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Odedra D, Mellnick VM, Patlas MN. Imaging of Trauma in Pregnancy. Radiol Clin North Am 2023; 61:129-139. [DOI: 10.1016/j.rcl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Basile A, Palmieri L, Lanzetti R, Sessa P, Spoliti M, Giai Via A, Pipino G. Suprapatellar intramedullary nailing of tibial shaft fractures in pregnancy. A report of two cases. BMC Pregnancy Childbirth 2022; 22:528. [PMID: 35765043 PMCID: PMC9241291 DOI: 10.1186/s12884-022-04835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Treatment of closed tibial shaft fractures in the 3rd trimester of pregnancy is controversial. Since there are few case reports published in literature, there is no consensus on the appropriate management of these fractures. This case report proposes intramedullary nailing throught the suprapatellar approach for the treatment of tibial shaft fracture in pregnant women, never described before in literature. Case presentation We report 2 cases of a tibial diaphyseal fracture treated by intramedullary nailing in women at the 3rd trimester of pregnancy. Conclusion Surgical treatment of tibial shaft fracture of pregnant women in the 3rd trimester of pregnancy with intramedullary nailing seems to be safe. The use of the specific suprapatellar approach helps in the intra-operative management of the pregnant patients.
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Affiliation(s)
- Attilio Basile
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Laura Palmieri
- Department of Orthopedic Surgery and Traumatology, Policlinico Tor Vergata, School of Medicine, University of Tor Vergata, Rome, Italy
| | - Riccardo Lanzetti
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Pasquale Sessa
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Spoliti
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Alessio Giai Via
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy. .,School of Medicine, University of Salerno, Salerno, Italy.
| | - Gennaro Pipino
- UCM Malta University, campus Lugano, Lugano, Switzerland.,Department of Orthopedic Surgery and Traumatology, Villa Erbosa Hospital, Gruppo San Donato, Bologna, Italy
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De Vito M, Capannolo G, Alameddine S, Fiorito R, Lena A, Patrizi L, D' Antonio F, Rizzo G. Trauma in pregnancy clinical practice guidelines: systematic review. J Matern Fetal Neonatal Med 2022; 35:9948-9955. [PMID: 35703623 DOI: 10.1080/14767058.2022.2078190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To objectively evaluate the methodological quality and clinical heterogeneity robustness of the published clinical practice guidelines (CPGs) on the management of trauma in pregnancy. MATERIALS AND METHODS Pubmed, Google Scholar, UpToDate, and Scopus Database were searched. The risk of bias and quality assessment of the included CPGs were performed using "The Appraisal Of Guidelines for Research and Evaluation (AGREE II)" tool. The following points relating to the management of trauma during pregnancy were addressed: quality of evidence assessment, classification of recommendations, main causes of trauma in pregnancy, importance of correct use of seat belts, ultrasound scans and/or pregnancy test in every female of reproductive age, description of physiological changes in pregnancy, classification in primary and secondary survey, primary survey based on ABCD Approach, fetus viable based on the weeks, radiographic studies for maternal evaluation, duration of fetal monitoring, use of anti-D immunoglobulin in rhesus-D-negative pregnant trauma patients, description of dose of RhD-Ig, the way to define gestational age if it was undetermined, descriptions of obstetrical complications, use of tetanus vaccination, and timing to perimortem cesarean section (CS). RESULTS Six CPGs were included. Quality of evidence assessment was described in 16.7% of CPGs (1/6), while it was not reported in 83.3% (5/6). Classification of recommendations was reported in 50% (3/3) of the CPGs. Motor vehicle crash was reported as the main cause of trauma in pregnancy in all the CPGs included in the present review, despite that the importance of a correct use of seat belts was described only in the 50% (3/6). Definition of fetal viability was also different among the included CPGs; in 50% (3/6) defined a fetus viable when it from 23 weeks, 33.3% (2/6) from 24 weeks, and 16.7% (1/6) from 20 weeks of gestation. Regarding the type of fetal monitoring, 33.3% (2/6) CPGs recommended CTG assessment at least every 4 h, 16.7% (1/6) at least every 6 h, 33.3% for 24 h if there are not reassuring signs and 16.7% (1/6) did not specify the duration of monitoring. Recommendations about the use of anti-D-immunoglobulin in rhesus-D-negative pregnant were also heterogeneous: 50% (3/6) of the CPGs suggested administration in all rhesus-D-negative pregnant women, 16.7% (1/6) only according to gestational age at trauma or in case of significant abdominal trauma, and 16.7% (1/6) only in case of positive Kleihauer test while 16.7% (1/6) did not specify it. Administration of tetanus vaccination was suggested in in 33.3% (2/6) of CPGs. Finally, there were different descriptions of timing to perimortem CS: 33.3% (2/6) of CPGs claims to do CS no later than 4 min, 50% (3/6) no later than 5 min, and 16.7% (1/6) does not describe timing for CS. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 69%. Only three CPGs scored more than 60% and revealed a consensus agreement between the reviewers on recommending the use of these CPGs. CONCLUSION There is clinical heterogeneity in some of the most relevant aspects of the management of pregnant women with trauma. The findings from this systematic review highlight the need for up to date and shared guidelines promoted by the main body societies in order make management of pregnant women with trauma homogenous.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Roberto Fiorito
- Department of Surgery Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Alessandro Lena
- Department of Obstetrics and Gynecology Ospedale San Paolo Civitavecchia, Roma, Italy
