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The author proposes to confront the two contiguous fields of the feminine and the maternal based on Freud's considerations on the "black continent", i.e. femininity, and on the notion of feminine jouissance deployed by Jacques Lacan. In the light of clinical psychoanalytical psychopathology, this article aims to highlight that if Oedipus does not make The Woman, the fact of the devastation which is its consequence invades the feminine, as well as the maternal. Indeed, the opaque part of the mother's jouissance, i.e. the feminine in the mother, contaminates both the woman's femininity and her maternity, as shown by the devastating relationship that can exist between a daughter and her mother. Thus, we point out that no more than becoming a woman, becoming a mother is not given from the outset, it is rather constructed from the relationship with language, with fantasy, with jouissance and with the Other in the figure of maternal love, for each one. [ABSTRACT FROM AUTHOR]

INTRODUCTION: All pregnant women are at potential risk of obstetric complications; majority of which can be treated if appropriate care is accessed promptly. A shift in focus to quality of care has the potential to unlock significant returns for every mother and newborn to end preventable maternal and infant deaths. The study aimed to assess the quality of maternal health services in primary health facilities in urban and rural communities of Kano State. METHODS: using a comparative cross-sectional study design that utilized mixed method of data collection, interviewer administered questionnaire were used to collect information from 438 women (219) each attending health facilities for maternal health services in rural and urban areas of Kano using multistage sampling technique June to November, 2019. Six Key Informant Interviews with the heads of units/ facilities were purposively conducted. Quality of care was assessed using perspectives and system models based on the components of antenatal care received, postnatal care and perception of care received. A statistical significance was set at p-value 0.05. Thematic framework analysis was used to analyze verbatim transcript from qualitative interviews. RESULTS: the age of the respondents ranged from 18-48 years with majority having secondary education in both communities. In both urban and rural communities’, majority of the respondents had only 1-3 antenatal care visits making up 63.5% and 70.3% respectively. Almost similar proportions of the urban (58.4%) and rural (50.2%) respondents were delivered by a skilled birth attendant. About two-third of the respondents, 67.6% and 65.3% in the urban and rural communities respectively were completely satisfied with the quality of care received. Qualitative interviews pointed ignorance as the major factor that prevent mothers from accessing quality care and reported that satisfactory services were provided in all facilities. CONCLUSION: considerable disparity exists between urban and rural communities in quality of maternal health services with better provision of most services in the urban communities. There is need for improvement in the desirable and minimum acceptable quality of maternal health services in Kano State.

The author explores clinical implications of Julia Kristeva's concept of the abject. The abject describes the developmental moment when the infant is first separating from the mother, when separation of self from other is incomplete and tenuous. The other, still desired, must be made abject, extruded from the self with a lingering sense of horror and terror. The concept of the abject underlies the feelings of desire and fear directed toward the "feminine" or the maternal body by individuals and society and provides an explanation of misogyny. The author provides clinical material to illustrate this concept in men who loathe and desire the female body, and in women who hate themselves and their female bodies. The clinical cases raise issues about the primitive affect of horror, how the abject is related to early narcissism, and the inseparability of desire, affect, defence, and object. [ABSTRACT FROM AUTHOR]

A lot of infectious diseases can occur in pregnancy. Their acquisition, clinical presentation, and course during gestation may be altered due to deficiency of the maternal cellular immunity. Herpes zoster, also known as shingles, (reactivation of varicella zoster virus) is one of the least infections which can be contracted by pregnant woman. But it does not present a big problem to mother or baby. The complications of zoster in pregnancy are no different from those in non-pregnant women.

INTRODUCTION: Among the most critical health systems components that requires strengthening to improve maternal, newborn and child health (MNCH) outcomes in Nigeria is the concept of equity. UNICEF has designed the Equitable Impact Sensitive Tool (EQUIST) to enable policymakers improve equity in MNCH and reduce disparities between the most marginalized mothers and young children and the better-off. METHODS: using the latest available DHS data sets, we conducted EQUIST situation and scenario analysis of MNCH outcomes in Nigeria by sub-national categorization, wealth and by residence. We then identified the intervention package, the bottlenecks and strategies to address them, and the number of deaths avertible. RESULTS: EQUIST profile analysis showed that the number of under-five deaths was considerably higher among the poorest and rural population in Nigeria and was highest in North-West region. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Highest maternal mortality was recorded in the North-West Nigeria. Ante-partum, intra-partum, and post-partum haemorrhages and hypertensive disorder, were responsible for highest maternal deaths. EQUIST scenario analysis showed that an intervention package of insecticide treated net can avert more than 20,000 under-five deaths and delivery by skilled professionals can avert nearly 17,000 under-five deaths. While as many as 3,370 maternal deaths can be averted by deployment of skilled professionals. CONCLUSION: scaling up integrated packages of essential interventions across the continuum of care, addressing the human resource shortages in rural area and economic/social empowerment of women are policy recommendations that can improve MNCH outcomes in Nigeria.

