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Coping with pregnant patients with major injuries is a rare problem, but demands a special approach. Pregnancy produces physiological changes, particularly in the cardiovascular system including:
 -cardiac output increases by 20-30% in first 10 weeks of pregnancy
 -average heart rate increases by 10 to 15 beats per minute
 -both systolic and diastolic blood pressure (BP) fall on average by 10-15mmHg
 -in the supine position the enlarged uterus compresses the inferior vena cava. This reduces venous return to the heart, causing a further drop in BP
 -as the pregnancy develops, the diaphragm becomes splinted and breathing effort, rate and tidal volume are increased.
 -both blood volume (45% increase) and numbers of red cells increase, but not in proportion, so the patient becomes relatively anaemic
 -gastric emptying is delayed and the lower oesophageal sphincter is relaxed, therefore both vomiting and passive regurgitation are more common and the airway is at    increased risk.

There are fundamental rules which must be followed at all times when managing the pregnant patient and this guideline provides guidance for paramedics¹ for the assessment and management of trauma in pregnancy.

¹The principles will be applicable to all pre-hospital clinicians.

Current guideline - issued 2006