| | - Lodovico Patrizi
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Francesco D' Antonio
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Chaar A, Abdallah W, Kharrat R, Nassar M. Splenic rupture after sexual intercourse in a pregnant woman: an extremely rare case. Future Sci OA 2021; 7:FSO741. [PMID: 34737883 PMCID: PMC8558856 DOI: 10.2144/fsoa-2021-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
A 33-year-old pregnant woman presented at 36 weeks gestation to the emergency with acute abdominal pain that started after vaginal intercourse. No bruising was present on the abdominal examination. An emergent cesarean delivery was performed for resistant hypotension and collapse. A fetus with cardiac arrest was delivered, and active spleen bleeding was identified at the splenocolic and gastrosplenic ligament insertion. The patient had a conservative treatment of the spleen and an uncomplicated postoperative course. The infant was resuscitated and discharged after 18 days. In conclusion, traumatic spleen rupture is an etiology to consider in pregnant women presenting with acute abdominal pain following sexual intercourse. Early suspicion and emergent cesarean delivery are the keys to optimize maternal and perinatal outcomes. Although sexual activity is generally considered safe in pregnancy, we present a rare case of post-coital spleen rupture in a third-trimester pregnant woman. However, rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal morbidity. The aim of this article is to highlight the role of early suspicion to optimize maternal and perinatal outcomes.
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Affiliation(s)
- Abdallah Chaar
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Wael Abdallah
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Richard Kharrat
- Department of Gynecology & Obstetrics, Bellevue Medical Center Hospital, Saint Joseph University, Beirut, Lebanon
| | - Malek Nassar
- Department of Gynecology & Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
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Cain U, Gaetke-Udager K, Siegal D, Yablon CM. Musculoskeletal Injuries in Pregnancy. Semin Roentgenol 2020; 56:79-89. [PMID: 33422186 DOI: 10.1053/j.ro.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Usa Cain
- Musculoskeletal Imaging Fellow, University of Michigan, Ann Arbor, MI
| | | | - Daniel Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI
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Yoo BJ. Pelvic Trauma and the Pregnant Patient: a Review of Physiology, Treatment Risks, and Options. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0136-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cairo SB, Fisher M, Clemency B, Cipparone C, Quist E, Bass KD. Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers. J Pediatr Surg 2018. [PMID: 29519567 DOI: 10.1016/j.jpedsurg.2018.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers. METHODS A regional survey was administered to emergency medical response units identifying variability and confusion regarding factors influencing patient disposition. A course was developed to guide the triage of pediatric and pregnant trauma patients. Pre- and posttests were administered to address course principles, including decision making and triage. RESULTS A total of 445 participants completed the course at 22 sites representing 88 different prehospital provider agencies. Pre- and posttests were administered to 62% of participants with an average score improvement of 53.4% (pretest range 30% to 56.6%; posttest range 85% to 100%). Improvements were seen in all categories including major and minor trauma in pregnancy, major trauma in adolescence, and knowledge of age limits and triage protocols. CONCLUSION Education on triage guidelines and principles of pediatric resuscitation is essential for appropriate prehospital trauma management. Pre- and posttests may be used to demonstrate short term efficacy, while ongoing evaluations of practice patterns and follow-up surveys are needed to demonstrate longevity of acquired knowledge and identify areas of persistent confusion. LEVEL OF EVIDENCE Level IV, Case Series without Standardized.
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Affiliation(s)
- Sarah B Cairo
- John R Oshei Children's Hospital, Department of Pediatric Surgery, Buffalo, NY 14202, United States.
| | - Malachi Fisher
- Women and Children's Hospital of Buffalo, Trauma Injury Prevention and Education, Buffalo, NY 14222, United States
| | - Brian Clemency
- Erie County Medical Center, Department of Emergency Medicine, Buffalo, NY 14215, United States
| | - Charlotte Cipparone
- Jacobs School of Medicine State University of New York at Buffalo, University at Buffalo, Buffalo, New York 14214, United States
| | - Evelyn Quist
- Jacobs School of Medicine State University of New York at Buffalo, University at Buffalo, Buffalo, New York 14214, United States
| | - Kathryn D Bass
- John R Oshei Children's Hospital, Department of Pediatric Surgery, Buffalo, NY 14202, United States; Jacobs School of Medicine State University of New York at Buffalo, Department of Surgery, University at Buffalo, Buffalo, New York 14214, United States
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Abstract
RATIONALE About 60,0000 people are involved in traffic accident each year in China and spinal cord injury (SCI) often occurs. Pregnant women with paraplegia is rare, and they face higher risk during pregnancy and childbirth. PATIENT CONCERNS We report a case of a 35-year-old patient with SCI, who had vaginal forceps delivery at 38 weeks and 5 days of gestation. DIAGNOSES The patient was diagnosed with term pregnancy with traumatic tetraplegia. INTERVENTIONS A vaginal forceps delivery was performed at 38 weeks and 5 days of gestation. OUTCOMES A vaginal forceps delivery of the patient was smooth. After delivery the patient recovered quickly, her vaginal blood was less, blood pressure was favoring. LESSONS This study presents a case with traumatic tetraplegia during pregnancy. We suggest that regular prenatal care is necessary.