INTRODUCTION: Globally, intrapartum stillbirth accounts for 1 million deaths of babies annually, representing approximately one-third of global stillbirth toll. Intrapartum stillbirth occurs due to causes ranging from maternal medical and obstetric conditions; access to quality obstetric care services during pregnancy; and types, timing and quality of intrapartum care. Different medical conditions including hypertensive and metabolic disorders, infections and nutritional deficiencies during pregnancy are among risk factors of stillbirth. Ethiopia remains one of the 10 high-burden stillbirth countries with estimated rate of more than 25 per 1000 births. METHODS: a case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 23 public health facilities of Addis Ababa during the period July 1, 2010 - June 30, 2015 was conducted. Data were collected from charts of all cases of intrapartum stillbirth meeting the inclusion criteria and randomly selected charts of controls in two to one (2:1) control to case ratio. RESULTS: chronic medical conditions including diabetes, cardiac and renal diseases were less prevalent (1%) among the study population whereas only 6% of women experienced hypertensive disorder during the pregnancy in review. Moreover, 6.5% of the study population had HIV infection where being HIV negative was protective against intrapartum stillbirth (aOR 0.37, 95% CI 0.18-0.78). Women with non-cephalic foetal presentation during last ANC visit were three times more at risk of experiencing intrapartum stillbirth whereas singleton pregnancy had strong protective association against intrapartum stillbirth (p=0.05). CONCLUSION: untreated chronic medical conditions, infection, poor monitoring of foetal conditions and multiple pregnancy are among important risk factors for intrapartum stillbirth.

Kemawi Village is one of the active Alert Village in the Semarang District. Based on information from the Public Health Center (PHC), the reporting of the Birth Planning and Complication Prevention Program (P4K) has not been done scheduled by the village midwife. The purpose of this research is to know how is the knowledge of midwife about the importance of registration reporting of P4K and then to analyze how the reporting of P4K is done by the village midwife. Research conducted in 2014. The type of research is a case study, with a qualitative approach. The main informant was a Kemawi village midwife, with several triangulation informant persons. The research gives the results of the recording have been done according to the procedure but the filling of the P4K sticker has not been suitable, for example, blood donor candidate is not filled with a clear identity due to there is no data processing training and supervision. Further reporting of P4K programs is made by the midwife only when there is a request at any time, no scheduled reporting. Therefore, it is recommended to PHC and District PHC (DHO) to make training and supervision for the village midwife in order to improve the ability of P4K program data management in particular, including data reporting and Maternal Child Health (MCH) in general.

Background: Attrition of community health workers (CHWs) continues to threaten the full realisation and sustainability of community-based health programmes globally. Aim: This study aimed to understand factors associated with CHWs’ recruitment and their retention. Setting: This study was conducted in five districts of the Simiyu Region, namely, Bariadi, Busega, Itilima, Maswa and Meatu in north-western Tanzania. Methods: In this cross-sectional study design, 341 CHWs who were working with the maternal health programme were randomly selected. Semi-structured questionnaires were administered to all participants. Data were descriptively and inferentially analysed using SPSS version 20. Results: Majority (58.0%) of CHWs were below 35 years. Over half (53.1%) had completed primary education only. Motivation factors for being CHW were aspiration to serve the community and desire for further training to become a qualified medical practitioner. Community recognition and financial incentives were among the key retention reasons for the CHWs. Being married (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.7–20.1) having prior volunteer experience (OR 10.5 95% CI 12.7–40.5) and prior employment OR 21.8 (CI 12.2–38.9) were positively associated with retention of CHWs, while being a female was negatively associated with retention OR 0.4 (CI 0.2–0.8). Conclusions: Both financial and non-financial incentives were critical in contributing to the retention of CHWs. Thus, health programmes should carefully select CHWs by understanding their motives beforehand, and provide them with incentives.

