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

Abstract

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Division of Trauma Surgery at University of California Davis, School of Medicine, Sacramento, 95817, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15284764

Citation

El-Kady, Dina, et al. "Trauma During Pregnancy: an Analysis of Maternal and Fetal Outcomes in a Large Population." American Journal of Obstetrics and Gynecology, vol. 190, no. 6, 2004, pp. 1661-8.
El-Kady D, Gilbert WM, Anderson J, et al. Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. Am J Obstet Gynecol. 2004;190(6):1661-8.
El-Kady, D., Gilbert, W. M., Anderson, J., Danielsen, B., Towner, D., & Smith, L. H. (2004). Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. American Journal of Obstetrics and Gynecology, 190(6), 1661-8.
El-Kady D, et al. Trauma During Pregnancy: an Analysis of Maternal and Fetal Outcomes in a Large Population. Am J Obstet Gynecol. 2004;190(6):1661-8. PubMed PMID: 15284764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trauma during pregnancy: an analysis of maternal and fetal outcomes in a large population. AU - El-Kady,Dina, AU - Gilbert,William M, AU - Anderson,John, AU - Danielsen,Beate, AU - Towner,Dena, AU - Smith,Lloyd H, PY - 2004/7/31/pubmed PY - 2004/8/20/medline PY - 2004/7/31/entrez SP - 1661 EP - 8 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 190 IS - 6 N2 - 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. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/15284764/Trauma_during_pregnancy:_an_analysis_of_maternal_and_fetal_outcomes_in_a_large_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002937804002145 DB - PRIME DP - Unbound Medicine ER -