(719) National Consensus on Fetal Monitoring Protocols Following Maternal Trauma: Results from a Nationwide Survey

Objective:
Trauma is the leading cause of nonobstetric death among pregnant women. However, management of obstetrical trauma varies significantly across U.S. institutions, largely due to the absence of standardized guidelines from the Society of Maternal-Fetal Medicine or ACOG. This study aimed to describe current practices for fetal monitoring after maternal trauma among maternal-fetal medicine (MFM) fellowship programs nationwide, highlighting variability and gaps.

Study Design:
A cross-sectional online survey was distributed via email to all current MFM fellows. The survey collected data on hospital characteristics and fetal and maternal evaluation practices after trauma. One response per fellowship program was analyzed using descriptive statistics.

Results:

A 70% response rate was achieved. For previable fetuses (< 24 weeks), no clear consensus emerged. Only 42.3% of respondents conducted comprehensive fetal assessments, including ultrasound or Doppler for fetal heart rate, vaginal or speculum exams, and labs.

By contrast, practices for viable gestations showed more consistency. Most programs reported a minimum of 4 hours of fetal monitoring, extended to 24 hours if contractions were present. Monitoring beyond 24 hours was reported by only ~10% of institutions. Monitoring began at the time of trauma in 61.5% of responses, versus hospital presentation in 38.5%.

Most respondents ( >90%) routinely obtained a standard lab panel for suspected placental abruption, including CBC, PT, PTT, fibrinogen, and type and screen. Additional labs such as Kleihauer-Betke (KB) and urinalysis (UA) were rarely obtained unless the patient was Rh-negative, in which case KB testing was routine.

Conclusion:
This study shows significant variability in the evaluation and management of pregnant trauma patients, especially those under 24 weeks. While monitoring is more consistent in viable pregnancies, the lack of protocols for previable gestations highlights a critical gap. Findings support the need for evidence-based guidelines to ensure consistent care and improve outcomes.