Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population.

Am J Obstet Gynecol. 2004 Jun;190(6):1661-8.
  
Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large 
population.

El-Kady D, Gilbert WM, Anderson J, Danielsen B, Towner D, Smith LH.

Department of Obstetrics and Gynecology, Division of Trauma Surgery at University 
of California Davis, School of Medicine, Sacramento, 95817, USA.

OBJECTIVE: This study was undertaken to determine the occurrence rates, outcomes, 
risk factors, and timing of obstetric delivery for trauma sustained during pregnancy. 

STUDY DESIGN: This is a retrospective cohort study of women hospitalized for 
trauma in California (1991-1999). International Classification of Disease, ninth 
revision, Clinical Modification codes, and external causation codes for injury 
were identified. Maternal and fetal/neonatal outcomes were analyzed for women 
delivering at the trauma hospitalization (group 1), and women sustaining trauma 
prenatally (group 2), compared with nontrauma controls. Injury severity scores 
and injury types were used to stratify risk in relation to outcome. Statistical 
comparisons are expressed as odds ratios (ORs) with 95% CIs. 

RESULTS: A total of 10,316 deliveries fulfilling study criteria were identified 
in 4,833,286 total deliveries. Fractures, dislocations, sprains, and strains 
were the most common type of injury. Group 1 was associated with the worst 
outcomes: maternal death OR 69 (95% CI 42-115), fetal death OR 4.7 
(95% CI 3.4-6.4), uterine rupture OR 43 (95% CI 19-97), and placental abruption 
OR 9.2 (95% CI 7.8-11). Group 2 also resulted in increased risks at delivery: 
placental abruption OR 1.6 (95% CI 1.3-1.9), preterm labor OR 2.7 
(95% CI 2.5-2.9), maternal death OR 4.4 (95% CI 1.4-14). As injury severity scores 
increased, outcomes worsened, yet were statistically nonpredictive. The type of 
injury most commonly leading to maternal death was internal injury. The risk of 
fetal, neonatal, and infant death was strongly influenced by gestational age at 
the time of delivery. 

CONCLUSION: Women delivering at the trauma hospitalization (group 1) had the 
worst outcomes, regardless of the severity of the injury. Group 2 women (prenatal 
injury) had an increased risk of adverse outcomes at delivery, and therefore 
should be monitored closely during the subsequent course of the pregnancy. This 
study highlights the need to optimize education in trauma prevention during 
pregnancy.

PMID: 15284764 [PubMed - indexed for MEDLINE] 


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