Starting in the year 2000 and ending in 2015, the eight millennium development goals (MDGs) were an impressive global success, even though success varied from country to country. It was therefore logical when these ended, to develop a new set of targets with the goal of overall improvement in the context of sustainability. Development of these targets led to the setting of 17 sustainable development goals (SDGs), ending in 2030. This has led to the expression 'Agenda 2030' as the 'result' of the SDGs. The third SDG pertains directly to health, and includes maternal, neonatal, and child health. However, several other SDGs have a direct impact on perinatal health including: SDG 1: poverty; SDG 2: food security; SDG 4: education; SDG 5: gender; SDG 6: WASH (WAter, Sanitation and Hygiene); or SDG 16: peace. SDGs provide general directions and a structured setting, knowing that perinatal care providers, particularly in high-income countries are already responding largely to the demands. [ABSTRACT FROM AUTHOR]

INTRODUCTION: systemic lupus erythematosus (SLE) is a multi-system auto-immune disease common in females of child-bearing age. The effect of pregnancy on SLE and vice versa have not been well characterised in Africans. The aim of this study is to describe the pregnancy outcomes of patients with SLE presenting to the maternity department of Groote Schuur Hospital, Cape Town. METHODS: this study was designed as a retrospective review of records of pregnant women known with SLE and followed-up at the maternity section of Groote Schuur Hospital. The duration of survey was from the 1st January 2003 to 31st December 2013. RESULTS: there were 61 pregnancies reviewed in 49 patients; 80.3% of the pregnancies were in patients of mixed ancestry and the rest (19.7%) in black African patients. The mean age at presentation of the current pregnancy was 27.2,5.0 years. Mean gestational age at presentation and delivery was 13.0 , 6.0 weeks and 28.9 , 9.8 weeks respectively and 47.5% of the pregnancies were in patients with lupus nephritis (LN). Thirty nine (63.9%) pregnancies reached the third trimester and 11.5% of all pregnancies ended in the first trimester. There was a lower number of live births to mothers of African ancestry than to those of mixed ancestry (p=0.001). In 55.7% of the pregnancies, no flare was reported while a renal flare was reported in 23%. Pregnancies in patients with LN had higher frequencies of flares (58.6% vs 31.3%; p=0.032), pre-eclampsia (34.5% vs 12.5%; p=0.041), longer stay in hospital (12.0 , 9.1 days vs 6.1 , 5.1 days; p=0.004) and low birth weight babies (1.94 , 1.02 kg vs 2.55,0.95 kg; p=0.046) than in patients without LN. Only 36 (59%) of the neonates were discharged home alive and of these 2 (5.6%) were to mothers of black African ancestry (p=0.001). CONCLUSION: increased lupus activity in pregnant SLE patients may account for the increased deaths of neonates born to SLE mothers. Patients of black African descent and those with LN tend to have a poorer outcome. A multi-disciplinary approach to the management of SLE patients (of child-bearing age or pregnant) needs to be further assessed for better outcomes.

This article critically engages Julia Kristeva’s latest work on maternal passion as an antidote to what she calls “feminine fatigue.” Oliver elaborates, criticizes, and expands Kristeva’s view that maternity can be a model for thinking about passion and its relation to creativity and even to ethics. She relates Kristeva’s thinking about feminine fatigue to contemporary feminism in the United States.

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of Maternal, Newborn and Child Health (MNCH)in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. METHODS: It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level. RESULTS: The study showed that traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas. CONCLUSION: It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.

Created at the 2010 G8, the French Muskoka Fund represents France's commitment to maternal and child health. This innovative coordination mechanism between four UN agencies (WHO, UN-Women, UNICEF and UNFPA) has helped improving the health and well-being of mothers, newborns, children, teenagers and young people in 9 countries of Western and Central Africa (Benin, Burkina Faso, Chad, Côte d'Ivoire, Guinea, Mali, Niger, Senegal, and Togo) for the past 11 years. This rare longevity can be explained by its innovative governance structure, its ability to adapt to the local context, its capacity to leverage through high-impact interventions, and its impact on the ground. As the French Muskoka Fund has been renewed for another five years by France in 2021, reflection has been launched to further enhance the catalytic effect of this effective and promising initiative., (Copyright © 2022 SFMTSI.)

