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The tragedy of minor pregnancy trauma

Pregnant women in North Adams, Massachusetts, trust their physicians not only with their own health but with the health of their unborn children. Physician care is particularly crucial to the health of mother and child after trauma occurs, but when physicians dismiss minor injuries during pregnancy, the results can be devastating.

According to a study published in American Family Physician, pregnancy trauma “is the leading cause of nonobstetric death among pregnant women.” This trauma can occur from intentional acts, such as domestic violence, or from other events, such as falls and car accidents. One out of every 12 pregnancies is reportedly complicated by trauma. When a woman visits her physician after experiencing minor trauma during pregnancy, her health care provider is likely to provide treatment for physical injuries, including administering any necessary vaccines, and discuss the warning signs of abruption—that is, the partial or complete separation of the placenta from the uterus.

Such treatments might indicate that minor traumas are relatively low risk, but this is a false impression. It is estimated that minor injuries are responsible for loss of the fetus in 60–70 percent of post-trauma fetal deaths. These numbers suggest that minor pregnancy trauma is anything but minor.

Fetal loss is not the only tragedy that can result from pregnancy trauma. Since 1986, the Centers for Disease Control and Prevention has been monitoring reported pregnancy-related deaths, which have been on the rise over the last three decades. The CDC reports that in 2011, there were 17.8 deaths per 100,000 live births compared to the rate in 1987, when 7.2 deaths were reported per 100,000 live births. The cause of this increase has not yet been identified, although it may result in part from doctors’ increased ability to identify pregnancy-related deaths.

According to the CDC, 1,329 pregnancy-related deaths occurred between 2011 and 2012. Non-cardiovascular diseases were identified as the leading causes of these deaths, but other leading causes included hemorrhage, infection and sepsis, which could result from trauma during pregnancy. The ratio of pregnancy-related deaths was racially disparate, with an elevated rate of death among black women. 

Physician care is essential after any form of trauma occurs during pregnancy. It is the physician’s responsibility to ensure that the mother is informed about the risks of pregnancy trauma and that she receives the treatment necessary to protect her own health and the health of her child.

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