The 22:1 issue of JPNN focuses on trauma during the perinatal and neonatal period. Trauma is the most common cause of nonobstetric death among pregnant women in the United States.1 It affects 5% to 8% of pregnancies-about 1 in 12 pregnancies.1,2 Motor vehicle accidents alone account for more than 50% of all trauma during pregnancy, followed by falls, assaults, and burns.3

In this issue, Jevitt, Morse, and O'Donnell discuss shoulder dystocia, both nursing management and posttrauma care. Shoulder dystocia can be followed by broken clavicle or humerus, permanent brachial plexus injury, fetal hypoxia, or death. Nurses play a vital part during a shoulder dystocia, and these authors review the nursing role and the value of shoulder dystocia drills.

Although burn injuries during pregnancy are considered relatively rare, the exact incidence is unknown. Multiple factors influence the morbidity and mortality from burn injuries in pregnancy. Kennedy, Baird, and Troiano present a team approach to burn care in pregnancy to maximize the best outcomes for mother and fetus.

Shoffner's article on intimate partner violence during pregnancy and postpartum focuses on trauma of a different nature. Physical or sexual abuse may be readily observed or be well hidden. All types of violence require sensitive assessment and intervention by healthcare professionals. Suggestions for both assessment and intervention are offered.

The pregnant woman who has experienced trauma needs to be transferred to an appropriate setting once stabilized. Sosa discusses the teamwork and specialties involved in managing blunt trauma in pregnancy. The trauma team and the perinatal team need to work as one team when such injuries occur. Together the combined knowledge of all teams can provide safe care for both the woman and fetus.

This volume offers three articles relating to trauma that should be of interest to neonatal nurses, including maternal posttraumatic stress, neonatal birth injuries, and shaken baby syndrome (SBS).

Parental psychological trauma and stress relating to the neonatal intensive care experience are well documented, and neonatal nurses are encouraged to assess parent stress and refer for support or other care. Callahan reviews known preexisting risk and protective factors for such distress, focusing on individual variables and familial or other social support networks. She also provides an overview of a publicly available tool to measure such distress.

Birth trauma has been documented in the literature, and neonatal nurses are involved in assessment and interventions related to birth injuries; however, no classification system exists. Pressler's article provides a classification table that synthesizes published and online literature regarding the timing, prediction, and outcomes of major newborn birth injuries. The classification includes types of tissue involved in the primary injury, how and when the injury occurred, and the relationship of the injury to birth outcomes.

Nonaccidental head trauma or SBS is the leading cause of infant death by injury. Inconsolable crying is a major precipitating event for this type of injury, and premature birth, disability, and special needs are considered risk factors. Knowledge of SBS is important for neonatal nurses as they assess parental stress and attachment and teach parents about infant behavior and coping.

Diane J. Angelini, EdD, CNM, FACNM, FAAN, CNAA, BC

Perinatal Editor

Susan Bakewell-Sachs, PhD, RN, APRN, BC

Neonatal Editor

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