Cet article dresse un portrait de l’utilisation du portfolio comme outil d’évaluation auprès d’enfants d’âge préscolaire. Le principal objectif est de répertorier les quelques études empiriques ayant traité du portfolio comme outil d’évaluation au préscolaire. À la lumière de l’information recueillie et des limites des études recensées, des pistes de recherches futures sont proposées. Pour bien mettre en contexte l’usage du portfolio au préscolaire, la première partie de l’article aborde les diverses facettes entourant l’utilisation du portfolio dans le cadre de la dernière réforme de l’évaluation au Québec. La seconde partie présente les études recensées.

Abstract: Objectives: The projective protocols are due for analysing one type of gender dysphoria, a kind from transsexual females, looking for an anatomical sexual status to prove their one''s identity. This psychogenesis feeling comes directly from their maternal imago. The female identity and these derived experiences, through transsexuals, are the fundamentals of this article. Patients and methods: From five cases submitted to the multi-clinical exams protocol, we can observe three charts from Murray''s Thematic Aperception Test (TAT). In chart 5, 7 GF, 9 GF, we can see the saturation level of the latent attraction from the maternal and female identity question. According to a psycho-dynamical clinical conception to intervene on the body, the deadlock in the conflict between the transsexual female and the mother lead to less fantasy. From the TAT results, one could notice a clash to the facts, a difference in perception, an unmarked or avoiding the reality (type C on the analysis rates, originated by Shentoub). Results: The analysis of the observed individual indicates a shortage of the narrative ability as well as the inter-personal one. It comes to stories overstepping the external reality. The dramatic effect does not exist and the perception fulfils a non-significant internal reality. In that case the perception takes the place of the representation and the affect is therefore plaid down. At the end of the narration, it occurs that the psychodynamic test of personality of the candidates to a sexual reassignment is more important and reinforced. Conclusion: Some questions are pending due to the non conflictual relationship from the transsexuals to their mothers and about the sexual post-reassignment. Once reconciled with her own look, how should the transsexual female deal with her own mother, and in the future how should her be in love or having sexual relations with other females? [Copyright &y& Elsevier]

Abstract: Objective: The objective of this systematic review was to assess the effect of preoperative rather than after umbilical cord clamping antimicrobial prophylaxis for caesarean delivery on maternal and neonatal infectious postoperative morbidity. Study design: Meta-analysis. Methods: Three electronic databases (Pubmed, Cochrane Central Register of Randomized Controlled Trials and Embase) were searched without language restriction and retrieved 201 potentially relevant trials. Five randomized controlled trials (n =1108) studying the timing of antimicrobial prophylaxis for caesarean section were included. The quality of included trials was assessed on the modified Oxford validity scale. Results: Preoperative administration of antibiotics (n =456) rather than after cord clamping (n =563) provides a significant reduction in the incidence of endometritis (Odds Ratio (OR) 0.59 [95% Confidence Interval (CI) 0.35–0.98]) and of total maternal infectious morbidity (OR 0.51 [95% CI 0.32–0.82]). This benefit was not observed regarding the incidence of wound infection (Peto OR 0.58 [95% CI 0.29–1.16]), neonatal infection (Peto OR 1.06 [95% CI 0.57–1.96]), neonatal sepsis workup (OR 1.02 [95% CI 0.67–1.54]), neonatal documented sepsis (Peto OR 0.93 [95% CI 0.43–2.02]) or neonatal intensive care unit admission (OR 0.97 [95% CI 0.61–1.56]). No significant heterogeneity was observed between the included studies. Conclusion: This meta-analysis provides strong evidence that the preoperative rather than after cord clamping administration of antimicrobial prophylaxis for caesarean delivery provides a reduction in the incidence of endometritis and maternal total infectious morbidity without affecting the incidence of wound infection and neonatal infectious morbidity. [Copyright &y& Elsevier]

