Anesthetic Management and Challenges in the Pregnant Patient

Trauma during pregnancy is the leading cause of non-obstetric morbidity and mortality and presents a unique set of challenges to the anesthesiologist, as there are inherently two patients to care for. The best treatment for the fetus is expeditious evaluation and resuscitation of the mother. Evaluation of the fetus by an obstetrician should be part of the secondary survey, including fetal heart rate monitoring for pregnancies exceeding 20 weeks gestation. The duration of fetal heart rate monitoring should be guided by the severity and mechanism of injury, as well as by maternal and fetal responses. Pregnancy brings about a multitude of physiologic changes that must be considered when evaluating and treating the pregnant trauma patient. The anesthesiologist may have more familiarity with the physiology of pregnancy and can play an important role in resuscitation. The initial goals of resuscitation are maintenance of adequate ventilation and oxygenation, volume replacement, and avoidance of aortocaval compression.