In Pregnancy Anatomical And Physiological Considerations Is the mother receiving appropriate basic life support and advanced cardiac life support care, including: CPR with compressions performed with the mother angled to the left? Clin Obstet Gynecol. With major trauma . The Kleihauer-Betke test allows identification of fetal blood cells. Disclaimer, National Library of Medicine Patients must speak with a health care provider for . 8600 Rockville Pike "Any pregnant woman who's been traumatically injured should be checked out by an OB-GYN just to ensure there's no vaginal bleeding, premature rupture of membranes, uterine contractions anything that can lead to complications.". Proper seat belt use reduces the risk of maternal and fetal injuries in motor vehicle crashes. 2013 Mar;31(1):141-56. doi: 10.1016/j.anclin.2012.10.002. Rasmussen PE, Nielsen FR. 2022 May 18;10(1):e39. Force from trauma can sheer the placenta from the uterine wall and lead to fetal demise. Uterine rupture, though rare, usually occurs in the third trimester and is associated with high risk of fetal and maternal mortality. Copyright 2014 by the American Academy of Family Physicians. 2009 May;5(3):269-83; quiz 284-5. doi: 10.2217/whe.09.6. 2019 Jun;45(3):383-392. doi: 10.1007/s00068-017-0839-x. The treatment of pregnant patients with traumatic injuries requires knowledge of the fundamentals of general trauma management as well as the specific anatomic and physiologic changes brought about by pregnancy. A view from the bench: Perspectives on COVID-19 and pregnancy from an immunologist, Fetoscopic laser ablation for placental anastomoses for twin-to-twin transfusion syndrome, Mayo study finds that pregnancy increases risk for women to develop first-time symptomatic kidney stones. 2, 4, 5, 11 Due to the protection of the . Seat belt use actually decreases during pregnancy, because women fear that the seat belt will hurt the fetus. Traumatic injuries to the pregnant patient: a critical literature review. 2011 Dec;27(12):1367-9. doi: 10.1007/s00383-011-2915-3. Although trauma in pregnancy is rare, it is one of the most common causes of morbidity and mortality to pregnant women and fetus. Hypercoagulability on arrival TEG, assessed by an increased angle and MA, is associated with increased rates of thromboembolic events in trauma patients. It should be performed in pregnant women who sustain major trauma to detect fetomaternal transfusion, regardless of Rh status, to determine the degree of fetomaternal hemorrhage.8 Although the Kleihauer-Betke test screens for the degree of trauma in all patients, the result is used only to dictate Rh immune globulin therapy in Rh-negative patients. PMC treatment of trauma in pregnancy - pingiiit.org Evaluation and treatment of the gravida and fetus following trauma during pregnancy. This site needs JavaScript to work properly. Paul A Elliott DO PA. 506 SW Federal Hwy Ste 101, Stuart, FL 34994. PDF Orthopaedic Trauma in the Pregnant Patient Epub 2017 Sep 15. Ten Rules for the Management of Moderate and Severe Traumatic Brain Injury During Pregnancy: An Expert Viewpoint. Laboratory: blood type, Rh factor test, hematocrit measurement, Kleihauer-Betke test, coagulation studies, If greater than 20 weeks' gestation, monitor for contractions, If fewer than three contractions per hour, monitor for four hours, then discharge, If three to seven contractions per hour, monitor for 24 hours, then discharge, All Rh-negative patients should receive Rh immune globulin therapy unless the injury is remote from the uterus (e.g., isolated distal extremity), Perform manual uterine displacement, or 25- to 30-degree left lateral tilt, Decreased chest wall compliance with breast hypertrophy and diaphragmatic elevation, Use cricoid pressure, if assistance is available, Perform compressions higher on the sternum (slightly above center of sternum), Remove fetal and uterine monitors before defibrillation, Loss of adequate cardiac shock dose; produces skin burns at monitor sites, Heimlich maneuver; use chest thrust if unable to encircle the gravid abdomen, Start intravenous therapy above diaphragm, Early tracheal intubation; use short laryngoscope handle and smaller endotracheal tube, Difficult ventilation with pharyngeal edema, breast hypertrophy, diaphragmatic elevation, Consider other etiologies (e.g., magnesium toxicity), Consider left wide paddle, adhesive pad, or breast displacement, Dextrorotation of the heart; breast hypertrophy, Verify endotracheal tube with carbon dioxide detector, Esophageal detector more likely not to reinflate after compression, Tailor ventilator support to oxygenation and ventilation, Perform emergency hysterotomy after four minutes, Decreased aortocaval and venous compression, Continue all maternal resuscitative efforts (cardiopulmonary resuscitation, positioning, defibrillation, and drugs) during and after cesarean delivery. Siebenga J, van der Schoot JT, Keeman JN. 2022 Jun 9;13:911460. doi: 10.3389/fneur.2022.911460. Trauma in Pregnancy: Emergency Department Management - EB Medicine HHS Vulnerability Disclosure, Help A systematic review of studies on trauma in pregnancy reported the following estimates of trauma prevalence by subtype of trauma [ 3 ]: Domestic violence - 8307/100,000 live births. Di Filippo S, Godoy DA, Manca M, Paolessi C, Bilotta F, Meseguer A, Severgnini P, Pelosi P, Badenes R, Robba C. Front Neurol. All women of childbearing age should be routinely screened for intimate partner violence. Trauma in Pregnancy: Assessment, Management, and Prevention The inferior vena cava may be compressed by the gravid uterus, causing the patient to be at risk of supine hypotension syndrome. An official website of the United States government. A uterine fundus measurement of 3 to 4 cm above the umbilicus correlates with a 23- to 24-week singleton gestation, and is a quick, easy assessment of gestational age that can be made in the field. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. Disclaimer, National Library of Medicine Is vaginal bleeding or membrane rupture present that may require neonatal delivery? 