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Affiliation(s)
- Changfang Yao
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Yongjuan Xu
- Department of Obstetrics and Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Li Dai
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Yan Lv
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Xiaoli Xu
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
| | - Wenfeng Ye
- Department of Obstetrics and Gynecology, the Third Affiliated Hospital, Soochow University
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Chaiworapongsa T, Romero R, Erez O, Tarca AL, Conde-Agudelo A, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L, Korzeniewski SJ. The prediction of fetal death with a simple maternal blood test at 20-24 weeks: a role for angiogenic index-1 (PlGF/sVEGFR-1 ratio). Am J Obstet Gynecol 2017; 217:682.e1-682.e13. [PMID: 29037482 PMCID: PMC5951183 DOI: 10.1016/j.ajog.2017.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fetal death is an obstetrical syndrome that annually affects 2.4 to 3 million pregnancies worldwide, including more than 20,000 in the United States each year. Currently, there is no test available to identify patients at risk for this pregnancy complication. OBJECTIVE We sought to determine if maternal plasma concentrations of angiogenic and antiangiogenic factors measured at 24-28 weeks of gestation can predict subsequent fetal death. STUDY DESIGN A case-cohort study was designed to include 1000 randomly selected subjects and all remaining fetal deaths (cases) from a cohort of 4006 women with a singleton pregnancy, enrolled at 6-22 weeks of gestation, in a pregnancy biomarker cohort study. The placentas of all fetal deaths were histologically examined by pathologists who used a standardized protocol and were blinded to patient outcomes. Placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor-1 concentrations were measured by enzyme-linked immunosorbent assays. Quantiles of the analyte concentrations (or concentration ratios) were estimated as a function of gestational age among women who delivered a live neonate but did not develop preeclampsia or deliver a small-for-gestational-age newborn. A positive test was defined as analyte concentrations (or ratios) <2.5th and 10th centiles (placental growth factor, placental growth factor/soluble vascular endothelial growth factor receptor-1 [angiogenic index-1] and placental growth factor/soluble endoglin) or >90th and 97.5th centiles (soluble vascular endothelial growth factor receptor-1 and soluble endoglin). Inverse probability weighting was used to reflect the parent cohort when estimating the relative risk. RESULTS There were 11 fetal deaths and 829 controls with samples available for analysis between 24-28 weeks of gestation. Three fetal deaths occurred <28 weeks and 8 occurred ≥28 weeks of gestation. The rate of placental lesions consistent with maternal vascular underperfusion was 33.3% (1/3) among those who had a fetal death <28 weeks and 87.5% (7/8) of those who had this complication ≥28 weeks of gestation. The maternal plasma angiogenic index-1 value was <10th centile in 63.6% (7/11) of the fetal death group and in 11.1% (92/829) of the controls. The angiogenic index-1 value was <2.5th centile in 54.5% (6/11) of the fetal death group and in 3.7% (31/829) of the controls. An angiogenic index-1 value <2.5th centile had the largest positive likelihood ratio for predicting fetal death >24 weeks (14.6; 95% confidence interval, 7.7-27.7) and a relative risk of 29.1 (95% confidence interval, 8.8-97.1), followed by soluble endoglin >97.5th centile and placental growth factor/soluble endoglin <2.5th, both with a positive likelihood ratio of 13.7 (95% confidence interval, 7.3-25.8) and a relative risk of 27.4 (95% confidence interval, 8.2-91.2). Among women without a fetal death whose plasma angiogenic index-1 concentration ratio was <2.5th centile, 61% (19/31) developed preeclampsia or delivered a small-for-gestational-age neonate; when the 10th centile was used as the cut-off, 37% (34/92) of women had these adverse outcomes. CONCLUSION (1) A maternal plasma angiogenic index-1 value <2.5th centile (0.126) at 24-28 weeks of gestation carries a 29-fold increase in the risk of subsequent fetal death and identifies 55% of subsequent fetal deaths with a false-positive rate of 3.5%; and (2) 61% of women who have a false-positive test result will subsequently experience adverse pregnancy outcomes.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Adi L Tarca
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Piya Chaemsaithong
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Chong Jai Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Mee Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sonia S Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Steven J Korzeniewski
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
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Abstract
Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered. The risks posed by anesthetic agents, antibiotic agents, anticoagulant agents, and radiation exposure must be understood. Positioning of the patient can affect the viability of the fetus. If surgery is necessary, the left lateral decubitus position decreases fetal hypotension. A specialized team including an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, radiologist, and nurse must collaborate to improve maternal and fetal outcomes.
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