In this study, anorexia nervosa has been examined from an etiopathogenic and psychoanalytical viewpoint. The sociocultural environment and transgenerational context have been analyzed as contributing factors in the dysfunction of early parent-child relations and the subsequent effect of this on the development of the child, particularly during adolescence. We have hypothesized that the “failure’’ on the part of the mother to express her feminine and maternal nature, and the absence of attention paid to her child’s own body are major contributing factors. This absence of expression of the maternal instinct does not favor a positive perception and integration into the child’s personality of the feminine aspect of its nature, and thus contributes to the development of a sado-masochistic attitude that is focused on the infantile stage. The most frequently encountered condition in the mothers of anorexic patients appears to be the resurgence during maternity and in the initial mother-infant exchanges of a syndrome that can be defined in terms of a mind-body split which is responsible for the child’s failure to construct a psychic and somatic self. The structuring of the self in the child, in particular the impulsive and identificatory aspects of its personality are negatively affected by the absence of a feminine role model, as when the self is separated from the carnal origin of the emotions this can cause a marked inability to constitute a body image. We therefore consider that in these pathologies, the underlying cause is an absence of focus on the somatic self, which has an effect on the initial construction of a body image. We hypothesize that a “body to body’’ transmission (in the form of body engrams) of a maternal psychopathology occurs, and that as the child is confronted with the unstructured development and lack of management of its mother’s feminine and maternal nature, it does not have a physical or psychic reference. Therefore the bodily sensations become linked to the development of a morbid autosensuality and autoeroticism, as they have not been physically or mentally stimulated in a positive manner by the object, that is to say by the mother. [Copyright &y& Elsevier]

Summmary : In Belgium, as in most developed countries, routine antenatal screening for cytomegalovirus (CMV) remains controversial and is not recommended. However, 1-2 % of seronegative pregnant women will develop a primary infection during pregnancy and, with a prevalence of 0.7 % of live births, CMV is the leading cause of congenital infection. Among infected newborns, 20 to 25 % will develop auditory or neurological sequelae. The initial objective of our study was to evaluate, from a cohort of 48 patients followed in the antenatal diagnosis Unit of the University Hospital of Liège, the rates of maternal-fetal transmission, medical termination of pregnancy and rates of sequelae in infected newborns and to compare them with findings found in the literature. The second objective was to synthesize the current state of knowledge on maternal-fetal CMV infection and, in the light of recent data on prenatal treatment with valaciclovir, to propose a screening and management algorithm for primary CMV infection in the first trimester of pregnancy.

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ketoacidosis complicating gestational diabetes is rare and responsible for severe maternal-fetal mortality. It is an acute metabolic emergency whose management is multidisciplinary. Early diagnosis and treatment affect the vital prognosis of both the mother and the fetus. We report the case of a 27-year old pregnant woman at term, with a family history of diabetes, admitted to the emergency obstetric care with alertness problems associated with dyspnoea. The diagnosis of inaugural ketoacidosis decompensated due to severe malaria associated with gestational diabetes was retained on the basis of patient's medical history, of clinical examination and paraclinical assessment. The patient received insulin therapy, rehydration therapy, correction of electrolyte imbalance as well as antimalarial treatment. She underwent emergency cesarean section under general anesthesia and a dead-born macrosome macerated male fetus was extracted. Patient's evolution was favorable, with return of consciousness and standardization of biological parameters.

