# National variation in guidance for the management of pregnant women presenting with major trauma

## TL;DR

This study examines how hospitals in the UK handle major trauma in pregnant women and finds significant variation in guidelines and practices.

## Contribution

The study reveals a lack of national consistency in guidelines for managing major trauma in pregnant women and highlights the need for standardized protocols.

## Key findings

- Only 19% of trusts have specific guidelines for managing major trauma in pregnant women.
- There is significant variation in whether and how obstetric or pediatric teams are involved in trauma calls.
- Most trusts do not have a protocol for when to transfer pregnant trauma patients to major trauma centers.

## Abstract

The initial assessment of pregnant women presenting with significant injuries is more complicated than that of non-pregnant women because of physiological and anatomical changes, and the presence of the fetus. The aim of this study was to determine whether guidelines for the early management of severely injured pregnant women exist, which aspects of assessment/management they cover and to what extent there is national consistency.

A freedom of information request was submitted to 125 acute National Health Service trusts in England and six in Wales. The trusts were asked to confirm whether they have a guideline for the management of major trauma in pregnant women presenting to the emergency department and what the guidelines were.

In total, 96.2% of trusts responded, of which 19% have a specific guideline and 7.9% have a generic guideline for assessing pregnant women in the emergency department, irrespective of injury severity. Of the responding trusts, 19.8% have a protocol that specifies when an obstetric trauma call should be put out by the emergency department and when a pregnant woman should be transferred to a major trauma centre for definitive management. Our results found that 69.8% routinely call obstetrics or gynaecology to the trauma call compared with 36.5% calling paediatrics.

The heterogeneity evident across trusts necessitates the establishment of national guidelines for the assessment of pregnant women with major trauma to standardise communication and delivery of care.