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Teen pregnancies are at high risk of obstetrical complications with an increased rate of adverse maternal and fetal outcomes. Acute care clinicians should be familiar with, and adept at, caring for the common or emergent obstetrical complications that may occur in a pregnant teenager.
— Ann M. Dietrich, MD, FAAP, FACEP, Editor
Introduction
Despite a recent decline in teen birth rates in the United States, adolescent pregnancy rates remain high when compared to other developed countries.1,2 There are many unique barriers and considerations when diagnosing and caring for pregnant patients of adolescent age, many of which are discussed in depth in “Teen Pregnancy Part 1.” (See Pediatric Emergency Medicine Reports, September 2020.) This article will focus on the medical adverse outcomes and obstetrical complications that can occur in adolescent pregnancy. Topics include trauma in pregnancy; preeclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; venous thromboembolism; as well as precipitous delivery and postpartum hemorrhage.
Trauma in Pregnancy
A 17-year-old female, gravidity 1, parity 0, at 33 weeks’ gestation arrives to the emergency department via emergency medical services after being involved in a motor vehicle crash. The patient was the restrained driver of a vehicle that was rear-ended at approximately 20 miles per hour. She had no loss of consciousness, self-extricated, and was ambulatory on the scene. Her vital signs are within normal limits. She is complaining of mild abdominal pain and cramping without vaginal bleeding or leakage of fluid. She reports normal fetal movement.
Trauma is the number one cause of nonobstetrical, pregnancy-associated maternal death in the United States.3 The most common causes of trauma include motor vehicle collisions (accounting for 50% of pregnancy-related trauma), falls, and assault.4 Complications of trauma during pregnancy include preterm labor, premature rupture of membranes, placental abruption, fetal maternal hemorrhage, uterine rupture, and fetal demise. It is important to note that some of these complications, particularly placental abruption, can occur with even minor maternal injuries.5
During evaluation and resuscitation of a pregnant trauma patient, maternal resuscitation always takes priority because fetal survival is dependent on maternal survival. Fetal viability is considered at approximately 22-24 weeks’ gestation (fundal height at least at or above the umbilicus).
The initial approach to a pregnant...