A car accident is frightening, and the anxiety is heightened when you are pregnant. If you are involved in a collision, your immediate focus must be on seeking medical care, as even minor impacts can pose unseen risks to both you and your developing baby. This guide outlines the immediate steps you should take and what to expect from a medical evaluation to ensure the safest possible outcome.
Immediate Actions Following an Accident
The first priority after a collision is ensuring your immediate safety and the safety of your unborn child. Once the vehicles have stopped, quickly check yourself and any passengers for obvious injuries. If you are able to do so safely, move your car to the side of the road or a protected area, engaging your hazard lights to alert other drivers.
Call emergency services right away and inform the dispatcher that you are pregnant, including your approximate gestational age if known. This information allows first responders and the hospital to prepare for a specialized obstetric assessment. Even if the accident seems minor, you must seek medical evaluation, because physical shock can mask symptoms of serious internal complications.
When first responders arrive, clearly communicate your pregnancy status and any symptoms you are experiencing, such as abdominal pain, cramping, or a change in fetal movement. The rush of adrenaline following a crash can obscure pain or other signs of internal injury, making an objective medical examination necessary. Some concerning pregnancy-related complications can present with subtle or delayed symptoms, requiring immediate attention.
Specific Medical Risks to Mother and Fetus
Blunt force trauma from a motor vehicle accident introduces unique and serious risks during pregnancy, even in low-impact collisions. The most significant concern is placental abruption, where the placenta prematurely separates from the inner wall of the uterus. This separation interrupts the fetus’s supply of oxygen and nutrients and can cause severe bleeding in the mother.
Placental abruption occurs in up to 5% of minor crashes and a much higher percentage of severe ones, representing the most common cause of fetal death following trauma. The rapid deceleration in a crash creates a shearing force because the elastic uterine wall moves differently than the less-flexible placenta, causing it to tear away. Symptoms include vaginal bleeding, abdominal pain, and frequent uterine contractions. However, in up to 20% of cases, the bleeding is concealed, meaning no external signs are visible.
The risk of uterine rupture, a tear in the wall of the uterus, is rare but carries a near 100% fetal mortality rate and significant risk to the mother. This injury typically requires a high-force impact and is most likely to occur in the third trimester when the uterine wall is thinner and extends beyond the bony protection of the pelvis. Trauma can also trigger preterm labor, where contractions begin before 37 weeks, leading to premature delivery.
As pregnancy progresses, the enlarged uterus and changes to the maternal center of gravity increase vulnerability to trauma and compromise. The pregnant body’s physiological adaptations, such as increased blood volume, can also mask early signs of maternal shock by redirecting blood away from the uterus to compensate for blood loss elsewhere. These factors underscore why a trauma assessment must prioritize both maternal stabilization and specialized fetal monitoring.
Hospital Evaluation and Monitoring Protocol
Upon arrival at the emergency department, the medical team’s primary focus is stabilizing the mother before assessing the fetus. Once the mother is stable, the protocol for a pregnant trauma patient typically includes continuous electronic fetal monitoring. For pregnancies beyond 20 to 23 weeks, this monitoring uses a cardiotocograph (NST/Toco) to track the baby’s heart rate and the mother’s uterine contractions for at least four hours.
An abnormal fetal heart rate pattern or sustained contractions (more than six in an hour) may indicate a developing abruption or the onset of preterm labor. An obstetrical ultrasound will also be performed to assess the location of the placenta, check for signs of separation, and evaluate the volume of amniotic fluid. However, ultrasound may miss up to 50% of placental abruptions.
Laboratory tests will include a blood draw to check the mother’s Rh status. If the mother is Rh-negative, she will likely receive a dose of Rh immunoglobulin (Rhogam). This prophylactic injection is necessary because trauma can cause a small amount of fetal blood to mix with the mother’s circulation, potentially leading to the development of antibodies that could harm future pregnancies. If the monitoring period is unremarkable and there are no signs of injury, the patient may be discharged, often with instructions for close follow-up.
Before leaving the hospital, be aware of “red flag” symptoms that require an immediate return for re-evaluation. These warning signs include:
- Vaginal bleeding.
- Any trickle or gush of fluid suggesting ruptured membranes.
- Persistent, painful abdominal cramping or contractions.
- A decrease in the baby’s usual movement or a change in the frequency of those movements.
Delayed complications like placental abruption can manifest hours or even days after the initial trauma, making vigilance at home a necessary part of the recovery process.