Objective: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient., Outcomes: Significant health and economic outcomes considered in comparing alternative practices., Evidence: Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies., Values: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1)., Benefits, Harms, and Costs: This guideline is expected to facilitate optimal and uniform care for pregnancies complicated by trauma. Summary Statement Specific traumatic injuries At this time, there is insufficient evidence to support the practice of disabling air bags for pregnant women. (III) Recommendations Primary survey 1. Every female of reproductive age with significant injuries should be considered pregnant until proven otherwise by a definitive pregnancy test or ultrasound scan. (III-C) 2. A nasogastric tube should be inserted in a semiconscious or unconscious injured pregnant woman to prevent aspiration of acidic gastric content. (III-C) 3. Oxygen supplementation should be given to maintain maternal oxygen saturation > 95% to ensure adequate fetal oxygenation. (II-1B) 4. If needed, a thoracostomy tube should be inserted in an injured pregnant woman 1 or 2 intercostal spaces higher than usual. (III-C) 5. Two large bore (14 to 16 gauge) intravenous lines should be placed in a seriously injured pregnant woman. (III-C) 6. Because of their adverse effect on uteroplacental perfusion, vasopressors in pregnant women should be used only for intractable hypotension that is unresponsive to fluid resuscitation. (II-3B) 7. After mid-pregnancy, the gravid uterus should be moved off the inferior vena cava to increase venous return and cardiac output in the acutely injured pregnant woman. This may be achieved by manual displacement of the uterus or left lateral tilt. Care should be taken to secure the spinal cord when using left lateral tilt. (II-1B) 8. To avoid rhesus D (Rh) alloimmunization in Rh-negative mothers, O-negative blood should be transfused when needed until cross-matched blood becomes available. (I-A) 9. The abdominal portion of military anti-shock trousers should not be inflated on a pregnant woman because this may reduce placental perfusion. (II-3B) Transfer to health care facility 10. Transfer or transport to a maternity facility (triage of a labour and delivery unit) is advocated when injuries are neither life- nor limb-threatening and the fetus is viable (≥ 23 weeks), and to the emergency room when the fetus is under 23 weeks' gestational age or considered to be non-viable. When the injury is major, the patient should be transferred or transported to the trauma unit or emergency room, regardless of gestational age. (III-B) 11. When the severity of injury is undetermined or when the gestational age is uncertain, the patient should be evaluated in the trauma unit or emergency room to rule out major injuries. (III-C) Evaluation of a pregnant trauma patient in the emergency room 12. In cases of major trauma, the assessment, stabilization, and care of the pregnant women is the first priority; then, if the fetus is viable (≥ 23 weeks), fetal heart rate auscultation and fetal monitoring can be initiated and an obstetrical consultation obtained as soon as feasible. (II-3B) 13. In pregnant women with a viable fetus (≥ 23 weeks) and suspected uterine contractions, placental abruption, or traumatic uterine rupture, urgent obstetrical consultation is recommended. (II-3B) 14. In cases of vaginal bleeding at or after 23 weeks, speculum or digital vaginal examination should be deferred until placenta previa is excluded by a prior or current ultrasound scan. (III-C) Adjunctive tests for maternal assessment 15. Radiographic studies indicated for maternal evaluation including abdominal computed tomography should not be deferred or delayed due to concerns regarding fetal exposure to radiation. (II-2B) 16. Use of gadolinium-based contrast agents can be considered when maternal benefit outweighs potential fetal risks. (III-C) 17. In addition to the routine blood tests, a pregnant trauma patient should have a coagulation panel including fibrinogen. (III-C) 18. Focused abdominal sonography for trauma should be considered for detection of intraperitoneal bleeding in pregnant trauma patients. (II-3B) 19. Abdominal computed tomography may be considered as an alternative to diagnostic peritoneal lavage or open lavage when intra-abdominal bleeding is suspected. (III-C) Fetal assessment 20. All pregnant trauma patients with a viable pregnancy (≥ 23 weeks) should undergo electronic fetal monitoring for at least 4 hours. (II-3B) 21. Pregnant trauma patients (≥ 23 weeks) with adverse factors including uterine tenderness, significant abdominal pain, vaginal bleeding, sustained contractions (> 1/10 min), rupture of the membranes, atypical or abnormal fetal heart rate pattern, high risk mechanism of injury, or serum fibrinogen < 200 mg/dL should be admitted for observation for 24 hours. (III-B) 22. Anti-D immunoglobulin should be given to all rhesus D-negative pregnant trauma patients. (III-B) 23. In Rh-negative pregnant trauma patients, quantification of maternal-fetal hemorrhage by tests such as Kleihauer-Betke should be done to determine the need for additional doses of anti-D immunoglobulin. (III-B) 24. An urgent obstetrical ultrasound scan should be undertaken when the gestational age is undetermined and need for delivery is anticipated. (III-C) 25. All pregnant trauma patients with a viable pregnancy who are admitted for fetal monitoring for greater than 4 hours should have an obstetrical ultrasound prior to discharge from hospital. (III-C) 26. Fetal well-being should be carefully documented in cases involving violence, especially for legal purposes. (III-C) Obstetrical complications of trauma 27. Management of suspected placental abruption should not be delayed pending confirmation by ultrasonography as ultrasound is not a sensitive tool for its diagnosis. (II-3D) Specific traumatic injuries 28. Tetanus vaccination is safe in pregnancy and should be given when indicated. (II-3B) 29. Every woman who sustains trauma should be questioned specifically about domestic or intimate partner violence. (II-3B) 30. During prenatal visits, the caregiver should emphasize the importance of wearing seatbelts properly at all times. (II-2B) Perimortem Caesarean section 31. A Caesarean section should be performed for viable pregnancies (≥ 23 weeks) no later than 4 minutes (when possible) following maternal cardiac arrest to aid with maternal resuscitation and fetal salvage. (III-B).