Fetal Sonographic Evaluation

Ultrasound can be used to assist in the initial evaluation of the fetus after maternal trauma.1 First, ultrasound can aid in making a quick estimate of gestational age. Knowledge of the gestational age is important, since subsequent management decisions will be based on it. Next, a sonographic determination of immediate fetal viability can be made. If the fetus is dead (no cardiac activity and no fetal movement), the management of the mother will become the sole priority. Gross injury to the fetus, placenta, or uterus may be apparent on the initial ultrasound examination. Oligohydramnios following maternal trauma suggests uterine injury or premature rupture of the membranes. Large placental abruptions may be visualized and fetal distress (fetal heartbeat above 180 or below 120) may indicate unrecognized maternal, fetal, or placental injury. Urgent delivery of the significantly compromised fetus is indicated if the gestational age is at least 24 to 26 weeks. Traumatic uterine rupture is usually accompanied by massive bleeding and requires repair or hysterectomy regardless of gestational age. Although sonographic imaging may detect some large abruptions and gross fetal injury, cardiotocographic monitoring is a much more sensitive indicator. Fetal bradycardia, late decelerations, and loss of beat to beat variation are signs of distress. Fetal distress and frequent uterine contractions nearly always appear within 4 h following significant traumatic placental abruption.

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