2-4 In 1990, one of the few prospective . These situations require clinical judgment about the extent of maternal and fetal assessment. doi: 10.22037/aaem.v10i1.1573.. eCollection 2022. Maxillofacial trauma in a pregnant patient: Contemporary management All female patients of childbearing age with significant trauma should have a human chorionic gonadotropin (-HCG) performed and be shielded for X-rays whenever possible. A retrospective analysis over a 5-year period]. Fracture management in pregnant patients is challenging. Treating a pregnant woman does not differ from the ITLS (International Trauma Life Support) principles, however, one has to consider the possibility of pregnancy-characteristic injuries as well as the fact that physiological pregnancy can mask some life and health threatening symptoms. Trauma in pregnancy | Emergency Care Institute [PDF] Treatment of trauma in pregnancy | Semantic Scholar Phone Icon. Order a pregnancy test Treat the mother first, most of the time it is also the best way to treat the fetus Do not deviate from established trauma guidelines Image when indicated Left lateral decubitus position Kleihauer-Betke test and RhoGAM Buckle up, especially if you are pregnant Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. The anatomic and physiologic changes make treatment of the pregnant trauma patient complex. The effect of trauma on the pregnant woman and unborn fetus can be devastating. Is the mother's cardiac arrest caused by a chronic hypoxic state? Wallberg CD, Smart DM, Mackelprang JL, Graves JM. Introduction. Trauma in pregnancy has a wide spectrum, ranging from mild (single fall from standing height or striking the abdomen on an open drawer) to major (penetrating or high force blunt injury such as motor vehicle accident). Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. What is the status of the fetus at the time of the mother's cardiac arrest? PDF Management of The Pregnant Trauma Patient - State University of New Gestational age less than 20 weeks: emergency hysterotomy is not indicated for a single fetus, but it may be indicated for more than one fetus. "Even if mom looks good and has normal vital signs, there can be signs of fetal distress," says Dr. Loomis. 2012 Nov;30(4):937-48. doi: 10.1016/j.emc.2012.08.003. Abstract. Would you like email updates of new search results? The fetus is unlikely to survive if mom doesn't survive. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. She cannot be declared refractory to CPR and advanced cardiac life support unless all interventions have been implemented and implemented well. Gestational age greater than 23 weeks: emergency hysterotomy is indicated to save the life of both the mother and fetus. 1 This energy transfer takes place in three stages that condition the greater or lesser traumatic effect: pre-collision (prevention), collision (initial . There were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). This site complies with the HONcode standard for trustworthy health information: verify here. Thus, for a pregnant female, even what look like normal blood gas or lab values may actually be signs of impending respiratory failure. Has too much time passed for the mother to survive? In out-of-hospital settings, is bystander support available? This site needs JavaScript to work properly. In minor trauma, four to 24 hours of tocodynamometric monitoring is recommended. Prostaglandins are produced in response to severe trauma which could cause preterm labor. Unable to load your collection due to an error, Unable to load your delegates due to an error. >> Cite two specific injuries unique . Ned Tijdschr Geneeskd. A placental abruption may become apparent shortly after the injury. Hydronephrosis during . Trauma during pregnancy - PubMed Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma: 84% of women had blunt injuries and 16% had penetrating injuries. or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Epub 2011 Apr 26. Has the mother responded to arrest interventions? Unique aspects of advanced cardiac life support include early intubation, removal of all uterine and fetal monitors, and performance of perimortem cesarean delivery. The abdomen is the most common target for blows, kicks, and other assaults. Do not lose sight of the goal of this dramatic event: a live, neurologically intact infant and mother. Adequate oxygenation and pulse oximeter monitoring are im-portant because hypoxia is a signifi-cant factor in fetal distress. Przystpujc do udzielania pomocy kobiecie. Trauma is defined as a "fatal injury at the organic level, result of an acute exposure to a type of mechanical, thermal, electrical, chemical, or radiant energy, in amounts that exceed the threshold of physiological tolerance". Major trauma has been associated with 7 percent of maternal and 80 percent of fetal mortality. Trauma in Pregnancy: Causes and Types - Medscape N2 - Women between the ages of 10 and 50 year-old have the potential for pregnancy; therefore this condition must be taken into consideration when a woman is examined in the Emergency Room after sustaining a traumatic event. Not lose sight of the all women of childbearing age should be considered! Health information: verify here clinical judgment about the extent of maternal and fetal assessment event a... Prostaglandins are produced in response to severe trauma were treated at treatment of trauma in pregnancy of... To save the life of both the mother to survive if mom does survive. 14 maternal deaths ( 9.4 % ) injuries to the protection of the fetus the! Test allows identification of fetal mortality injuries unique use actually decreases during pregnancy, because women fear that seat! Major causes of morbidity and mortality to pregnant women and fetus SW Federal Hwy Ste 101 Stuart. 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treatment of trauma in pregnancy

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